Althaea officinalis / Echte heemst

Heemst als slijmstofplant is vooral geschikt is om droge, geïrriteerde luchtwegen te smeren en tot rust te brengen. Dus te gebruiken bij keelpijn, heesheid en infecties van de luchtwegen die gepaard gaan met een droge hoest. Bij Petrus Nylandt ( - ) klinkt dat zo: “Voor Sinckinge ende dunne Catharren die op de borst vallen” en “voor zwaren hoest”. Bij geïrriteerde en ontstoken slijmvliezen van maag en darmen kan Heemst ook gebruikt worden, al zijn dan andere slijmplanten zoals Lijnzaad en IJslands mos. Het kauwen op de gedroogde wortel bij het doorkomen van de melktandjes is wel de merkwaardigste toepassing van Heemst. De zachte smaak is aanvaardbaar voor kinderen en het knabbelen maakt slijmstoffen vrij die verzachtend werken op het geïrriteerde tandvlees. Een droge huid wordt weer soepel met kompressen van heemstwortel, maar ook het blad en de bloem kan als lotion gebruikt worden bij kloven en couperose.

Als men lang genoeg zoekt, vindt men ook voor Heemst een waslijst van andere indicaties: siroop tegen slapeloosheid, blaasontsteking, dampbaden bij sinusitis, …Voor deze kwalen kan Althaea officinalis wel geprobeerd worden, maar zijn er toch veel betere planten.

Hoe te gebruiken
Het meest gebruikt en het bekendst is de Heemstsiroop (Sirupus Althaeae). In de Nederlandse Farmacopee 4 wordt hij als volgt bereid:
Macereer drie delen Althaeawortel, in dunne schijfjes gesneden en goed gewassen met vijfenveertig delen water gedurende 6 uur. Coleer en overgiet de wortel opnieuw met water tot een colatuur van veertig delen. Bereid van deze colatuur (het gefiltreerde), met zestig delen suiker, honderd delen siroop.

Zelf maak ik meestal ‘siroop’ door verse heemstwortel, in de lengte doorgesneden, in honing te laten trekken. Gemakkelijk te maken en gezond. Een kruidenthee maakt men best door 1 koffielepel kleine stukjes heemstwortel gedurende 30 minuten te macereren in een kopje water. Kauwen op de verse of gedroogde wortel is een sympathieke en zeker ook efficiënte gebruikswijze bij droge hoest, heesheid, keelpijn en ook te proberen bij aften en andere tandvleesproblemen.

Samengestelde kruidennmengsels met Heemst zijn overdadig aanwezig in apothekersboeken, vooral combinaties met Zoethout (Glycyrrhiza glabra L.) en Anijs (Pimpinella Anisum L.) zijn smakelijk en efficiënt.

Een veel gebruikte en interessant mengsel, waarschijnlijk afkomstig van Dr Valnet en weer opnieuw in gebruik bij Dr Moatti:
2 delen Heemstpoeder,
1 deel Zoethoutpoeder,
1 deel lactose
te gebruiken bij constipatie 1g, 1 tot 3x daags.

Voor uitwendig gebruik zijn er de ‘Species emollientis sen ad cataplasmata’, waarbij slijmstofplanten als papje gebruikt worden voor het verzachten en de rijping van abcessen.
Uit de Duitse farmacopee (DAB 6):
  • Matricariae flos (bloemen van Kamille) 20 gewichtsdelen
  • Althaeae fol. pulv. (poeder van Heemstblad) 20
  • Malvae fol. pulv. (poeder van Kaasjeskruidblad) 20
  • Meliloti hb. pulv. (poeder van Akkerhoningklaver) 20
  • Lini sem. pulv. (poeder van Lijnzaad) 20
Een eetlepel van dit mengsel wordt 30 minuten getrokken met een kop koud (20°) water. Daarna kookt men dit tot een brij, die zo warm mogelijk opgelegd wordt.

Heemst, een beroemde plant uit het verleden, is in onze tijd wat vergeten. Hopelijk wordt deze mooie plant met zijn duidelijke indicatie opnieuw opgenomen in onze hedendaagse gebruikstuinen.



Heemst  Althaea officinalis L.

Deze grote, winterharde, behaarde plant voelt zacht aan. De rechtopstaande stengels kunnen een hoogte bereiken van anderhalve meter. De gelobde en gekartelde bladeren hebben een heldere groengrijze kleur. Heemst heeft bleekroze bloemen met een korte bloemsteel. De vruchten bestaan uit een groot aantal geelachtige, in een cirkel staande vruchtbladeren.
Afkomst
Europa, Azië (gematigd klimaat van Turkije tot China), Noord-Afrika (Algerije, Tunesië).

Gebruikte delen
De wortels

Actieve bestanddelen
Polysacchariden (pectine, rhamnogalacturonaan): helpen de werking van het maagzuur af te remmen en beschermen het maagslijmvlies. Ze hebben ook een verzachtend effect op de keel.
Flavonoïden: antioxiderende werking.
Fenolzuren: antioxiderende werking.

Gebruik
De bloemen en de jonge bladeren, die eetbaar zijn, worden vaak gebruikt in salades. De bladeren kunnen ook worden gekookt, net als spinazie.
Vroeger werd de schoongemaakte wortel gegeven om op te kauwen aan kinderen die tanden kregen.
In de traditionele geneeskunde werd deze plant gebruikt tegen de hoest, maar ook om zijn laxerende en eetlustopwekkende eigenschappen. Heemstwortel werd daarnaast gebruikt bij maagpijn, tegen maagzweren of bij maagontsteking. Dankzij het slijmstoffengehalte is de plant ideaal om de huid te verzachten, waardoor er ook cosmetische toepassingen zijn.

Heemst werd al in het oude Egypte gebruikt in met honing gezoet snoepgoed, om keelpijn te behandelen. In het begin van de negentiende eeuw zorgden Franse suikerwerkfabrikanten voor een innovatie door geconcentreerd heemstsap met suiker stijf te kloppen tot een soort schuim.
Een latere versie van het recept, de zogenaamde 'pâte de guimauve' (wit drop), omvatte het wit van een ei en gelatine om de zachte basis te creëren. De creatie werd vaak gearomatiseerd met rozenwater en andere geurstoffen.
Vandaag bevat het snoepgoed niet langer echte heemst.

Recent wetenschappelijk onderzoek heeft uitgewezen dat heemstwortels een antibacteriële werking hebben en bijdragen aan de spijsvertering en een regelmatige darmtransit.1-10

Bibliographic References
  1. Aqueous extracts and polysaccharides from Marshmallow roots (Althea officinalis L.): cellular internalisation and stimulation of cell physiology of human epithelial cells in vitro.Deters A, Zippel J, Hellenbrand N, Pappai D, Possemeyer C, Hensel AJ Ethnopharmacol. 2010 Jan 8;127(1):62-9. Pubmed: http://www.ncbi.nlm.nih.gov/pubmed/19799989
  2. Vibrational spectroscopy and electrophoresis as a "golden means" in monitoring of polysaccharides in medical plant and gels.Spectrochim Acta A Mol Biomol Spectrosc. 2012 Jul;93:63-9.Pubmed: http://www.ncbi.nlm.nih.gov/pubmed/22465769
  3. The detection of antibacterial actions of whole herb tinctures using luminescent Escherichia coli.Watt K, Christofi N, Young R.Phytother Res. 2007 Dec;21(12):1193-9.Pubmed: http://www.ncbi.nlm.nih.gov/pubmed/17661335
  4. Antioxidant activity of medicinal plant polysaccharides.Kardosová A, Machová E.Fitoterapia. 2006 Jul;77(5):367-73. Epub 2006 May 24.Pubmed: http://www.ncbi.nlm.nih.gov/pubmed/16797146
  5. Antibacterial activity of medicinal plant extracts against periodontopathic bacteria.Iauk L, Lo Bue AM, Milazzo I, Rapisarda A, Blandino G.Phytother Res. 2003 Jun;17(6):599-604.Pubmed: http://www.ncbi.nlm.nih.gov/pubmed/12820224
  6. Gastroprotective effect and structure of a rhamnogalacturonan from Acmella oleracea.Nascimento AM, de Souza LM, Baggio CH, Werner MF, Maria-Ferreira D, da Silva LM, Sassaki GL, Gorin PA, Iacomini M, Cipriani TR.Phytochemistry. 2013 Jan;85:137-42.Pubmed: http://www.ncbi.nlm.nih.gov/pubmed/23014505
  7. Anti-ulcerative effect of non-starch polysaccharides.Krylova SG, Efimova LA, Zueva EP, Khotimchenko IuS, Razina TG, Amosova EN, Lopatina KA, Fomina TI.Vestn Ross Akad Med Nauk. 2009;(11):35-9.Pubmed: http://www.ncbi.nlm.nih.gov/pubmed/20017406
  8. Gastroprotective effect of natural non-starch polysaccharides.Krylova SG, Khotimchenko YS, Zueva EP, Amosova EN, Razina TG, Efimova LA, Khotimchenko MY, Kovalyov VV.Bull Exp Biol Med. 2006 Oct;142(4):454-7.Pubmed: http://www.ncbi.nlm.nih.gov/pubmed/17415435
  9. Efficacy of a pectin-based anti-reflux agent on acid reflux and recurrence of symptoms and oesophagitis in gastro-oesophageal reflux disease.Havelund T, Aalykke C, Rasmussen L.Eur J Gastroenterol Hepatol. 1997 May;9(5):509-14.Pubmed: http://www.ncbi.nlm.nih.gov/pubmed/9187886
  10. Chemistry and uses of pectin--a review.Thakur BR, Singh RK, Handa AK.Crit Rev Food Sci Nutr. 1997 Feb;37(1):47-73  http://www.ncbi.nlm.nih.gov/pubmed/9067088


Marshmallow (Althaea officinalis)
Synonyms / Common Names / Related Terms
Althaea leaf, althaea root, Althaea officinalis L. var robusta, Althaeae folium, althaeae radi, althaea radix, Althea, althea leaf, althea root, Altheia, Apothekerstockmalve (German), bismalva (Italian), buonvischio (Italian), cheeses, Eibischwurzel (German), Guimauve (French), gul hatem (Turkish), Herba Malvae, hitmi (Turkish), kitmi (Turkish), Mallards, Malvaceae (family), malvacioni (Italian), malve, malvavisco (Spanish), mortification root, Racine De Guimauve, sweet weed, witte malve, wymote.

Note: Not to be confused with mallow leaf or mallow flower. Not to be confused with confectionery marshmallows; although confectionery marshmallows were once made from the Althaea officinalis plant, they now primarily contain sugar.

Mechanism of Action
Pharmacology:

Constituents: Marshmallow root preparations consist of peeled or unpeeled dried root of Althaea officinalis L., and contain mucilage polysaccharides (6.2-11.6%) composed of galacturonorhamnans, arabinans, glucaris, arabinogalactans; carbohydrates (25-35 %); flavanoids; glycosides; sugars (10% sucrose); amines (up to 12% asparagines); fat (1.7%); calcium oxalate; coumarins; phenolic acid9; and sterols. Purified homogenous mucilage of marshmallow mucilage is composed of L-rhamsose, D-galactose, galacuonnic acid, and D-glucuronic acid in molar ratio of 3:2:3:31. Scopoletin, quercitin, kaempferol, chlorgenic acid, caffeic acid and p-coumaric acid are also present in the roots. Marshmallow is high in aluminum, iron, magnesium, selenium, tin, and substantial amounts of calcium. It is also high in pectin, which may lower blood glucose concentrations. The root contains 25-35% of the mucilage; however, the content of purified mucilage is much lower. Asparagine, sugar, pectin and tannin have also been identified in the root. The mucilage content of the root, leaves and flowers is highest in the late fall and winter (approximately 11%) and lowest in the spring and summer (5-6%). Xylose, glucan, arabinogalactan, acidic polysaccharide containing 2-O-alpha-D-galacturonopyranosyl-l-rhamnose10 are also present in the hydrolysate of leaf and flower mucilage. Extracts from hybrid plants have been found to be more mucilaginous with different sugar composition compared to native plants.11

Anti-inflammatory effects: In 1966, Beaune et al. conducted an experimental study and found that the anti-inflammatory properties of marshmallow alone were superior to dexamethasone monotherapy rabbits.4 Although these data suggest that marshmallow may possess anti-inflammatory properties that are additive to topical steroids, measurement techniques and statistical methods were not adequately described.
Antimicrobial effects: Marshmallow given intraperitoneally to rats at a dose of 10mg/kg exhibits phagocytic activity, suppresses mucociliary action, and stimulates phagocytosis. It also exhibits antimicrobial activity against P. aeroginosa, P. vulgaris and S. aureus.2,3

Antitussive/mucociliary effects: Mucilaginous herbs like marshmallow root may inhibit coughing by forming a protective coating on the mucosal lining of the respiratory tract, shielding it from irritants.2,6 Marshmallow reduces the transport velocity of isolated ciliary epithelia and may protect mucous layers in the hypopharynx, exert spasmolytic, antisecretory, and bactericidal properties.2 Antitussive activity has been demonstrated by oral doses of marshmallow root extract and a marshmallow polysaccharide (100mg/kg and 50mg/kg respectively) in cats as compared to a non-narcotic cough suppressant. A polysaccharide dose of 50mg/kg was equally effective as "Syrupus Althaeae" in a dose of 1,000mg/kg.7 The extract was less effective than marshmallow polysaccharide.5 Demulcent properties of marshmallow may be due to reduction of local irritation that causes gastritis.

Dermatologic effects: Combinations of marshmallow preparations with steroids have been used in the management of dermatological conditions, and the plant appears to possess anti-inflammatory activity that potentates the effect of topical steroids.8,12 In vitro, anti-inflammatory effects of an ointment containing marshmallow extract and dexamethasone (0.05%) was superior to the individual ingredients in the alleviation of chemically-induced rabbit ear irritation.4 Marshmallow extract in vivo stimulates phagocytosis and the release of cytokines from monocytes, including interleukin-6 and tumor necrosis factor.13
Hypoglycemic effects: At doses of 10mg/kg, 30mg/kg and 100mg/kg, marshmallow reduces plasma glucose levels to 74%, 81% and 65% of prior values, respectively, after seven hours in rats.1

Pharmacodynamics/Kinetics:
Marshmallow mucilage is not altered in the digestive tract until it reaches the colon, where it may be partially or completely digested via bacterial action.5

References
  1. Tomoda, M., Shimizu, N., Oshima, Y., Takahashi, M., Murakami, M., and Hikino, H. Hypoglycemic activity of twenty plant mucilages and three modified products. Planta Med 1987;53(1):8-12. 3575513
  2. Muller-Limmroth, W. and Frohlich, H. H. [Effect of various phytotherapeutic expectorants on mucociliary transport]. Fortschr Med 1-24-1980;98(3):95-101. 7364365
  3. Recio MC and et al. Antimicrobial activity of selected plants employed in the Spanish Mediterranean area, Part II. Phytother Res 1989;3:77-80.
  4. Beaune, A. and Balea, T. [Anti-inflammatory experimental properties of marshmallow: its potentiating action on the local effects of corticoids]. Therapie 1966;21(2):341-347. 5935643
  5. Bone K. Marshmallow soothes cough. Br J Phytother 1993;3(2):93.
  6. Meyer E. Behandlung akuter und chronischer Bronchitiden mit Heilpflanzen. Therapiewoche 1956;6:537-540.
  7. Nosal'ova, G., Strapkova, A., Kardosova, A., Capek, P., Zathurecky, L., and Bukovska, E. [Antitussive action of extracts and polysaccharides of marsh mallow (Althea officinalis L., var. robusta)]. Pharmazie 1992;47(3):224-226. 1615030
  8. Huriez, C. and Fagez, C. [An association of marshmallow-dexamethasone: the pommade Dexalta]. Lille Med 1968;13(2):121-123. 5745965
  9. Gudej J. Flavonoids, phenolic acids and coumarins from the roots of Althaea officinalis. Planta Med 1991;57:284-285.
  10. Franz G. Die Schleimpolysaccharide von Althaea officinalis und Malva sylvestris. Planta Med 1966;14:90-110.
  11. Franz, G. and Chladek, M. [Comparative studies on the composition of crude mucus from crossbred descendants of Althaea officinalis L. and Althaea armeniaca Ten]. Pharmazie 1973;28(2):128-129. 4687561
  12. Piovano, P. B. and Mazzocchi, S. [Clinical trial of a steroid derivative (9-alpha-fluoro-prednisolone-21- acetate) in association with aqueous extract of althea in the dermatological field]. G Ital Dermatol Minerva Dermatol 1970;45(4):279-286. 5537593
  13. Scheffer J and König W. Einfluss von Radix althaeae und Flores chamomillae Extrakten auf Entzündungsreaktionen humaner neutrophiler Granulozyten, Monozyten und Rattenmastzellen. Abstracts of 3rd Phytotherapie-Kongress 1991;Abstract P9.- See more at: http://www.sigmaaldrich.com/life-science/nutrition-research/learning-center/plant-profiler/althaea-officinalis.html#sthash.xlTr4w1Q.dpuf



Althaea officinalis  scientific studies

The polysaccharides in Althaea officinalis have been studied to determine its potential to treat coughs. Sutovska, Nosalova, Franova, and Kardosova (2007) conducted experiments to determine the influence of polysaccharides from Althaea officinalis L. var. Robusta and from other plants such as Arctium lappa L. var. Herkules and Prunus persica L. Batsch on induced cough. In this study, purified and modified polysaccharides from these plants were tested for their cough-suppressive (i.e., antitussive) activities, the cough being induced mechanically in conscious cats. Results from this study showed that the tested polysaccharides from Althaea officinalis L. var. Robusta and from the other already mentioned plants revealed “statistically significant cough-suppressing activity, which was noticeably higher than that of the non-narcotic drug used in clinical practice to treat coughing.” Most notably, it is the polysaccharide in Althaea officinalis L. var. Robusta that showed the most noteworthy antitussive activity. [4]

The results of in vivo experiments suggest that Althaea officinalis may have greater efficacy as a cough suppressant than over-the-counter remedies. Sutovska et al. (2011) performed another more recent study where they investigated the antitussive activity of marshmallow (Althaea officinalis). In this study, the polysaccharide rhamnogalacturonan was scrutinized for its ability to inhibit the cough reflex and to alter the reactivity of airways in guinea pigs in vivo, as well as its changes during conditions of inflammation associated with allergies. Results revealed that the rhamnogalacturonan in Althaea officinalis inhibited the cough reflex in unsensitized guinea pigs in a dose-dependent fashion but did not modulate the airway’s reactivity in vivo. Therefore, this translates to the finding that the rhamnogalacturonan isolated from Althaea officinalis renders a very high antitussive effect in guinea pig models. [5]

The cough-suppressive activity of codeine was also experimentally determined in this study under the same circumstances as that of Althaea officinalis’s rhamnogalacturonan. At an oral dose of 10 mg kg-1 b.w., codeine’s activity was said to be comparable to that of higher-dose rhamnogalacturonan in unsensitized animals. [5]

Nosál'ova et al. (1992) also had ventured on studying the efficiency of Althaea officinalis polysaccharides in suppressing cough. In their study, the polysaccharide obtained from the said plant’s roots was investigated for its antitussive activity in unanaesthetized cats, and cough was evaluated with respect to the changes in tracheal pressure. The results demonstrated the ability of the Althaea officinalis polysaccharide to effectively decrease the number of cough efforts from both laryngopharyngeal and tracheobronchial areas of the respiratory system. Moreover, when compared to prenoxdiazine (a certain antitussive) at a dose of 30 mg kg-1 b.w., the polysaccharide (at 50 mg/kg b.w.) was considered more effective as regards cough suppression. [6]

Aside from its purported antitussive property, J. Williamson and C. Wyandt’s Herbal Therapies: The Facts and the Fiction (1997) lists Althaea officinalis as among the traditional treatments for the irritation of mucous membranes (i.e., demulcent), throat ulcers, and gastric ulcers. According to this guide, the plant has other properties of medicinal value, too, including being an expectorant and diuretic. [7]

A study by Hage-Sleiman, Mroueh, and Daher (2011) also has reinforced prior findings about the potential role of the aqueous extract of Althaea officinalis flower in lipemia, gastric ulcer, inflammation, and platelet aggregation. In their study, a rat model was used, and no visible adverse effect from the administration of Althaea officinalis flower aqueous extract was observed. [8]

According to analyses of laboratory tests, Althaea officinalis has a high rate of antioxidant activity. [3]

[3] Elmastas, Mahfuz et al. Determination of Antioxidant Activity of Marshmallow Flower (Althaea officinalis L.). 2004. Analytical Letters. Vol 37(9). http://www.tandfonline.com/doi/pdf/10.1081/AL-120039431
[4] Sultovska M. et al. The antitussive activity of polysaccharides from Althaea officinalis l., var. Robusta, Arctium lappa L., var. Herkules, and Prunus persica L., Batsch. (2007). http://www.ncbi.nlm.nih.gov/pubmed/17685009
[4] Sutovska M., Nosalova G., Franova S., & Kardosova A. (2007). The antitussive activity of polysaccharides from Althaea officinalis l., var. Robusta, Arctium lappa L., var. Herkules, and Prunus persica L., International Journal Bratislava Medical Journal, 108(2):93–99. Retrieved February 13, 2013, from http://www.ncbi.nlm.nih.gov/pubmed/17685009
[5] Sutovska M. et al. (2011). Antitussive activity of Althaea officinalis L. polysaccharide rhamnogalacturonan and its changes in guinea pigs with ovalbumine-induced airways inflammation. International Journal Bratislava Medical Journal, 112(12): 670–675. Retrieved February 13, 2013, from http://www.ncbi.nlm.nih.gov/pubmed/22372330
[6] Nosál'ova G. et al. (1992). Antitussive action of extracts and polysaccharides of marsh mallow (Althea officinalis L., var. robusta). Pharmazie. 47(3): 224–226. Retrieved February 13, 2013, from http://www.ncbi.nlm.nih.gov/pubmed/1615030
[7] Williamson J.S. & Wyandt C.M. (1997). Herbal Therapies: The Facts and the Fiction. The University of Mississippi School of Pharmacy.
[8] Hage-Sleiman R., Mroueh M., & Daher C.F. (2011). Pharmacological evaluation of aqueous extract of Althaea officinalis flower grown in Lebanon. Pharmaceutical Biology, 49(3):327–333. doi: 10.3109/13880209.2010.516754. Retrieved February 13, 2013, from http://www.ncbi.nlm.nih.gov/pubmed/21281251

http://mens-en-gezondheid.infonu.nl/alternatief/22584-de-tuin-als-huisapotheek-heemst-en-kaasjeskruid.html



Pharm Biol. 2011 Mar;49(3):327-33. doi: 10.3109/13880209.2010.516754. Epub 2011 Feb 1.
Pharmacological evaluation of aqueous extract of Althaea officinalis flower grown in Lebanon.
Hage-Sleiman R1, Mroueh M, Daher CF.

CONTEXT:
Althaea officinalis Linn. (Malvaideae) flower is commonly used in folk medicine in Lebanon and neighboring countries. Although most of the studies have been conducted on the mucilage-rich roots, little is known about the flower.
OBJECTIVE:
This study investigates the potential role of aqueous extract of Althaea officinalis flower in lipemia, gastric ulcer, inflammation, and platelet aggregation using the rat model.
MATERIAL AND METHODS:
Blood lipid profile and liver function were assessed after 1 month of extract intake via drinking water. Anti-inflammatory activity was tested against acute and chronic inflammation induced by carrageenan and formalin, respectively. Antiulcer activity was evaluated using ethanol-induced gastric ulcer. Antiplatelet activity was investigated in vitro using the adenosine 5'-diphosphate (ADP)-induced platelet aggregation bioassay.
RESULTS:
The 50 mg/kg body weight dose resulted in significant increase in serum HDL cholesterol level with no effects on stool cholesterol and triacylglycerol. Increasing the dose to 500 mg/kg body weight caused a significant decrease in stool water content. No adverse effect on liver enzymes was observed. Significant anti-inflammatory (acute and chronic inflammation) and antiulcerogenic activities were observed at all used doses (50, 100, and 250 mg/kg body). Time-dependent inhibition of platelet aggregation was demonstrated at 500 µg/ml concentration.
DISCUSSION AND CONCLUSION:
The aqueous extract of Althaea officinalis flower demonstrated potential benefits in lipemia, inflammation, gastric ulcer, and platelet aggregation with no visible adverse effect.

Bratisl Lek Listy. 2007;108(2):93-9.
The antitussive activity of polysaccharides from Althaea officinalis l., var. Robusta, Arctium lappa L., var. Herkules, and Prunus persica L., Batsch.
Sutovska M1, Nosalova G, Franova S, Kardosova A.
BACKGROUND:
The therapy of pathological type of cough presents serious medical problem.
OBJECTIVES:
The aim of experiments was to investigate polysaccacharide influence on experimentally induced cough.
METHODS:
The purified and/or modified polysaccharides from the flowers and plants, characterized by chemical composition and molecular properties were subjected to tests for antitussive activity on cough, induced mechanically in conscious cats of both sexes.
RESULTS:
The results revealed that the tested polysaccharides exhibited statistically significant cough-suppressing activity, which was noticeably higher than that of the non-narcotic drug used in clinical practice to treat coughing. The most expressive antitussive activity was observed with the polysaccharide from marsh mallow, containing the highest proportion of the uronic acid constituent. Negative influence of the tested compounds on expectoration was negligible when compared to that of codeine.
CONCLUSION:
Antitussive activity of various plant polysaccharides was confirmed. These results allow ranging them among prospective antitussive agents (Tab. 2, Fig. 6, Ref. 15) Full Text (Free, PDF) www.bmj.sk.

J Ethnopharmacol. 2010 Jan 8;127(1):62-9. doi: 10.1016/j.jep.2009.09.050. Epub 2009 Sep 30.
Aqueous extracts and polysaccharides from Marshmallow roots (Althea officinalis L.): cellular internalisation and stimulation of cell physiology of human epithelial cells in vitro.
Deters A1, Zippel J, Hellenbrand N, Pappai D, Possemeyer C, Hensel A.
AIMS:
Aqueous extracts from the roots of Althea officinalis L. (Malvaceae) are widely used for treatment of irritated mucosa. The clinical proven effects are related to the presence of bioadhesive and mucilaginous polysaccharides from the rhamnogalacturonan type, leading to the physical formation of mucin-like on top of the irritated tissues. No data are available if the extracts or the polysaccharides from these extract exert an active influence on mucosal or connective tissue cells, in order to initiated changes in cell physiology, useful for better tissue regeneration.
METHODOLOGY:
In vitro investigations of aqueous A. officinalis extract AE and raw polysaccharides (RPS) on epithelial KB cells and primary dermal human fibroblasts (pNHF) using WST1 vitality test and BrdU proliferation ELISA. Gene expression analysis by microarray from KB cells. Internalisation studies of polysaccharides were performed by laser scanning microscopy.
RESULTS:
AE (1, 10 microg/mL) had stimulating effect on cell viability and proliferation of epithelial KB cells. RPS (1, 10 microg/mL) stimulated cell vitality of epithelial cells significantly without triggering the cells into higher proliferation status. Neither AE nor RPS had any effect on fibroblasts. FITC-labeled RPS was shown to be internalised into epithelial cells, but not into fibroblasts. FITC-RPS was shown to form bioadhesive layers on the cell surface of dermal fibroblasts. Microarray analysis indicated an up-regulation of genes related to cell adhesion proteins, growth regulators, extracellular matrix, cytokine release and apoptosis.
CONCLUSION:
Aqueous extracts and polysaccharides from the roots of A. officinalis are effective stimulators of cell physiology of epithelial cells which can prove the traditional use of Marshmallow preparations for treatment of irritated mucous membranes within tissue regeneration.

J Physiol Sci. 2014 May;64(3):171-6. doi: 10.1007/s12576-014-0305-z. Epub 2014 Jan 25. Protective effects of Althaea officinalis L. extract in 6-hydroxydopamine-induced hemi-Parkinsonism model: behavioral, biochemical and histochemical evidence. Rezaei M1, Alirezaei M.
It is well known that Parkinson's disease (PD) is the second most common neurodegenerative disorder in humans. In this regard, the neuroprotective effect of Althaea officinalis (AO) has already been reported. Therefore, this study examined whether administration of AO extract would improve behavioral, biochemical and structural abnormalities in an experimental animal model of PD in rats. For this purpose, we induced hemi-Parkinsonism by unilateral intranigral injection of 6-hydroxydopamine (6-OHDA, 8 μg/5 μl saline-ascorbate). The rats were pretreated i.p. with AO extract (10 mg/kg) started 6 days before surgery and continued until the 3rd day post-surgery. Regarding oxidative stress, brain MDA concentration (as a lipid peroxidation marker) increased significantly in the 6-OHDA-administered group in comparison with rats pretreated with AO extract. It was found that AO treatment attenuated rotational behavior in the 6-OHDA-administered group and protected the neurons of substantia nigra pars compacta against 6-OHDA toxicity. Overall, AO extract administration indicated neuroprotective effects against 6-OHDA-induced hemi-Parkinsonism in rats.



Marshmallow monograph
HerbalGram. 2007; 75:1-5 American Botanical Council

Althaea officinalis
Family: Malvaceae
A perennial herb, marshmallow is native throughout damp areas of Europe and Western Asia. Marshmallow is naturalized in North America in salt marshes from Massachusetts to Virginia, and it’s cultivated from Western Europe to Russia.1,2,3 Its material of commerce consists of both the whole or cut dried leaves and the peeled or unpeeled, whole or cut, dried roots.4 These materials are harvested from cultivated plants mainly from Belgium, Bulgaria, Croatia, Hungary, Russian Federation, and Serbia.3,5 The therapeutic activity of high-mucilage-containing materials, like marshmallow, can be predicted in part by volumetrically measuring their swelling index. This quality indicating test directly corresponds to the demulcent action (i.e., the soothing of mucous membranes caused by the expansion of mucilage polysaccharides when they absorb moisture, swell, and form a demulcent gel that has bioadhesive properties). Pharmacopeial quality marshmallow root should have a swelling index of not-less-than 10, and for marshmallow leaf, not-less-than 12.4 The material used in the traditional systems of medicine in India, the mature dried seeds and roots, are often cultivated in Punjab and Kashmir.6,7 The plant should be at least two years old before harvesting its roots.8 The seeds are collected when they are mature, before the dried fruits fall to the ground.6

History and Cultural Significance

Reportedly, marshmallow has been used in traditional European medicine for over 2000 years.2 Its therapeutic use was first recorded in the 9th century BCE, and it was used widely in Greek medicine.9 Its genus name Althaea comes from the Greek altho, meaning to cure, and its family name, Malvaceae, is derived from the Greek malake, meaning soft.10 The root is often used as a component of preparations intended for the treatment of coughs (e.g., teas and syrups).11

Marshmallow’s use in traditional Greek medicine spread to Arabian medicine and to traditional Indian Ayurvedic and Unani medicines.1 Early Arab physicians prepared a poultice with the leaves to suppress inflammation. The Ayurvedic Pharmacopoeia of India (2006) reports the therapeutic uses of the roots and/or seeds for treating coughs and bronchitis, coryza (runny nose), and throat disorders, among other conditions. An important formulation that contains both marshmallow seed and root, “Gojihvadi Kvath,” indicated for cough, is listed in the Government of India’s Essential Ayurveda Drugs for Dispensaries and Hospitals.12 In the Unani system of medicine, marshmallow seed is used for treatment of bronchitis, pleurisy, pneumonia, and kidney stones.6 The Unani formulation, “Lauq-e-Sapistan,” is indicated for dry and irritative cough, scanty sputum, chronic bronchitis, and chronic catarrh. Lauq-e-Sapistan is a soft, honey-based compound medicine with powdered marshmallow seed, snap melon seed (Cucumis melo, var. momordica, Cucurbitaceae), jujube fruit (Ziziphus jujuba, Rhamnaceae), and quince fruit (Cydonia oblonga, Rosaceae), among other herbs.13

The sweet confection known as “marshmallow” is related to the plant through history. In 2000 BCE, ancient Egyptians reportedly made a candy of marshmallow root and honey, which was reserved for gods and royalty.14 In the more recent past (circa mid-17th century CE), French druggists made a meringue of marshmallow root extract, egg white, and sugar called Pâté de Guimauve to treat chest complaints.10 By the late 19th century, marshmallow confections were easily available to the public, mass-produced, and no longer contained marshmallow extract.14

In 1989, the German Commission E approved both marshmallow leaf and root for irritation of the oral and pharyngeal (throat) mucosa and associated dry cough.15 The root was also approved for mild inflammation of the gastric mucosa (stomach lining). The German Standard License for marshmallow leaf or root teas indicates their use to alleviate irritation of the mucous membranes of the mouth and throat accompanied by dry irritated cough, and for mild inflammation of the gastric mucosa.3 As all national pharmacopeias and formularies of European Community member states are in the process of harmonization, a European Community Herbal Monograph for marshmallow root is in development. This monograph will eventually become official in all 27 member states for the purpose of uniform product licensing and labeling for drug preparations containing marshmallow root.16

The non-official British Herbal Compendium, 1st edition, indicates marshmallow root internally for soothing the stomach and intestinal tract.8 Topically, liquid preparations made from marshmallow root are indicated as a mouthwash or gargle for soothing inflammations in the mouth and throat.8

For marshmallow leaf, the British Herbal Compendium, 2nd edition, states that no indications are adequately substantiated by pharmacological or clinical studies. However, uses based on experience or tradition include internal use of the tea infusion or liquid extract for irritation and inflammation of the oral and pharyngeal mucosa, dry irritating coughs, respiratory catarrh and bronchitis, digestive tract disorders (peptic ulcer), and urinary tract disorders (cystitis).17

Similarly, the European Scientific Cooperative on Phytotherapy (ESCOP) indicates marshmallow aqueous cold macerate or syrup for dry cough and irritation of the oral or pharyngeal (throat), and the cold macerate form for gastrointestinal irritation.18 However, the World Health Organization (WHO) monograph states that medicinal uses for marshmallow root are not supported by clinical data. For uses described in pharmacopeias and in traditional systems of medicine, the WHO lists the same aforementioned indications citing the monographs of the British Herbal Compendium, ESCOP, and the German Commission E.19

In the United States, marshmallow leaves and roots are used as components of herbal teas, dietary supplement products, and topical demulcent preparations.11 Marshmallow flower and root, and extracts thereof, are also classified by the Food and Drug Administration (FDA) as generally recognized as safe (GRAS) natural flavoring substances when used in the minimum quantity required to produce this intended effect.20

Modern Research

In a pharmacological study involving male and female adult cats with mechanically induced cough, a mucilage polysaccharide extractive of marshmallow flowers demonstrated significantly higher antitussive activity than the non-narcotic drug dropropizine (frequently prescribed for cough treatment). However, it showed somewhat lower activity than the narcotic drug codeine, and whereas codeine had a negative impact on expectoration, marshmallow mucilage was shown to be an effective antitussive with no negative impact on expectoration. No adverse effects were observed in the marshmallow group.21

In a randomized, placebo controlled study involving 63 patients who had developed dry cough while taking angiotensin-converting enzyme (ACE) inhibitor drugs, patients received a liquid preparation of marshmallow root or placebo. The marshmallow group showed a significant reduction in cough score compared to placebo.22

An open-label clinical study containing 42 patients with chronic cutaneous leishmaniasis (CCL) involved the application of an herbal paste to lesions. The herbal paste was prepared from a special extract designated as “Z-HE,” which was modified from a traditional Iranian medicine formula. The Z-HE extract contained extractives of marshmallow and the related hollyhock (A. rosea) (plant parts not specified in study), as well as other herbs. The study reported that 69% had a complete cure, 12% had partial cure, and 19% failed to respond to the therapy. In a subsequent open-label trial, the authors concluded that although the active ingredient(s) and the mechanism(s) of action of Z-HE are not known, its ease of preparation, topical application, lack of adverse effects, low cost, and satisfactory cosmetic effects make it a promising drug for use in the treatment of lesions of CCL.23

An open-label clinical study containing 62 patients with irritating cough used a combination syrup (Weleda Hustenelixier, Weleda, Schwäbisch Gmünd, Germany) containing extracts of English ivy leaf (Hedera helix, Araliaceae), thyme leaf and wild thyme leaf (Thymus vulgaris and T. serpyllum, Lamiaceae), anise fruit (Pimpinella anisum, Apiaceae), and marshmallow root. The syrup alleviated coughs resulting from the common cold, bronchitis, and respiratory tract diseases that formed mucous.24

A double-blind, placebo-controlled study contained 60 patients diagnosed with acute pharyngitis. The patients were treated with an herbal tea (Throat Coat®, Traditional Medicinals, Sebastopol, CA) that contained marshmallow root, licorice root (Glycyrrhiza glabra, Fabaceae), slippery elm bark (Ulmus rubra, Ulmaceae), and wild cherry bark (Prunus serotina, Rosaceae), among others. The tea was found to be significantly superior to placebo and provided a rapid, temporary relief of sore throat pain.25

Future Outlook

Wild marshmallow is considered a threatened plant in Germany and is listed in the German Federal Ordinance on the Conservation of Species.26 A permit is necessary for import or export of any wild-collected material. Marshmallow is also listed as “nationally scarce” in the United Kingdom,27 and due to its scarcity in Bulgaria, it is prohibited from collection in the wild.28 Commercial marshmallow is, and should continue to be, harvested only from cultivated plants, especially when the root is being sought.

—Gayle Engels

References

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  3. Wichtl M, ed., Brinckmann JA, Lindenmaier MP, trans. Herbal Drugs and Phytopharmaceuticals. Stuttgart: Medpharm Scientific Publishers; 2004.
  4. European Pharmacopoeia Commission. Marshmallow Leaf; Marshmallow Root. In: European Pharmacopoeia, 5th Edition. Strasbourg, France: European Directorate for Quality of Medicines and Healthcare. 2006;1974-1975.
  5. British Herbal Medicine Association. British Herbal Pharmacopoeia, 4th ed. Exeter, UK: British Herbal Medicine Association; 1996.
  6. Central Council for Research in Unani Medicine (CCRUM). Khatmi. In: Standardization of Single Drugs of Unani Medicine, First Edition, Part 1. New Delhi, India: CCRUM. 1987;166-169.
  7. Government of India Department of Ayurveda, Yoga-Naturopa
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  14. Sri Lanka Ayurvedic Pharmacopoeia Committee. Ayurveda Pharmacopoeia Unani, Volume I. Maharagama, Sri Lanka: Ministry of Health & Indigenous Medicine Department of Ayurveda. 1998.
  15. Marshmallows. The Food Timeline website. Available at: http://www. foodtimeline.org/foodcandy.html#marshmallows. Accessed March 13, 2007.
  16. Blumenthal M, Busse WR, Goldberg A, Gruenwald J, Hall T, Riggins CW, Rister RS, editors. Klein S, Rister RS, translators. The Complete German Commission E Monographs?Therapeutic Guide to Herbal Medicines. Austin, TX: American Botanical Council; Boston: Integrative Medicine Communication; 1998.
  17. Committee on Herbal Medicinal Products (HMPC). Overview of status of HMPC assessment work – May 2007. London, UK: European Medicines Agency. 2007.
  18. Bradley PR ed. British Herbal Compendium, Vol. 2. Bournemouth, UK: British Herbal Medicine Association; 2006.
  19. European Scientific Cooperative on Phytotherapy. ESCOP Monographs. 2nd ed. New York: Thieme New York; 2003.
  20. World Health Organization. Radix Althaeae. In: WHO Monographs on Selected Medicinal Plants, Vol. 2. Geneva, Switzerland: WHO. 2002;5-11.
  21. Food and Drug Administration. 21 CFR §172.510 Natural flavoring substances and natural substances used in conjunction with flavors. In: Code of Federal Regulations. Washington, DC: National Archives and Records Administration. 2007;54-57.
  22. Sutovska M, Nosalova G, Franova S, Kardosova A. The antitussive activity of polysaccharides from Althaea officinalis L., var. Robusta, Arctium lappa L., var. Herkules, and Prunus persica L., Batsch. Bratisl Lek Listy. 2007;108(2):93-99.
  23. Rouhi H, Ganji F. Effect of Althaea officinalis on cough associated with ACE inhibitors. Pakistan Journal of Nutrition. 2007;6(3):256 258.
  24. Zerehsaz F, Beheshti SH, Rezaian GR, Joubeh S. Erysipeloid cutaneous leishmaniasis: treatment with a new, topical, pure herbal extract. Eur J Dermatol. March-April 2003;13(2):145-148.
  25. Buechi S, Vogelin R, von Eiff MM, Ramos M, Melzer J. Open trial to assess aspect of safety and efficacy of a combined herbal cough syrup with ivy and thyme [abstract]. Forsch Komplementarmed Klass Naturheilkd. December 2005;12(6):312-313.
  26. Brinckmann J, Sigwart H, van Houten Taylor L. Safety and efficacy of a traditional herbal medicine (Throat Coat) in symptomatic temporary relief of pain in patients with acute pharyngitis: a multicenter, prospective, randomized, double-blinded, placebo-controlled study. J Altern Complement Med. Apr 2003;9(2):285-298.
  27. Lange D, Shippmann U. Trade Survey of Medicinal Plants in Germany-a Contribution to International Plant Species Conservation. Bonn: Bundesamt f?r Naturschutz; 1997.
  28. Vascular plants—nationally scarce plants without an IUCN designation. Joint Nature Conservation Committee. Available at: http://www. jncc.gov.uk/page-1793. Accessed March 22, 2005.
  29. Lange D, Mladenova M. Bulgarian model for regulating the trade in plant material for medicinal and other purposes. FAO Corporate Document Repository. Available at: http://www.fao.org/documents/ show_cdr.asp?url_file=/docrep/W7261E/W7261e16.htm. Accessed March 22, 2005.

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