Potentilla erecta, tormentil

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CHAPTER 24
Potentilla erecta, tormentil
Description
©2009 Elsevier Ltd, Inc, BV
DOI: 10.1016/B978-0-443-10344-5.00029-X
Family: Rosaceae
Part used
Rhizome, root
Flora Europaea gives 75 species in the genus (Tutin et al 1968) and Stace (1991) gives 17 species in Britain. Potentilla
species are rather similar and distinguishing characteristics are emphasized by Gibbons and Brough (1996). The Flora of
Turkey (Davis 1972) gives 53 Potentilla species, including Potentilla erecta, Potentilla anglica and Potentilla reptans.
Potentilla erecta is a herbaceous perennial with a stout, hard rootstock. It is found throughout Europe on acid soils
such as mountainous bog and moorland and upland meadows but also on dry sandy pinewoods and heathland. It is rare
in the Mediterranean (Tutin et al 1968).
Procumbent and erect stems (10–25 cm) are non-rooting and the height is greater where the land is damp and not
grazed by sheep. The alternate leaves are unstalked, toothed at the apex and hairy underneath. The leaves occur in groups
of three with two stipules which resemble small leaflets so it appears to have five leaflets. The yellow flowers occur in
summer in cymes and have four petals and many yellow stamens. There are four sepals and a four-sectioned epicalyx. All
other Potentilla have five petals. The seed is an achene.
Potentilla erecta is used in botanical sources rather that the synonym Potentilla tormentilla Stokes. Stace (1991)
distinguishes Potentilla erecta subsp. erecta from subspecies strictissima, which is taller with more dentate leaves, stem
leaves which are serrate all round and larger flowers. As with other Rosaceae (see Alchemilla vulgaris), it can be apomictic
so a population may be one clone. Hybrids occur: Potentilla x suberecta is a cross between Potentilla erecta and trailing
tormentil Potentilla anglica, which has rooting stems. Potentilla × mixta is a cross between Potentila erecta or Potentilla
anglica and creeping cinquefoil Potentilla reptans, which has rooting, flowering stems (Stace 1991). Henriette’s Herbal
Homepage (2009) gives useful photographs of Potentilla species.
Other species used: Given the similarity between species it is probable that other species are collected, such as
creeping cinquefoil Potentilla reptans, which is found throughout Europe (Tutin et al 1968). White cinquefoil Potentilla
alba, which has white flowers, is used in a similar way (Oszmianski et al 2007). Silverweed Potentilla anserina is widely
used in herbal medicines in Europe (Bisset & Wichtl 2001, Tomczyk & Latté 2009). It is a widespread perennial that spreads
by stolons. The leaves are silver underneath and pinnate with 7 to 12 leaf pairs and the flowers are yellow with five petals.
Astrigency is the theme
but which Potentilla?
Tormentil is described by Weiss as the main vegetable
astringent. Astringency in the widest sense must be the
theme for this herb. Tannins have been identified as the
astringent compounds in medicinal plants. They exert
their effects through local action in the digestive tract in,
for example, diarrhoea. The extent to which such large
compounds are absorbed into the systemic circulation is
a current topic of research but compounds which derive
from tannins must be absorbed and be responsible for
these actions (Rasmussen et al 2005). Tormentil can be of
exceptional value as an astringent in heavy periods, and,
although this action is not explained, it is one of those
actions exerted by medicinal plants, of which perhaps the
action of comfrey Symphytum officinale in bruising is the
archetype, where once seen, always believed. ‘Probatus est’
as the old writers called it.
Dioscorides (IV 42) describes pentadactylon (‘five
fingers’ in Greek) with five leaves on a petiole, saw edged
all around, with a pale white flower, found growing in
damp places and around water conduits. The Potentilla
named pentadactylon by Dioscorides could be Potentilla
alba, which has five white petals and five-fingered leaves
that are only saw edged at the end. Beck gives Potentilla
reptans, which is yellow like Potentilla erecta, for tormentil,
which cannot be correct as Dioscorides describes a white
flower. Dioscorides refers to a reddish root and, as red is
the colour associated with tannins, this plant can be
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Figure 24.1 Potentilla erecta, tormentil (Wharfedale, Yorkshire, May).
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identified as a Potentilla but is not tormentil. Fresh roots
of tormentil are brown with a black surface but aqueous
extracts and tinctures of potentilla are a rich, deep red-
brown. Dioscorides refers to uses in intermittent fevers
and jaundice for the leaves; this usage is taken up by later
authors mainly when discussing cinquefoil and must be
associated with other Potentilla species.
Dioscorides says that pentadactylon is cut for religious
ceremonies and purifications, which suggests a larger plant
as he also refers to the sprays, which are a span long, like
dry sticks and bear fruit. Pliny appears to be referring to
the same herb when he describes cinquefoil with a red
root which turns black on drying, ‘commendable for the
strawberries it bares’ and used to bless a house against evil
spirits. The possible identity is discussed at length by Par-
kinson, who reviews the names given for pentadactylon
by the authors. As Turner argues, it must be a cinquefoil,
also named quinquefolium, five-fingered grass or the five-
fingered herb. Turner includes tormentil in his third
volume, which covers herbs not found in Dioscorides.
Galen refers to pentaphyllum, a five-leaved plant, cinque-
foil, as very drying in the third degree with a minimum
heat and little sharpness, so very useful. Dioscorides,
Pliny, Galen and Theophrastus, according to Parkinson,
all refer to a plant with a five-fingered leaf, which is there-
fore not tormentil but will be another Potentilla species,
probably one of the cinquefoils.
Other Potentilla species are referred to by the Renais-
sance authors and it seems likely that various Potentilla
species were used. Fuchs (1980) gives quinquefolium
luteum maius which is five fingered and could be Potentilla
reptans and quinquefolium luteum minor. Fuchs also gives
argemone altera uel potentilla, which appears to be silver-
weed and states that it has the character of quinquefolium
and therefore can be used when an astringent is required.
Fuchs gives an illustration of heptaphyllum that appears
to be tormentil. Interestingly, Parkinson comments that
tormentil is not found in Dioscorides yet has acquired the
Greek name of heptaphyllum. Today, Potentilla heptaphylla
is a mat-forming plant with tiny toothed leaves which is
found in eastern Europe but not in Britain. Dodoens refers
to tormentil as a plant with seven leaves on a stem,
growing in dark and shadowy woods and green ways,
which flowers all summer. He describes leaves with
snipped, toothed edges and Dalechamps gives a very
similar description. Parkinson discusses the plants sug-
gested by other authors as being the pentaphyllum of
Dioscorides and Theophrastus and disagrees with Tragus
(Bock), who argues that tormentil must be equivalent as
it is the ‘best and most noble pentaphyllum’, as he points
out that the plant of Dioscorides had distinctive five-
parted leaves and whitish flowers. Parkinson makes a long
diversion into the question of leaves and argues that the
leaves of Potentilla species are made up of leaflets as they
wither and fall in one piece. As discussed below, Parkin-
son inherited the notes of de l’Obel and one wonders
whether these are the words of de l’Obel, who studied
leaves in depth having developed a classification system
for plants based on leaf form (Pavord 2005).
Parkinson gives tormentil first but then states that the
cinquefoils will do as well. He divides the cinquefoils into
three categories: those with white flowers, those with
yellow flowers which creep on the ground with a lax habit,
and erect plants with yellow flowers. Parkinson recom-
mends use of common cinquefoil, pentaphyllum vulgaris-
simum, which he describes as having yellow flowers,
spreading by runners like strawberries, with toothed, five-
fingered leaves, and blackish brown roots ‘seldom as thick
as the little finger’ but spreading quickly by creeping along
the ground. This could be Potentilla reptans. Parkinson
states that Bauhin names it quinquefolium majus repens
and Hill (1756) repeats the recommendation and lists this
cinquefoil as pentaphyllum vulgare stating that Caspar
Bauhin names it quinquefolium majus repens, and Jean
Bauhin pentaphyllum vulgare repens. These names are
confusing but are reproduced to show how much the
Linnean binomial system was rooted in the labours of
preceding authors (Louis 1980).
The conclusion thus far is that the authors refer to various
Potentilla species and the roots are used interchangeably.
Cultivation of these species would allow for more definitive
recommendations. For this book we have selected herbs
that are commonly used by herbalists, yet we have discov-
ered enormous problems in both the identification of
similar members of the same genus, and in the interpreta-
tion of recommendations where it is unclear which herb
was originally used. One of the main aims of the Renais-
sance writers such as Turner, Fuchs, Dodoens, Mattioli and
Parkinson was to determine the correct species. Yet as a
profession we still have some way to go today in this matter
because of the continuing wild collection of many medici-
nal plants (ISSC-MAP 2009). Parkinson expresses his frus-
tration, while discussing hermodactylus (see below), at the
‘shame of the physicians’ who leave these matters to apoth-
ecaries and merchants, but should ‘give orders that the
unknown should be made more manifest’. Yet he feels that
his admonitions will be pointless, ‘but what do I in so
saying run my Barke (ship) upon the Rockes and put her
in danger of splitting’.
use in ‘All fluxes’
It is the root of tormentil that is used, and we must start
with recommendations for usage of root. Dioscorides
advises a decoction of the root, reduced to one third,
drunk for use in diarrhoea and dysentery and for suffering
in the joints and hip ailments. He recommends the juice
extracted when the root is soft for ills of the liver and lung
and for deadly poisons. He gives a dose of 3 cyathoi
(135 mL) for jaundice. Culpeper advises 4 fl oz of the
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suggests tormentil is ‘good against the disease called
choler or melancholy’ and Dalechamps advises the decoc-
tion in an earthen vessel given to cholerics who were
considered to become peevish due to an overheated
spleen.
The astringent qualities of tormentil lead to its use on
‘all fluxes’ of which the main one is diarrhoea, with or
without blood in the stool. This cannot be separated from
the recommendation for use in pestilence as infectious
disease would have been a common source of uncontrol-
lable diarrhoea. Turner advises a broth of the roots or
stilled in a bain marie, for ‘bloody flux’ and pestilence.
Culpeper gives recipes for distilling extracts from roots
using a bain marie to avoid burning.
Dodoens states that tormentil opens and heals stop-
pings and hurts of the lungs and liver such as in jaundice.
juice for the same. However, use of the leaf is also recom-
mended for jaundice. For example, Apuleius refers to the
seven-leafed plant found in cultivated and sandy places
and advises the herb for jaundiced people.
Fuchs, Turner, Dodoens and Parkinson suggest a mixture
of powdered root, blended with egg white, and cooked in
a terracotta pan, for biliousness or the desire to vomit.
Dalechamps and Bauhin give a recipe: take powdered root
and the same amount of oatmeal, with half as much egg
white and nutmeg Myristica fragrans. Mix to make small
cakes and cook ‘in an iron spoon’ (which could be adapted
to a bun tin) to make small cakes. Take one daily, in the
morning according to Parkinson, for fluxes, choleric
humours, loss of appetite and vomiting, and what
Culpeper describes as ‘choleric belches and much
vomitings with loathing in the stomach’. Dodoens
Figure 24.2 Potentilla erecta, tormentil.
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powdered root. He also gives pastilles, powders, electuar-
ies and drinks as useful in dysentery. Culpeper states that
juice of the herb or root of tormentil resists all poison and
venom of any creature, even pestilential fevers and the
plague itself, and contagious disease such as the pox,
measles and ‘purples’ by expelling the venom and infec-
tion from the heart by sweating. He also includes the
distilled water of the herb and roots of tormentil in his list
of antidotes.
The authors describe tormentil as dry in the third degree
but opinions vary on its heat. Galen describes ‘pentaphyl-
lum’ as without manifest heat. Parkinson gives it as
cold in the second degree whereas Culpeper says it is
hot in the first degree. This might be because of the dis-
crepancies in the plant or part of the plant being discussed
but use of aerial parts is definitely recommended in
infection and fever. Use of the leaf is recommended by
Dioscorides for intermittent fevers: the leaves of four
sprays for quartan fevers, three sprays for tertian fevers and
one spray for the quotidian. This is repeated by Culpeper
in his entry for cinquefoil. He describes Dioscorides as ‘full
of whimsies’ and says that a dose of 20 grains (1300 mg)
of cinquefoil in white wine or white wine vinegar will cure
agues of whatever type if given on three successive occa-
sions. Culpeper describes cinquefoil as an especial herb in
all inflammation or fever, ‘whether infectious or pestilen-
tial’. Culpeper states that Andreas Vesalius (anatomist,
1512–1564) thought tormentil as good as lignum
vitae Guaiacum officinale or china Smilax species in the
‘french pox’ (syphilis). This recommendation is also
given by Grieve, who refers to tormentil as the English
sarsaparilla.
Use in infection continues in the 18th century. Quincy
states that tormentil is most noted for its binding qualities,
yet is included amongst the alexipharmics particularly for
‘malignant cases attended with any flux, either of the
bowels or the womb’. Hill makes the same point, and
suggests a larger dose of cinquefoil for intermittent fevers.
Hill describes tormentil as cordial as well as astringent and
that it ‘operates by sweat’ and so is useful in any fever
associated with excessive diarrhoea. Cullen (1772) consid-
ers tormentil as equivalent to cinquefoil in intermittent
fevers used alongside gentian and other bitters. Hill rec-
ommends it for loose bowels associated with measles and
smallpox, and Cullen is more specific in that he uses
astringents to promote suppuration and thus resolve
disease.
Astringency in menorrhAgiA
Other usage of tormentil as a medicine is for the urinary
tract, for heavy periods and for arthritic pain. Turner
advises tormentil with juice of plantain for urinary
He recommends the dried root, powdered and drunk in
wine when there is no fever and with water in which iron
has been boiled, for bloody flux and all other fluxes. He
suggests the leaf with the root, boiled in wine, or juice, or
powdered root to provoke sweat and drive out venom
from the heart in poison, plague and pestilence. The
phrase ‘provoke sweat and drive out venom from the
heart’ refers to alexipharmics.
use to resist DiseAse
Pestilence refers to infectious disease, which may or may
not be epidemic, of which the archetypal example is
plague. The connection with the heart is that pestilence
was considered to be carried by the air into the lungs
where it would attack the heart and therefore corrupt the
vital spirit. Ancient authors were aware of the infectious
nature of disease (Nutton 1983), although not aware of
the mechanism of infection. Later, Hildegard makes an
explicit linkage between diarrhoea and food-borne infec-
tion. She describes the coldness of tormentil as effective
against fevers that arise from noxious foods. She advises
tormentil cooked in wine with a little honey added,
strained, and drunk frequently at night on an empty
stomach.
After the Black Death in the 1300s, it is hard to see
that people cannot have been aware of the transmission
of disease. According to Carmichael (1997) quarantine of
ships where passengers were not allowed to disembark
for a given period, began in 1377 in the Venetian port
that is now Dubrovnik. Zuckerman (2004) gives an
account of beliefs on contagion in the early 1700s when
Richard Mead wrote a report for the British government
on contagion and quarantine arrangements in response
to the last outbreak of bubonic plague in Europe, in
Marseille in 1720. Contagion was a problem for doctors,
who retained some loyalty to the humoral system with its
focus on the individual vulnerability of patients and
places but this is probably over-represented in the texts
which were written by educated people. Those with a less
theoretical bent must have relied on observation and
accepted that many diseases were contagious. However, it
is impossible to cast one’s mind back to the world views
of the past and French (2003) gives a thought-provoking
account of the changes in thought associated with the
observation that syphilis was spread from person to
person.
Dalechamps, perhaps citing Galen, notes that tormentil
is without manifest heat and has the faculties of cinquefoil
to resist poisons and suppress dysentery. Bauhin describes
tormentil and cinquefoils stating that they expel poisons
and plague by sweating by use of a warm decoction
of a handful of leaves and roots, or 1 drachm (4 g) of
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rheumAtic DisorDers AnD gout
Internal usage of root of tormentil for arthritic conditions
goes back to Dioscorides, who advises a decoction of the
root, reduced to one third, drunk for suffering in the joints
and hip ailments. Beck usefully translates the Greek as
‘hip disease’ rather than draw inferences about the
meaning of the words. This advice is repeated by Turner,
Parkinson and Culpeper but yet it is not a common
modern usage. Hip ailments is given by Turner as pain in
the hucklebone called sciatica, under his entry for root
of ‘the herb five leaf’. Culpeper recommends the juice
of the leaves and roots applied to sciatica, and states that
it is effective against ruptures and bursting, bruises and
falls both outward and inward. The entry in Culpeper is
word for word from Parkinson, who refers to sciatica as
hipgout. A recent review of five herbals found that the only
Rosaceae recommended for rheumatic disorders were
Potentilla species, given by Adam Lonitzer (Lonicerus) in
1557 and Jacob Theodor (Tabernaemontanus) in 1588 for
pain. The corresponding modern terms given by the
authors are ‘polyarthritis’ and ‘gout of the feet’ (Adams
et al 2009).
The 1656 edition of Culpeper includes a tantalizing
sentence that is not included in the modern edition. It is
copied from Parkinson and reads, ‘Lobel saith, that Ron-
delitus used it as Hermodactils for joint-aches’. Hermodac-
tils or hermodactylus was an imported herb that, according
to Parkinson, had not been identified but was most effec-
tive in purging phlegmatic, slimy and watery humours
from the joints and therefore valuable in gout and other
‘running joint aches’. Parkinson says some consider her-
modactylus to be roots of ‘Colchicum, but they are danger-
ous if not deadly’. This designation seems unlikely to him
partly because he says it was included in drinks with
lignum vitae Guaiacum officinale and sarsaparilla Smilax
species and also because he cites Mesue as stating that it
was a finger-shaped root. Pereira (1853) had the opportu-
nity to examine some material purchased as hermodactyl
in India that he considered could be the underground
parts of autumn crocus Colchicum autumnale, which is used
in the treatment of gout. Pereira gives a quote from Paulus
Aeginata, which may be referring to the use of Colchicum:
‘some, in the paroxysms of all arthritic diseases, have
recourse to purging with hermodactylus; but it is to be
remarked that the hermodactylus is bad for the stomach,
producing nausea and anorexia, and ought, therefore, to
be used only in the case of those who are pressed by urgent
business, for it removes rheumatism speedily, and after
two days at most, so that they are enabled to resume their
accustomed employment’. Another candidate is a Mediter-
ranean member of the Iris family, Hermodactylus tuberosus,
with a rootstock of ‘finger-like tubers’ (Grey-Wilson &
incontinence both as a decoction and as an extract in
vinegar ‘held on the kidneys’. This usage is also given by
Dalechamps, Gerard, Parkinson and Culpeper.
Tormentil is used today for heavy periods and it is
interesting to trace this usage. Turner states that it
stops women’s flows if the woman sits in a broth up to
the navel or the broken roots are laid on the belly with
honey and spikenard. Parkinson recommends roots of
either tormentil or cinquefoil for ‘all fluxes in man or
woman, whether the whites or the reds’. Parkinson states
that many women use the distilled water of leaves and
roots of tormentil ‘as a secret, to help themselves and
others, when they are troubled with an abundance of the
whites or the reds, as they call them’, both as a drink or
injected with a syringe. This sentence is copied in some
editions of Culpeper but not others. Bauhin also recom-
mends the distilled water and juice for excessive
menstruation.
Whilst herbal practitioners seek to prescribe for the
individual, there can be situations where a prescription
is effective for a particular symptom. Heavy periods are
a debilitating problem and occur in the perimenopause
as a result of anovulatory cycles (Apgar et al 2007). Ortho-
dox treatment has limitations, while hysterectomy is now
seen as a last resort (NICE 2007). The long-term prescrip-
tion will address the constitution of the individual but it
is useful to have a remedy to hand when the flow is
unmanageable. I used a prescription successfully for
perimenopausal heavy periods associated with uterine
fibroids and have since used it again in other women. It
is fluid extract of Capsella bursa-pastoris 30 mL and tinc-
tures of Potentilla erecta 30 mL, Achillea millefolium 30 mL,
Aesculus hippocastanum 10 mL, Zingiber officinalis 10 mL.
The dose is 10 mL four times a day which is a large dose
of alcohol so the patient must be warned of this. My
extract is prepared from a strong decoction of tormentil
which is allowed to cool and then ethanol and more water
is added to achieve a 1:3 concentration before macerating
the cold mixture in the normal manner. It is therefore
stronger than some tinctures available from herbal
suppliers.
Parkinson, followed by Culpeper, advises the powder or
decoction as a drink or as a bath as an assured remedy
against abortion in women if caused by the ‘over flexibility
or weakness of the inward retentive faculty’. I used tor-
mentil thus in a woman of 40 with no children who had
already had miscarriages but eventually gave birth to a
health baby. She had bleeding at 10 weeks, at 12 weeks
and again at 14 weeks and rested in bed when this
occurred. A scan at 16 weeks showed a 6 cm fibroid. My
concern was that she was struggling to support a healthy
pregnancy and the prescription included a decoction of
tormentil with lady’s mantle Alchemilla vulgaris and tinc-
tures of Viburnum prunifolium as an antispasmodic and
Alpinia galangal as a circulatory stimulant.
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externAl use As An Astringent
Before moving to current practice, we can trace long usage
of tormentil as an astringent in external remedies. Diosco-
rides advises the decoction of root, boiled down to one
third, held in the mouth to relieve toothache, used as a
rinse to control putrid humours in the mouth and as a
gargle for hoarseness of the trachea. These are also given
by Dodoens, who suggests the root and the leaf together.
Dioscorides then gives a long list of indications and rec-
ommends a preparation of boiled root, ground up in
vinegar to keep shingles in check, restrain herpes, disperse
scrophulous swellings in glands, indurations, swellings,
aneuryms, abscesses, erysipelas, fleshy excrescences in
fingers, callous lumps and mange. Galen recommends
pentaphyllum to dry wounds. Apuleius advises the juice
of the herb bruised and mixed with egg yolk, rubbed on
painful feet to take away the pain in 3 days. This usage
also is given by Dalechamps and Bauhin, and reappears
as a balm for the feet in Gloucestershire (Allen & Hatfield
2004). The Salernitan herbal refers to tormentil, which
resembles cinquefoil, and recommends the juice of the
root placed inside a fistula and the juice mixed with white
wine applied for fleck in the eye. Turner finds it similar to
bistort Polygonum bistorta and recommends it in running
sores and the powder on a wound as a styptic and an
extract in wine for ‘green wounds without and within’.
Green wounds may be taken to mean fresh wounds; this
phrasing is similar to Culpeper’s recommendation in
ruptures within and without. Dodoens also advises leaves
and root, decoction or juice, for wounds inwardly and
outwardly. Dalechamps recommends juice of leaves to
weeping fistulas, to the eyes to disperse blemishes and the
herb and root chewed for putrescent ulcers. Bauhin advises
tormentil for all wounds as a plaster or ointment or a wash
decocted in water or wine for putrid wounds, hardnesses
and swelling, especially around ears. He then gives a prep-
aration in vinegar for hip pain, haemorrhoids and scabies,
a preparation with amber for defluxions (discharge) in the
eyes and the fresh juice applied morning and evening for
vertigo. Culpeper lists bruises, falls, ruptures, wounds,
sores and ulcers of mouth and genitals, scabs, itches, scro-
phula and sciatica. Hill gives loose teeth, haemorrhages of
nose and mouth, and falling of the uvula. Grieve proposes
external use as a gargle for sore and ulcerated throat, in
leucorrhoea, ulcers, long standing sores and the decoction,
soaked in lint, regularly applied to remove warts. The
modern authors also give a range of external usage. Wren
describes tormentil as a tonic lotion in ulcers and old
sores, and recommends the fluid extract as a styptic. The
National Botanic Pharmacopoeia recommends a gargle for
sore, relaxed ulcerated throat, to remove purulent mucus
and as an injection for leucorrhoea (formerly referred to
Mathew 1981). Whatever the identity of hermodactylus,
the statement of Culpeper leads one to ask whether or not
tormentil could be particularly useful in pain associated
with arthritis.
Matthias de l’Obel (1538–1616) is influential in that he
was a significant figure in the development of botany and
transmission of knowledge (Louis 1980). He was born in
Flanders but studied medicine in Montpelier. In the 16th
century, the curriculum at the medical school in Montpe-
lier was influenced by humanist ideas in that the study of
original texts and of the living plants was encouraged
(Reeds 1991). New Greek versions and translations direct
from Greek into Latin were becoming available such as a
Latin version of De Simplicium Medicamentorum Facultati-
bus by Galen, which was published in Paris in 1530 (Reeds
1976). Rondelitus is the latinized name of Guillaume
Rondelet, who graduated in medicine at Montpellier in
1531 then returned as a lecturer. He was one of the pio-
neers of the use of Dioscorides and in 1545 he lectured
on the books of Dioscorides. A translation into Latin from
the Aldine Greek version published in 1499 had been
published in Paris in 1516 by Jean Ruel (Reeds 1976).
Rondelet pioneered field trips into the local countryside
to address the thorny questions surrounding the sources
of medicinal plants and the interpretation of the ancient
authors. He travelled to Italy, where he saw the ‘true
Roman absynthium’ in the ancient ruins and had contacts
with Italian, Swiss and German scholars (Reeds 1991).
Rondelet is important to this book as he taught two of our
authors, Dalechamps and Jean Bauhin. He taught Charles
de l’Ecluse, who translated the version of Dodoens which
we have used from Flemish into French, and de l’Obel, to
whom he left his papers at his death in 1566 (Arber 1986).
De l’Obel was inspired to continue searching for wild
plants throughout his life and, after graduating in 1565,
he travelled in Europe with Pierre Pena. He came to Britain
in 1569, returned to Antwerp until the early 1580s, then
settled in London, where he died in 1616. His first book,
Stirpium Adversaria Nova, was published in 1571 in London
but an edited later version was published by Plantin in
1605 with the addition of In G. Rondelletti Pharmaceuticum
Officinam Animadversiones (Lownes 1958). It could be that
the comment that ‘Lobel saith, that Rondelitus used it as
Hermodactils for joint-aches’ is taken from this book or
from the papers of de l’Obel, which were edited by Par-
kinson. Some material from the papers was included in
Theatrum Botanicum, published in 1640. Either way, the
comparison with hermodactylus confirms the relative effi-
cacy of tormentil. It also suggests that Rondelet used it in
his own practice for joint pains and thus that the recom-
mendation is not merely taken from Dioscorides. The
point here is that when reading Culpeper we have a
window into older usage as he copied Parkinson freely
and Parkinson used many sources in the preparation of
his material.
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3 and it may be better than any substitute (Comfort 1859).
It is certainly different in that it is a very peppery herb,
which causes sneezing. Fox advises tormentil in all classes
of bowel complaints, cholera, dysentery and diarrhoea
associated with consumption. This last recommendation
is also given by Robinson (1868), who ascribes the advice
to Dr Graham. Fox calls tormentil ‘the very best remedy
for ‘bloody flux’. He recommends half a cup every 30
minutes, as warm as convenient, of a tea made by pouring
1 pint of boiling water on 1 oz of herb. He notes that it
often ‘causes free perspiration’.
Robinson also recommends tormentil for all fluxes of
blood at the dose of 1 drachm (3.5 mL) four times a day
in an infusion of hops Humulus lupulus, which is also given
by Grieve. He adds a recommendation from Dr George
Fordyce for use in relaxed bowels, and recommends juice
or decoction of herb and root to expel fever if the person
is also laid to sweat. This appears to be the recommenda-
tion originally given by Culpeper. Robinson adds the rec-
ommendation of Dr Thornton for use in ‘agues which had
resisted the bark’, leg ulcers turned away as incurable,
scorbutic ulcers and long standing diarrhoea, and also
recalls earlier authors in recommending it to open obstruc-
tions of the liver such as in jaundice.
Grieve rates tormentil highly as very astringent and gives
a compound powder that is ‘very reliable’ in diarrhoea and
other discharges. Infuse powders of tormentil, marshmal-
low root Althea officinalis and galangal Alpinia galanga each
at 1 oz with ginger Zingiber officinale 4 drachms (16 g) in
1 pint of water. Cool, strain and take 1–2 fluid drachms
(3.5–7 mL) every 15 minutes and then reduce the dose to
three times a day. The National Botanic Pharmacopoeia
notes extensive use of the herb and root in diarrhoea and
other abnormal discharges to nourish and support bowels
and tone the uterus and whole uterine area.
20th century usAge
in DiArrhoeA
Of the modern authors, Weiss discusses the use of tormen-
til at length and recommends it highly. He gives a descrip-
tion which refers to Potentilla erecta and considers it the
best astringent in chronic enterocolitis, summer diarrhoea,
paratyphoid diarrhoea, acute and sub-acute enteritis and
colitis although less useful in chronic cases of colitis. He
recommends a good pinch of powder (500 mg) several
times a day. Weiss also recommends one cup several times
a day of a decoction prepared with 1–3 tablespoons of
rhizome, steeped for 15 minutes in 500 mL water. He
advises use with a carminative such as chamomile Matri-
caria recutita, lemon balm Melissa officinalis or peppermint
Mentha piperita. Weiss considers the tincture less effective
but gives a dose of 30–50 drops several times a day in
as the whites). The British Herbal Pharmacopoeia recom-
mends use as a stypic and vulnerary, as a gargle for the
mouth and mucous membranes of the throat and a lotion
for haemorrhoids. Williamson advises usage in pressure
sores and ulcers etc. Menzies-Trull recommends a poultice
to ease pain and use in haemorrhoids with witch hazel
Hamamelis virginiana. Chevalier advises use as a styptic and
use in mouth ulcers and infected gums. Barker (2001)
advises use of the powder as a styptic and up to 10 mL of
tincture (1:5 45%) in sore throat, gingivitis and pyorrhoea,
and use of a lotion in burns, warts and sunburn. Taken
together, there is a substantial amount of external usage.
’the most powerful of the
vegetAble Astringents’
Returning to internal usage, the focus in later authors is
clearly on astringency in diarrhoea. Cullen (1772) states
that tormentil is the most powerful of the vegetable astrin-
gents. He argues that the qualities are not sufficiently
extracted into water or alcohol and that it should be used
as a material substance in the form of a powder. Hill rec-
ommends tormentil in bleeding piles but Cullen makes
the point that haemorrhoids are often caused by ‘costive-
ness’ or constipation, and that this may be worsened by
the use of astringent herbs. Coffin gives tormentil as a
powerful astringent in diarrhoea, long-standing bowel
complaints and the powder for external use to sprinkle on
an old sore, or to stop bleeding.
Astringent herbs were important to the 19th century
authors as they were used to cleanse the digestive tract of
‘canker’. Robinson (1868) describes canker as ‘a morbific
state, tendency to disease in any locality, internal or exter-
nal’ which occurs in the throat, stomach or bowels and is
caused by cold as ‘when cold obtains power over the
inward heat, the stomach and bowels become coated with
canker’. Thomson emphasizes the cleansing of canker
from the bowel walls by use of astringents and this formed
the third stage, No. 3 of the Thomsonian course of treat-
ment (Comfort 1859). The sequence in the course of treat-
ment was to use lobelia Lobelia inflata as an emetic,
followed by cayenne Capsicum annuum to heat and then
astringents to heal the tissues. He writes that ‘the canker
is fixed on the inside and will ripen and come off in a
short time, if the fever is kept up so as to overpower the
cold’ (Thomson 1832). Stevens (1847) lists Thomson’s
astringents then gives, as the eleventh astringent Potentilla
erecta, and says that it was introduced to the list of tonic
astringents and could be used equally as their substitute.
When discussing astringency Fox refers to canker as
‘anything which corrupts, corrodes, destroys’ and also rec-
ommends bayberry Myrica cerifera to ‘detach morbid and
vitiated matter’. Bayberry is the original herb given as No.
4
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249
(Langmead et al 2002). There is some evidence in clinical
usage from a pilot study in 16 patients. The participants
had active ulcerative colitis, mainly left-sided, and contin-
ued with orthodox treatment alongside three doses of tor-
mentil extract each for 3 weeks with washout periods of 4
weeks. Scores on the Rachmilewitz colitis activity index
decreased during each treatment phase and a dose of
2400 mg was found to be most effective. Stool frequency
and blood in the stool decreased (Moss & Chefetz 2007).
Tests showed that the tannins were not systemically
absorbed.
An unusual clinical trial was undertaken in Russia where
children are routinely admitted to hospital with diarrhoea
to avoid further spread in the community so a clinical
priority is to stop the intensity of the diarrhoea. Forty
children were included who were admitted with diarrhoea
and whose stool samples were positive for rotavirus
antigen. The children were given 3 drops of tincture per
year of age three times a day of either tormentil or a
placebo. The 1:10 tincture was made from dried root using
40% ethanol. The treatment group was aged 4–79 months
(median 23.5) and the control group 3–60 months
(median 24.5). Both groups were also given oral rehydra-
tion therapy. The outcome for the treatment group was
significantly better as regards volume of parenteral rehy-
dration required, duration of abnormal stool consistency
and duration of hospitalization. For example, after 48
hours diarrhoea had ceased in 8 of 20 in the treatment
group but in only 1 of 20 in the control group. Tormentil
did not reduce the rate of vomiting (Subbotina et al
2003). This study is useful as it is a study whose results
can be applied in normal herbal practice as the dose and
the preparation is clearly stated. The results are all the
more interesting as the placebo was a tincture of Indian
tea. Indian black tea has been shown to inhibit bovine
rotavirus in vitro and is used to treat diarrhoea (Palombo
2006).
recommenDAtions
• Tormentil has been consistently advised for use in
diarrhoea, blood in the stools and ‘all fluxes’ and
could be particularly useful in ulcerative colitis.
There is a consistent tradition of use in dysentery
and infectious disease.
• Aerial parts of other Potentilla species, including
cinquefoil and silverweed, were used and continue
to be used more in Europe and could be integrated
into herbal practice.
• Use of the powder is recommended. Then large
doses could be given in, for example, ulcerative
colitis without giving a large amount of alcohol.
Equally, the randomized controlled trial described
above found that quite small doses of tincture were
peppermint tea. He gives a formula of tinctures of tormen-
til 30 mL, Atropa belladonna leaf 5 mL and carminative
tincture 15 mL, 30 drops three times a day. The final dose
of of Atropa belladonna should be calculated before consid-
ering use of this formula. The British Herbal Pharmacopoeia
gives the main actions as astringent and anti-haemorrhagic
and recommends it for ulcerative colitis and diarrhoea,
including acute diarrhoea and diarrhoea associated with
anxiety. Barker (2001) suggests it in tormina and colic,
and small doses in peptic ulcer. Wood describes another
Potentilla as he refers to a plant which has deeply serrated
leaves and pictures a Potentilla with five leaflets and five
petals. He finds the plant very similar in action to agri-
mony Agrimonia eupatoria, which one recalls is another
Rosaceae used in problems of the digestive tract.
Chevalier recommends tormentil in irritable bowel syn-
drome, colitis, ulcerative colitis, dysentery and rectal
bleeding. Low grade mucosal inflammation has been
identified as a factor in the pathogenesis of irritable bowel
syndrome (Hammerle & Surawicz 2008) and the indica-
tion given by all the authors for use in diarrhoea and
blood in the motions suggests usage in inflammatory
bowel disease such as ulcerative colitis and Crohn’s disease
where orthodox treatment remains of limited effectiveness
(McFarland 2008). The use of tormentil in inflammatory
bowel disease and in irritable bowel syndrome where diar-
rhoea is the predominant symptom has been linked to the
antioxidant activity of polyphenols. Tormentil and other
astringent herbs have been investigated as researchers have
asked whether astringency depends on the overall concen-
tration of polyphenols or on the concentration of particu-
lar polyphenols. For example, root of Potentilla alba was
shown to have a high level of condensed tannins and a
high antioxidant activity in vitro (Oszmianski et al 2007).
Bos et al (1996) investigated tormentil and found that the
dimers and trimers inhibited lipid peroxidation and pen-
tamers and hexamers inhibited the enzyme elastase. A
study of antioxidant activity (superoxide formation) using
the same extract found that the larger procyanidins pen-
tamers and hexamers were the most active (Vennat et al
1994). Condensed tannins are common in foods (Ham-
merstone et al 2000) and there is a high procyanidin
concentration in foods from the Rosaceae family, such as
apples and medicinal herbs such as hawthorn Crataegus
monogyna. One could therefore conclude that particular
compounds are responsible for the effectiveness of tor-
mentil as an astringent rather than the overall content of
procyanidins.
An in vitro study of herbs used in inflammatory bowel
disease investigated their antioxidant activity as reactive
oxygen metabolites are found in excess in colonic mucosa.
Tormentil extract was found to inhibit superoxide and
peroxyl formation and it was further found that incuba-
tion of inflamed tissue from human colorectal mucosal
biopsies in a 1:1000 dilution of tormentil resulted in
decreased formation of reactive oxygen metabolites
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Other herbs such as agrimony and raspberry leaf
could be more suitable for long-term use both
because they are a more pleasant tea and because
they are less astringent. Tannins have been shown to
complex with proteins and minerals (Haslam 1996)
and absorption of non-haem iron has been found to
be significantly reduced by concurrent consumption
of tea (Thankachan et al 2008). There is concern
about the long-term use of tannins, especially
where total intake of proteins and iron may be low,
such as in vegans. A recent review found that many
factors are relevant in iron status but recommended
that where iron status may be low, tea should not
be consumed with meals and at least an hour
should elapse after eating (Nelson & Poulter 2004).
The advice would the same for tannin-containing
herbs, as herbal teas have also been shown to
reduce non-haem iron absorption (Hurrell et al
1999).
effective in diarrhoea associated with rotavirus
infection in children.
• Tormentil has a more recent use in heavy periods. It
has been recommended both for excess bleeding and
leucorrhoea and in urinary incontinence.
• Usage internally for arthritic pain, and possibly for
gout, and external usage for a wide range of
indications is strong throughout the tradition. These
usages are now less common but could be
reintroduced into current practice.
Dosage: The British Herbal Pharmacopoeia recommends
2–4 g three times a day of dried rhizome.
recommenDAtions on sAfety
1. Use caution in dosage in long-term use, particularly
of a decoction or powder.
CONSTITUENTS
Reviews: Bisset & Wichtl (2001), Mills & Bone (2005), Tomczyk & Latté (2009), Williamson (2003), WHO (2002).
Triterpenoid saponins
Total 1.7%, euscaphic acid glycoside, tormentic acid glycosides: tormentoside (isomer of rosamultin) and isomers: kaji-
ichigoside F1 & arjunetin (cultivated, Poland) (Stachurski et al 1995).
Potentilla tormetilla, euscaphic acid, tormentic acid (commercial) (Kite et al 2007).
Potentilla tormetilla, nine glycosides: euscaphic acid, tormentic acid, ursolic acid, kaji-ichigoside F1, arjunetin, rosamultin
and newly isolated glycosides (commercial) (Bilia et al 1994); pomolic acid glycoside (commercial) (Bilia et al 1992).
Tannins
Mainly condensed tannins which are proanthocyanidin polymers, also hydrolysable tannins (Bruneton 1999).
Condensed tannins
Mainly procyanidins: dimers, trimers, tetramers, pentamers, hexamers (Vennat et al 1994).
Total 15–20% type B proanthocyanidins: mainly dimers and trimers (Tomczyk & Latté 2009).
Total 8% proanthocyanidins mainly polymers of (−) epicatechin (Potentilla alba, cultivated, Poland) (Oszmianski et al 2007).
(+)-catechin gallate and B3 dimer (wild, Russia) (Omurkamzinova & Erzhanova 1986).
Hydrolysable tannins
Ellagitannins: pedunculagin 1%, agrimoniin 3.5%, laevigatin B, laevigatin F (commercial, Germany) (Geiger et al 1994).
Potentilla alba, ellagic acid, p-coumaric acid (cultivated, Poland) (Oszmianski et al 2007).
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3
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