Monograph: Arctostaphylos uva ursi

Arctostaphylos uva ursi Monograph

Shannon V. Smith

Bastyr University

Materia Medica II

Winter 2016

Latin name: Arctostaphylos uva ursi

Standardized common name: Bearberry, Uva Ursi, Kinnikinnick, Bearberry manzanita, Mealberry [13] [16] [26]

Family: Ericaceae [2]

Authored By: Shannon V. Smith

Parts used: Leaf, berry (traditional) [2] [26]

Botanical description: Arctostaphylos uva ursi is a low growing shrub that grows in a mat of vines. It is opportunistic in that it only sets the roots of its runners where there is open space to, therefore is not considered invasive. For this reason it is frequently used as ground cover. The new growth of its vining stems are red when they are in full sun and green when they are in the shade, while the older stems are more woody with brown bark that is known to shred in patches. It has evergreen, spoon shaped, or obovate leaves, which are shiny and leathery and are darker on top when compared to its undersides. The leaves tend to be lighter green in spring, darker green in summer and reddish purple in winter. Leaves are arranged alternately on the stem attached by a short, thick petiole, and have entire margins and reticulate venation. The leaves are slightly cupped and have a prominent midvein.  A. uva ursi can flower from late winter to early summer in some regions, however, in the Northwest it flowers from April to July and has perfect flowers which form in a raceme at the terminal ends of the stem. The flowers are white to pinkish bell-shaped or urn-like and bear mealy, red drupes which resemble an apple. The fruit stays on until deep into winter and is therefore an important food source for wildlife including birds, deer, elk, small mammals, and bear. The name Arctostaphylos comes from the Greek words “arktos,” meaning bear and “staphylos,” meaning a bunch of grapes. Similarly, “uva ursi” comes from the Latin words, “uva” meaning grape, and “ursi” meaning bear. It may have been given this name due to the frequent sighting of bears eating its fruit upon wakening from their winter hibernation. [6] [34]

[5]  [3]  [4]

 Habitat:  Arctostaphylos uva ursi grows along open areas or clearings and on down slopes or hillocks, in the mountains, on the dry side of canyons, and in logged or burned forests. It prefers acidic soil and can tolerate full sun to full shade. It likes sandy and well-drained sites and rocky slopes. It is hardy in zones 4-8. A. uva ursi is found from sea level to 11,000 feet and is indigenous to Europe, North America, and Asia. It has a circumpolar range. [6] [34]

Taste: Arctostaphylos uva ursi tastes slightly pungent, slightly sweet, and astringent; due to the high tannin content it can also taste bitter [9] [10] [11]

Energetic Properties: Arctostaphylos uva ursi is astringent, cooling, and drying. It is tonifying due to its astringency. [12] [13]

Doctrine of Signatures: Arctostaphylos uva ursi grows low to the ground in a vining mat. Matthew Wood, master herbalist discusses how long, tubular structures, such as the vines of uva ursi are a doctrine of signature for the urinary tract. It is also known to grow in rocky, sandy, and gravelly areas which may be a doctrine of signatures to its use for treating kidney stones. The flower of A. uva ursi is a bell-shaped urn-like flower which looks like an open mouth attached to an enlarged throat. This may be a doctrine of signatures for treating swollen mucous membranes in the throat, as is described by Matthew Wood in his monograph for this herb.  [14] [15] [9]

Actions section: Arctostaphylos uva ursi is known to be antibacterial (against Staphylococcus spp., E. coli, Pseudomonas spp., Proteus spp.), particularly in the urinary tract. It is astringent, a mild diuretic, and stimulates tubular function and increases renal circulation. David Hoffman, clinical phytotherapist, also attributes a demulcent action to this herb. [16] [13] [19]

Constituents: Although Arctostaphylos uva ursi contains flavonoids such as hyperin, triterpenes, such as ursolic acid, some free hydroquinone, phenolic acids and bitter principles, such as iridoids and the aforementioned ursolic acid, the principle active constituents are a phenolic glycoside called arbutin, which is a hydroquinone-glucoside, and high levels of hydrolysable tannins in the form of gallotannins and ellagitannins. [16] [13] [6]

Collection: The leaves of Arctostaphylos uva ursi should be gathered in the morning after the morning dew has dried in good weather.  The leaves can be gathered from spring to late fall. Michael Moore, herbalist, says the easiest way to harvest the leaves of this plant is to find the long runners coming off the center of the mat of vines and them pull the stolons up until you reach the center where you can snip them off. Then these runners can be placed loosely in open bags to dry or bundled and hung to dry. After drying, the leaves can be stripped from the stems and kept in a cool, dry, dark place in glass jars. [18] [6]

Pharmacodynamics: The constituent arbutin, when broken down by the body, forms hydroquinone. Hydroquinone is an antibiotic that gets directly excreted through the urinary tract and therefore, does not have any undesired effects on the microbes of the intestines, but instead has a direct action on any microbes that are in the bladder and the urethra. Arctostaphylos uva ursi contains hydrolysable tannins. These tannins, when ingested, bind to and precipitate proteins, producing an astringent action on the mucosal tissues, which forces their dehydration. Hydrolysable tannins also show antioxidant and free-radical scavenging activity. Externally, tannins will astringe tissues as well and will have a styptic and anti-inflammatory action to external wounds.  Flavonoids and phenolic compounds of A. uva ursi have been shown to be responsible for the inhibition of growth 20 different bacterial strains to include 10 different strains of Gram-positive Enterococcus faecalis and 10 different strains of Gram-negative Escherichia coli, all of which are common in urinary tract infections. [20] [30] [32]

Pharmacokinetics: Arbutin is rapidly absorbed in the small intestine, then is conjugated by the liver to form hydroquinone conjugates and glucose. The hydroquinone is directly excreted in the urine and acts directly as an antibacterial on microbes of the bladder and urethra. Tannins of A. uva ursi are hydrolysable tannins. Therefore they are broken down easily by hot water, acids, alkali and enzymes, like tannase. A. uva ursi contains both types of hydrolysable tannins, gallitannins and ellagitannins. They can be hepatotoxic once hydrolyzed if absorbed, so should not be taken long term or if a person has an unhealthy gut. The flavonoids of Arctostaphylos uva ursi are hydrolyzed by gut flora in the intestines or otherwise would be poorly absorbed. However, even taken topically, flavonoids can be absorbed sufficiently through the skin to effect inflammation in the gastrointestinal tract favorably and seem to be consistently useful in treating all GI inflammatory conditions, such as diarrhea due to the astringent properties of the flavonoids. [30] [31]

Indications and Effects: A. uva ursi, as Naturopathic Doctor Sharol Tilgner describes, is indicated for atonic and chronic conditions or infectious conditions of the urinary tract. Gazmend Skenderi, Pharmacognostist and Phytopharmacist, recommends A. uva ursi to be used as a tea for inflammations of the genourinary tract such as cystitis, urethritis, prostatitis, pyelonephritis. Tilgner, Holmes and Skenderi advise enhancing the effects of A. uva ursi by making the urine alkaline, as arbutin can only be transmuted into hydroquinone in an alkaline pH environment. This may be done by eating foods such as fresh vegetables, which are more alkaline, or by taking a teaspoonful of baking soda daily while taking this herb. Also, recommended is to take 2 liters of fluids per day. Walter Lewis, Ethnobotanist, tells of A. uva ursi being used by early settlers of eastern North America for help in the treatment of kidney stones. It helps for this use due to its diuretic action and antimicrobial action. Henriette Kress, Finnish herbalist, identifies A. uva ursi to be specifically indicated in the relaxation of urinary tract with pain and mucous or bloody secretions or in the instance of a feeling of weight and dragging on the lower abdominal area, only when that dragging is not associated with prostatic enlargement. She claims it is also indicated in chronic vesical irritation and pain and the catarrhal discharge that is related to rhinitis or other upper respiratory infections.  [13] [16] [12] [21] [22]

Safety considerations: According to herbal medicine practitioners Simon Mills and Kerry Bone, herbs with high levels of tannins are not appropriate in the case of a person who is experiencing constipation, iron deficiency, anemia, and malnutrition. Hydroquinone, a constituent of A. uva ursi is known to be a topical irritant, so care must be used with the topical application of bearberry as it may cause allergy contact dermatitis with skin colloid degeneration or hyperpigmentation. Arbutin, one of the principle constituents of Arctostaphylos uva ursi can decrease placenta-uterine membrane permeability which has a theoretical risk to fetus development, making this herb contraindicated in pregnancy. A. uva ursi should also not be used during lactation due to the risk it may also bring to a developing infant that is nursing. A. uva ursi is contraindicated in highly inflamed or ulcerated conditions of the gastrointestinal system due to the high levels of tannins. Also, it may cause nausea, vomiting, or cramping. Herbs containing high levels of tannins should not be used long term as they cause inflammation of mucous membranes and may potentially cause liver damage due to the presence of hydroquinone, a known hepatotoxin. A. uva ursi is not recommended for children under 12. [17]

Classic formulas: [19]

Traditional smoking mixture:

Bearberry leaves (Arctostaphylos uva ursi)

Yerba santa leaves (Eriodictyon californicum)

Mullein leaves (Verbascum thapsus)

Osha root (Ligusticum porteri)

Red Willow Bark (Salix laevigata)

For the treatment of urinary frequency associated with infection:

2 parts Zea mays

1 part Arctostaphylos uva ursi

For the treatment of Dysuria:

1 part Viburnum prunifolium

1 part Zea mays

1 part Arctostaphylos uva ursi

For the Treatment of Prostatitis:

1 part Arctostaphylos uva ursi

 1 part Agathosma betulina

1 part Echinacea spp.

1 part Serenoa repens

1 part Zea mays

Traditional/ethnobotanical use:

Arctostaphylos uva ursi was used by several tribes, such as the Blackfoot, Lakota, Cheyenne, Chippewa, Clallam, Cree, Great Basin Indian, Hesquiat, Eskimo/Inukitut, Hoh, Makah, Navajo, Okanagan-Colville, Salish, Quiluete and many of the Alongoquin Tribes in ceremonial smoking mixtures or for use in the ceremonial pipe. One of the common names that this plant is known by, especially in the Native American population, is “Kinnick Kinnick,” which is the Algonquin word for “smoking mixture.” The Great Basin Indian also used the berries to make a grey-brown dye. The Blackfoot used the dried and pulverized leaves in a salve to the scalp for itching and peeling. Carrier tribe used leaves as a poultice for sores. Cheyenne used A. uva ursi as an analgesic in chronic back pain, which was applied to the skin as a poultice.  The Cherokee used it as a urinary aid for various urinary diseases.  Flathead used the leaves in a poultice for burns. A few tribes, such as the Chippewa and the Quileute, smoked the leaves for medicinal uses such as headaches. Many tribes used the leaves and stem as a diuretic or to treat conditions of the kidney and bladder or for persistent back pain (Cherokee, Cheyenne, Okanagan-Colville.) The Chippewa, and Cree made a medicine from the berries and grease to treat diarrhea. Many tribes also used the leaves and berries as a food source. The Bella Coola mixed berries with fat. Blackfoot used the dried leaves in tea. They also ate the berries fresh, or cooked with sweeteners or mashed and cooked with fat.  Many tribes ate the berries with meat in soups and broths, or mixed them with meat and fat as a source of stored food for traveling, such as the Eskimo/Inupiat, Koyucan, Hanaksiala and Cree. Some tribes ate the berries with salmon eggs, such as the Skokomish and Eskimo.  [8] [26]

Combinations:

For a UTI:

Arctostaphylos uva ursi + Vaccinium marcrocarpon

For urinary infections in general: [23]

Arctostaphylos uva ursi + Agrypyron repens + Achillea millefolium + Echinacea angustifolia

For kidney stones: [23]

Arctostaphylos uva ursi + Aphanes arvenses + Parietaria Judaica

For Diabetes: [18]

Arctostaphylos uva ursi + Vaccinium myrtillus

Preparations and Doses:

As a urinary septic: [9] [19]

Infusion of the crushed leaves; 1-2 tsp of dried leaves per cup of boiling water; TID

Tincture: 1:5 in 25% alcohol; 2-4 mL TID

Other posology: [33]

German E Commission Monographs

3 g drug to 150mL water as an infusion or cold maceration or 100-210 mg hydroquinone derivatives, calculated as water free arbutin up to 4 times daily.

WHO Monographs on Selected Medicinal Plants (Volume 2, 2002)

3 g of the drug/150 mL as an infusion or cold macerate 3 to 4 times daily; 400-840 mg hydroquinone derivatives; other preparations accordingly calculated as arbutin.

ESCOP Monographs (2003)

Cold water infusions of the dried leaf corresponding to 400-800 mg of arbutin per day divided into 2 to 3 doses; equivalent preparations not recommended for children.

British Herbal Compendium (1992)

3 to 4 times daily; dried leaf 1.5-2.5g or as infusion or as cold aqueous extract;

Liquid extract (1:1), ethanol 25%; 1.5-2.5 mL

Tincture (1:5), ethanol 25%; 2-4 mL

Sustainability/Ecological issues:

Arctostaphylos uva ursi is listed as “endangered” in Illinois, “rare” in Indiana, “endangered” in Iowa, “presumed extirpated” in Ohio, and “extirpated” in Pennsylvania. It is not listed as an at risk species by United Plant Savers, and appears to be abundant locally, despite being endangered or extirpated from a few of states in the U.S. of the many states in which it is native. It has a circumpolar range in which it is grown. Globally, A. uva ursi has been classified as rare in Albania, Bulgaria, the Czech Republic, Romania, and the Netherlands. In many cases, improper or wasteful harvesting of this species is the culprit that has led to its rarity as, though only the leaves are required for its medicinal uses, the plant has been being wholly uprooted during the harvest. [24] [25]

Current literature:

Can Arctostaphylos uva ursi be effective against MRSA?

MRSA infections are difficult to cure because it is resistant not only to Methicillin but to other antimicrobial agents as well. Most strains can be cured with the use of vancomycin, however not all of them, so the extract of Arctostaphylos uva ursi was concentrated using a rotary evaporator and then the concentrated extract was tested against MRSA to examine the viability of its use against MRSA. It was found that it markedly reduced the MIC of β-lactams in MRSA by inhibiting the production of β-lactamase. The compound that was isolated to be effective was corilagin, a polyphenol. Oxacillin was also tested to be effective against MRSA.  Both oxacillin and corilagin were tested together and found to be even more effective synergistically, as together they greatly reduced the number of viable MRSA cells, which exhibited a bactericidal effect. [27]

Arctostaphylos uva ursi can be used by new mothers externally as an Astringent

Many new mothers are suffering from vaginal tears, episiotomies, hemorrhoids, or swollen perinea from the trauma of giving birth. One convenient application of herbal remedies is in the sitz bath. Arctostaphylos uva ursi contains constituents that are astringent to these delicate tissues and can provide relief and safely be used by new mothers in this application which will reduce inflammation of the tissues and tone them for a faster recovery. One recipe for sitz bath suggests adding ½ oz. of uva ursi leaves to ½ oz. yerba mansa root, and ½ oz. of marshmallow root, and ½ oz. calendula blossoms with 2 Tbsp. sea salt. The herbs should be steeped in 2 quarts of boiled water for as long as possible, then the salt can be added and the whole mixture can be added to a warm sitz bath. [28]

Tannins of Arctostaphylos uva ursi may be effective at treating Peptic ulcers.

Tannins are astringent due to the fact that they react with proteins with which they come into contact. This relationship between Tannins and proteins may create a greater resistance to gastric ulcers by increasing resistance to chemical and mechanical injury, by their antioxidant activity, by promoting tissue repair and by the resisting the damage by Helicobacter pylori. This is especially true of Arctostaphylos uva ursi, as the phenolic compounds that exist in this plant have also shown to be bacteriostatic, specifically to Helicobacter pylori. [29]

Personal experience:

I have used Arctostaphylos uva ursi in a ceremonial smoking mixture, similar to the one described above in Classic formulas, for use in the Chanupa on several occasions in the Inipi ceremony, for my wedding ceremony to my husband who is Blackfoot and for some very important healing ceremonies. I find it to have a protective and positive energy, not very different to that of Sage and Sweet grass mixed together, as it seems to cast out the negativity and bring in the blessings and good energy. I have also used A. uva ursi with D-Mannose and copious amounts of fluids at the very early stages of a urinary tract infection with excellent effectiveness.

References:

1. Thomé, O. Flora von Deutschland, Osterrich und der Schweiz . Gera, Germany: Friedrich von Zezschwitz, 1985. Plate 462. [Herbarium drawing of Arctostaphylos uva ursi]
2. Mills, S. and Bone, K. The Essential Guide to Herbal Safety. Philadelphia: Elsevier Ltd., 2005. p.259.
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