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Salix: Willow bark and NSAID

by Paul Bergner

Medical Herbalism 3(2):7

Non-steroidal anti-inflammatory drugs (NSAIDS), which include aspirin, are the most common treatment for pain and inflammation in arthritis. Although aspirin was initially discovered and synthesized after studying the properties of willow bark it is highly unlikely that willow can be substituted for high dose prescriptions of NSAIDS. Willow bark would make an attractive substitute, since it will not irritate the gastrointestinal tract the way NSAIDS do. Willow bark contains only about 1% salicin, however, which is converted to salicylic acid by the body. Although the conversion is rapid—salicylic acid appears in the urine in about 30 minutes (USD)—it is less than perfect. Only about a third of the salicin is transformed to salicylic acid (Fotsch). Thus to attain a dose equivalent to the average aspirin dose given in rheumatoid arthritis (4.5 g/day) it would require more than three pounds of willow bark. At that amount, the tannin in the willow bark would produce a toxicity of its own. The official German monograph for willow bark asserts that it is effective in treating headache, fever and rheumatic pains, but prescribes a dose of 6-12 grams willow bark twice a day, giving the equivalent of 120-240 mg. Salicin, less than a single 5-grain tablet of aspirin.

    Another strategy, if NSAIDS cannot be discontinued, is to give herbal support to the gastrointestinal tract. Turmeric tincture may have a protective effect (Rafatullah) Demulcent herbs such as slippery elm or marshmallow may also be appropriate. Another possibility is cinnamon. A water extract of cinnamon has demonstrated anti-ulcer effects, and has constituents which both reduce stomach acid and pepsin secretion and also strengthen the protective mechanisms in the gut wall (Tanaka). Cinnamon tea or powder shouldn’t be taken alone for more than a few weeks.

Fotsch G, et al. “Biotransformation of phenolglycosides leiocarposide and salicin” Pharmazie 1989 Aug; 44(8):555-8

Tanaka, s, et al. “Antiulcerogenic compounds isolated from Chinese cinnamon.” Planta Medica. 55(1989):245-248

U.S. Dispensatory. 1947