Berberis

By Jeremy Ross

English: barberry
Botanical name: Berberis vulgaris L.
Pharmaceutical name: Berberidis cortex
Part: dried root and/or stem bark
Mandarin: sa¹n ke¹ zhe¹n is the stem or root bark from Berberis species
Family: Berberidaceae

A deciduous shrub, to 4 m tall, with yellow-brown ridged stems and 3-forked spines. Leaves are small, oval, finely serrated, and usually in clusters of 2-5. Flowers are bright yellow in pendant racemes. Fruit is a bright red berry, which is edible when ripe, but sour. Native to Central and Southern Europe, Northwest Africa, and Western Asia. Naturalized in Northern Europe and North America, growing in hedgerows, dry woodlands, and scrub.

Temperature
Tastes
Organs

cool
bitter
LR, GB, LU, HT, ST, IN

Please see the chapter on this herb in Principles, Practice and Materia Medica for herb combinations and for further information¹.

Actions, uses, and herb pairs

Chinese actions (Western actions)	Western uses	Pair examples (disorders)

I. clear Retained Pathogen, clear Heat Toxin (antimicrobial, antipyretic, alterative)	recurring (low grade) fever, post-febrile debility, acute bacillary dysentery, leishmaniasis, giardiasis, recovery from malaria	*Berberis + Achilllea* (recurring fever + exhaustion)*Berberis + Cinchona* (malaria recovery)
II. clear Liver-Gallbladder Damp Heat, clear Liver Heat (anti-inflammatory, alterative, hepatoprotective)	hepatobiliary disorders, skin disorders, or arthritis; with heat sensations, irritability, anger, or hypertension	*Berberis + Taraxacum* (cholecystitis + heat sensations)*Berberis + Rheum* (anger + heat sensations)
III. regulate and tonify Liver Qi (bitter hepatobiliary tonic, , cholagogue, alterative)	intolerances to foods (especially fatty foods) or medications, reduced appetite, epigastric or abdominal discomfort and distension, constipation, maybe headache or depression	*Berberis + Rosmarinus* (hepatic weakness + mixed signs of cold and heat)
IV. clear Lung Heat, clear Retained Pathogenic Heat, regulate Liver invasion of Lung (antimicrobial, antipretic, anti-inflammatory, alterative)	acute bronchitis with barking cough, thick yellow or green sputum, fever, thirst, sore throat, irritability	*Berberis + Asclepias* (acute bronchitis + irritability)
V. regulate Heart Qi and Blood (cardiotonic, cardioprotective, antiarrhythmic, vasodilatory, antihypertensive, antiatherosclerotic, anticholesterolemic, antithrombotic)	potential use for: cardiac weakness, cardiac hypertrophy, arrhythmia, prophylaxis and treatment of myocardial infarction, hypertension (see Constituents and Pharmacology)	*Berberis + Crataegus* (prophylaxis of myocardial infarction,)*Berberis + Scutellaria bai.* (hypertension + atherosclerosis)

Use of different types and plant parts

West Mahonia aquifolium (= B. aquifolium) has uses similar to B. vulgaris, but has a specific tradition of use for skin disorders.

China A variety of Berberis species are used in China, see PPMM¹.

Traditional use in China

Chinese Herbal Medicine Dictionary (1975)² sa¹n ke¹ zhe¹n was classified as cold and bitter, but meridians entered were not listed. sa¹n ke¹ zhe¹n can clear Damp Heat and Heat Toxin, and can be used for hematuria, jaundice, sore throat, red eyes, and diarrhea.

Chang and But (1986)³
sa¹n ke¹ zhe¹n can clear ‘latent heat syndromes’ (Retained Pathogen manifesting with Heat) such as tenesmus due to dysentery, pharyngolaryngitis, jaundice, and cough due to pathogenic heat in the lungs.

Traditional use in the West

Culpeper (1651)⁴

cleanses the body of choleric humors and treats diseases associated with choler, such as yellow jaundice, hot agues (malaria), scabs, itch, and boils
clears heat from the blood and heat from the liver
for diarrhea with blood
for burns and scalds

Lonicerus (1679)⁵

cold and dry in the second degree
for gallbladder-induced vomiting, for headaches if due to heat and acidity from gallbladder
strengthens the stomach and liver and increases appetite
strengthens the heart, for discomfort around the heart
cleanses the uterus to remove old leukorrhea

BHP (1983)⁶

cholecystitis, gall stones, jaundice
leishmaniasis, malaria

Comparison with similar herbs

Comparison of six bitter herbs in Artemisia

Comparison of six herbs with isoquinoline alkaloids in Sanguinaria
Berberis and Echinacea

Similarities: Both are cooling antimicrobial, anti-inflammatory, and alterative herbs. Both can be used to clear Retained Pathogen and Heat Toxin.

Differences: Allergies Echinacea is specific to clear Wind Heat for respiratory allergies with rhinitis or sinusitis.

Recurring infection Echinacea is specific for respiratory and urinary infections, whilst Berberis can also be used, as a specific, for bacillary dysentery and for protozoal infections.

Bronchitis Both can be used for acute bronchitis, but Echinacea is of more general application for Lung Phlegm Heat, and is the stronger anticatarrhal. Berberis is specific for Lung and Liver Heat, for bronchitis with barking cough and irritability.

Hepatobiliary disorders Berberis is specific to clear Liver-Gallbladder Damp Heat and Heat and Echinacea is not.

Urinary infections Echinacea is specific for Bladder Damp Heat, and, whilst Berberis can be used for this, it is not specific.

Cardiovascular disorders Recent research has emphasized the potential of Berberis for cardiovascular disorders.
Constituents and pharmacology

Types of constituents

- isoquinoline alkaloids⁷
  1.5-6% in stem bark, 12.8-16.2% in root bark- protobererine alkaloids berberine is the main alkaloid (1.9-6.8% in root bark); also jatrorrhizine (3.1% in root bark), palmitine, columbamine, and others- bisbenzylisoquinoline alkaloids berbamine (1.9% in root bark) and oxyacanthine (2.3% in root bark)- aporphine alkaloids mainly magnoflorine (1.3%in root bark)

- multidrug resistance pump inhibitors (MDRIs)
  – flavonolignans 5’-methoxyhydnocarpin (0.05-0.1% in leaves of B. fremontii)⁸– porphyrins pheophorbide A from B. aetnensis⁹
other⁷ data is scarce; older literature reported tannins, resins, polysaccharides, and chelidonic acid

Actions supported by research

The following actions have been reported for Berberis species (B. vulgaris unless otherwise stated) or for their isolated constituents.

antimicrobial antibacterial^8,9^H, antifungal (from B. aetnensis against Candida)¹⁰, antiprotozoal (from B aristata against Leishmania¹¹^H; against Entamoeba histolyca, Giardia lamblia, and Trichomonas vaginalis¹²^H)·
anti-inflammatory antipyretic¹³^H, anti-inflammatory (general¹³^H, pulmonary inflammation¹⁴^H, anti-gastric ulcer¹⁵^H)
spasmolytic antidiarrheal¹⁶^H, spasmolytic¹⁶^H
hepatobiliary hepatoprotective¹⁷^H, cholagogic¹⁸^u
antidiabetic hypoglycemic¹⁹^H
cardiovascular anticholesterol²⁰^H, antiatherotic²⁰^H, antiarrhythmic²¹^u^,22^H, cardiotonic²²^H, cardioprotective²⁰^H^,²¹^u, vasodilatory²¹^u^,22^H, hypotensive²⁰^H^,²¹^u, antithrombotic²¹^u
central nervous system antiamnesiac²³^H, antidepressant²⁴^H
anticancer²⁵^H^,26^u

Actions linked to a constituent

berberine actions marked^H
berbamine actions marked^u
MDRIs (potentiators of antimicrobials)
5’-methoxyhydnocarpin⁸, pheophorbide A⁹

Synergy between Berberis constituents

MDRs Multidrug resistant pumps protect microbial cells by pumping antibiotics out of the cell. Berberine, as an isolated chemical, has only moderate antibiotic activity, partly because the MDRs remove it from the cells.

MDRIs Constituents from the Berberis species, such as 5’-methoxyhydnocarpin and pheophorbide A, do not themselves have antibiotic activity. But they can inhibit the MDRs, so that the antimicrobial alkaloids, such as berberine, stay inside the microbial cells. MDRIs thus potentiate the antimicrobial effect of berberine, making Berberis a more potent antimicrobial than its isolated alkaloids.

Berberine and MRSA²⁷
Methicillin-resistant Staphylococcus aureus (MRSA) bacteria have been responsible for deaths in hospitals because they usually have multidrug resistance. Berberine has been reported to have antimicrobial activity against all tested strains of MRSA.

Berberine enhances antibiotics
An additive effect was reported between berberine and ampicillin, and a synergestic effect between berberine and oxacillin against MRSA.
Berberine may have the potential to restore the effectiveness of beta-lactam antibiotics against MRSA.

Berberine and retained pathogen

Comparison of berberine and sulfacetamide
Eye drops of sulfacetamide were reported as more effective than 0.2% berberine in treating patients with trachoma stages I and II caused by Chlamydia trachomatis. However, with sulfacetamide, Chlamydia remained in the conjunctiva and relapses occurred, whilst with berberine, the conjunctiva tested negative for Chlamydia and no relapses occurred²⁸.

Berberine enhances sulfacetamide
Nevertheless, in treatment of trachoma stage IIa or IIb, 0.2% berberine eye drops removed Chlamydia in only 50% of patients. The results were better when berberine was combined with neomycin²⁹.
Berberis and cardiovascular disease

Recently, berberine, berbamine, and tetrahydroberberine (see Hydrastis), have been reported to have multiple effects on the cardiovascular system, including one or more of:

cardiotonic (with increased exercise capacity and reduced dyspnea and fatigue), prevention of cardiac hypertrophy
antiarrhythmic
vasodilatory hypotensive
cardioprotective helping to prevent and treat the sequelae of myocardial infarction, by:
– reducing cholesterol
– reducing vascular inflammation and inhibiting proliferation of vascular smooth muscle cells, and thus reducing atherosclerosis
– reducing thrombosis

Dose and dispensing

Dried herb: 1-2 g of dried herb, or by decoction, three times per day (BHP)⁶.

Liquid extract: 3-6 ml of 1:2 liquid extract, or equivalent in tablet or capsule form, per day (M&B Safety)³⁰.

Tincture: 1-2 ml of 1:5 tincture in 45% alcohol, three times per day (JR).

Initial dose: Can start at the lower therapeutic dose (JR).

Duration: Can be taken 1-2 months, see Cautions (JR).

Topical application:
Wash for eczema A decoction of B. vulgaris can be used as a wash for Damp Heat type eczema with redness and irritation, in addition to taking Berberis internally as a single herb or in combination.

Preparation of decoction Soak 10 g dried cut bark in 500 ml water for one hour. Bring to the boil and simmer gently for 20 minutes. Strain the decoction, and use when at body temperature.

Cautions

General contraindications: The BHP gave diarrhea as a contraindication for B. vulgaris, but this contraindication has not been substantiated, and this herb has been widely used for bacillary dysentery, especially of Damp Heat type. But see Chinese contraindications.

Chinese contraindications: No contraindications are given in the Chinese Herbal Medical Dictionary. However, I would not use this herb in cases of Spleen Deficiency and Cold, especially with loose stools, unless it were combined with a warming herb such a Capsicum, Zingiber, or Rosmarinus..

Pregnancy and lactation: Avoid during pregnancy and lactation (BHC2)⁶. See discussion in M&B Safety.

Side effects: None known at recommended dose levels (BHC2).

Overdose: Nausea and vomiting have been reported in a few cases^3.

Drug interactions:
Berberis herb None known for B. vulgaris.

Isolated berberine There is concern over the possibility that berberine may reinforce the effect of drugs that displace the protein binding of bilirubin.
However, the adverse effects reported related to a study with isolated berberine, by intraperitoneal injection, at doses of berberine equivalent to higher than the maximum dose of Berberis herb²⁹.

This text is from the series: Combining Western Herbs and Chinese Medicine by Jeremy Ross. The book is entitiled “A Clinical Materia Medica: 120 Herbs in Western Use” and is due to be released in Spring 2009. The selection offered here is reprinted with permission. Joint copyright by Jeremy Ross and publisher, VGM.

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