Herbal Monograph
Cramp Bark
Viburnum opulus L.
Adoxaceae (formerly Caprifoliaceae)
Premier antispasmodic bark for menstrual cramps, muscle spasm, and uterine tension with centuries of Eclectic and...
Overview
Plant Description
Viburnum opulus is a vigorous, deciduous shrub growing 2-4 meters (6.5-13 feet) tall, occasionally reaching 5 meters under optimal conditions. It has a spreading, somewhat rounded habit with arching branches. The bark is greyish-brown, smooth on young branches becoming slightly rough and fissured with age; the inner bark is greenish-white when freshly exposed and turns reddish-brown on drying -- it is this stem bark that constitutes the medicinal drug. The leaves are opposite, palmately 3-5 lobed (resembling maple leaves), 5-10 cm across, with coarsely and irregularly toothed margins. Leaves are bright green above, paler and slightly pubescent beneath, turning vivid red, purple, or orange in autumn. The leaf stalks (petioles) bear conspicuous disc-shaped or stipitate glands near the leaf blade. Flowers appear in late spring to early summer (May-June) in flattened, lacecap-like corymbs (cymes) 5-10 cm across. Each flower cluster consists of small, fertile, cream-white bisexual flowers in the center surrounded by a ring of larger, showy, sterile flowers 1.5-2 cm across with 5 unequal petals. The cultivar 'Roseum' (Snowball Tree) produces entirely sterile, globular flower heads. The fruits are translucent, glossy, bright scarlet drupes, 8-10 mm in diameter, borne in pendulous clusters that ripen in autumn and often persist through winter. Each drupe contains a single flat, heart-shaped stone. The berries have a bitter, astringent taste and a somewhat unpleasant odor when crushed; they are mildly toxic when consumed raw in large quantities due to their viburnin content, but become less toxic after freezing or cooking and are used to make preserves in Eastern European and Russian cuisine. The species name 'opulus' is an ancient Latin name for a type of maple, referring to the maple-like leaf shape.
Habitat
Viburnum opulus grows in moist to wet habitats including hedgerows, woodland margins, thickets, scrubland, fens, stream banks, lake margins, and damp meadows. It tolerates a wide range of soil types but thrives in moist, moderately fertile, slightly alkaline to neutral soils. It grows in full sun to partial shade, with best flowering and fruiting occurring in more open positions. The species is characteristic of damp, lowland woodland edges and is a common component of hedgerows in the British Isles and across Europe. It is moderately frost-hardy and tolerates occasional waterlogging.
Distribution
Viburnum opulus has a wide native distribution across Europe, northern Africa, and central-northern Asia. It ranges from the British Isles and Scandinavia south to the Mediterranean region (though less common in the driest areas), east through Turkey, the Caucasus, Central Asia, and Siberia to the Russian Far East. It is particularly abundant and culturally significant in Ukraine, Russia, Belarus, and the Baltic states, where it is known as 'kalina' and holds deep cultural importance in folklore, song, and national symbolism. The species has been widely introduced and naturalized in North America, where it can become invasive in some regions. It is commonly cultivated as an ornamental and hedging plant throughout the temperate world, with numerous named cultivars including the popular 'Roseum' (Snowball Tree).
Parts Used
Stem bark (Viburni opuli cortex)
Preferred: Dried bark for decoction; tincture (1:5, 40% ethanol); fluid extract (1:1)
The dried stem bark is the primary and pharmacopeial medicinal drug, listed in the British Herbal Pharmacopoeia (BHP 1983, 1996) and formerly in the U.S. Pharmacopeia (1894-1916) and National Formulary. The bark contains the key active constituents including the bitter iridoid viopudial, coumarins (scopoletin, esculetin), tannins (catechins, proanthocyanidins), hydroquinones (arbutin), and the bitter glycoside viburnin. Bark is harvested from branches and lateral stems in autumn when constituent concentrations are highest. Both the inner and outer bark are used together. The bark has a distinctive astringent, slightly bitter taste and a faintly unpleasant odor when fresh, which diminishes on drying.
Root bark
Preferred: Decoction or tincture (historical use)
Root bark was occasionally used in Eclectic practice and in some Native American traditions. It contains similar constituents to the stem bark but harvesting root bark is less sustainable and more destructive to the plant. Root bark is not specified in the British Herbal Pharmacopoeia or other modern pharmacopeial references. Modern practice overwhelmingly favors the stem bark, and root bark is included here only for historical and ethnobotanical completeness.
Berries (fruit)
Preferred: Juice; preserves; decoction (Eastern European folk use)
The berries are not the primary medicinal part for antispasmodic use in Western herbalism, but have significant traditional importance in Eastern European and Russian folk medicine (kalina). The fruits are extremely rich in phenolic compounds including chlorogenic acid, proanthocyanidins, and anthocyanins with demonstrated antioxidant, anti-inflammatory, and gastroprotective activity. Research by Zayachkivska et al. (2006) demonstrated significant gastroprotective effects of fruit-derived proanthocyanidins. In Russian and Ukrainian folk medicine, berry preparations (juice, preserves, decoctions) are used for hypertension, colds and flu, cough, cardiovascular support, and gastrointestinal complaints. Raw berries in large quantities are mildly toxic due to viburnin content and can cause nausea and vomiting; toxicity is reduced by freezing or cooking.
Key Constituents
Iridoids
Iridoids, particularly viopudial, are considered primary active constituents responsible for the antispasmodic and hypotensive effects of cramp bark. Viopudial's dual activity -- smooth muscle relaxation and blood pressure reduction -- aligns closely with the traditional clinical indications of the herb. The iridoid content is an important quality marker for cramp bark preparations. These compounds are best extracted by hydroalcoholic solvents.
Coumarins
The coumarin fraction, led by scopoletin and esculetin, is central to the antispasmodic mechanism of cramp bark. These coumarins relax smooth muscle in the uterus, gastrointestinal tract, peripheral vasculature, and bronchi. The coumarin content, particularly scopoletin, distinguishes Viburnum opulus from many other antispasmodic herbs and provides a well-characterized pharmacological basis for its traditional use in dysmenorrhea, uterine spasm, and colic. Importantly, the coumarins present in Viburnum are simple hydroxycoumarins and NOT anticoagulant-type coumarins (dicoumarol, warfarin); they do not carry the bleeding risks associated with anticoagulant coumarins.
Tannins and proanthocyanidins
The tannin and proanthocyanidin fraction contributes the astringent action of cramp bark, which is relevant for its use in menorrhagia (heavy menstrual bleeding), diarrhea, and gastrointestinal complaints. The proanthocyanidins also provide significant antioxidant and gastroprotective effects. The astringent quality complements the antispasmodic activity: while the coumarins and iridoids relax spasm, the tannins help tone and protect mucosal surfaces. The alpha-amylase and alpha-glucosidase inhibitory activities of the tannin fraction are of emerging research interest for metabolic applications.
Hydroquinones
The hydroquinone glycoside content, principally arbutin, may contribute to the mild urinary antiseptic and anti-inflammatory properties noted in some traditional uses of cramp bark. However, the arbutin content in V. opulus is much lower than in dedicated urinary antiseptic herbs such as Arctostaphylos uva-ursi, and the hydroquinones are not considered primary active constituents for the main antispasmodic indication.
Bitter glycosides
Viburnin contributes to the overall therapeutic profile of cramp bark as a bitter constituent that stimulates digestive secretions and may independently contribute to antispasmodic and peripheral vascular effects. Its precise pharmacological contribution is less well-defined than the coumarins and iridoids, but historical and Eclectic sources attribute significant uterine antispasmodic activity to it. The bitter quality also enhances digestive function through the bitter reflex.
Triterpenes and sterols
The triterpene and sterol fraction contributes anti-inflammatory and hepatoprotective effects that complement the primary antispasmodic activity. Oleanolic acid and ursolic acid are well-characterized anti-inflammatory agents that may contribute to the pain-relieving effects observed clinically when cramp bark is used for dysmenorrhea and musculoskeletal cramping. The phytosterols contribute modestly to the overall therapeutic profile.
Phenolic acids
Phenolic acids provide supporting antioxidant and anti-inflammatory activity. Chlorogenic acid's abundance in V. opulus fruits underlies much of the antioxidant and metabolic activity demonstrated in research on the berry preparations. The minor salicin content may contribute a gentle analgesic effect. These compounds are secondary to the coumarins, iridoids, and tannins in terms of the primary antispasmodic indication but contribute to the herb's overall therapeutic breadth.
Flavonoids
Flavonoids contribute to the antioxidant, anti-inflammatory, and to some extent antispasmodic properties of V. opulus. The flavonoid profile is more significant in fruit-based preparations (relevant to Eastern European folk use) than in bark preparations, though bark does contain flavonoids. Quercetin's own smooth muscle relaxant activity may modestly complement the primary coumarin and iridoid antispasmodic mechanisms.
Volatile oils and organic acids
The valerianic acid content, though minor, may contribute to the gentle nervine-relaxant quality observed clinically. The association of mild sedative-anxiolytic effects alongside the primary antispasmodic action gives cramp bark its characteristic therapeutic quality of addressing muscle spasm that is accompanied by or exacerbated by nervous tension.
Herbal Actions
The hallmark and defining pharmacological action of cramp bark. Acts as a potent relaxant of both smooth muscle (uterine, gastrointestinal, vascular, bronchial, urinary) and, to a lesser extent, skeletal muscle. The antispasmodic activity is mediated primarily by scopoletin and other coumarins (calcium-dependent smooth muscle contraction inhibition) and viopudial (direct smooth muscle relaxation and vasodilation). Jarboe et al. (1966) confirmed the uterine relaxant properties of Viburnum species, identifying scopoletin as a major antispasmodic component. Nicholson et al. (1972) isolated viopudial and characterized its hypotensive and smooth muscle antispasmodic activity. The British Herbal Pharmacopoeia lists the primary action as spasmolytic. Cramp bark is considered the most potent uterine antispasmodic among Viburnum species due to its higher scopoletin content. David Hoffmann (2003) describes it as 'a very valuable relaxant for muscular tension and spasm,' noting activity on both visceral smooth muscle and voluntary skeletal muscle.
[1, 2, 3, 7, 8]Specific relaxant and sedative action on the uterine myometrium. Reduces both the force and frequency of uterine contractions. This action is the basis for the primary traditional indication of cramp bark -- dysmenorrhea -- and its historical use for threatened miscarriage in Eclectic medicine. The Eclectics (Felter & Lloyd, King's American Dispensatory) extensively documented the uterine sedative property, noting it was 'most useful in uterine and ovarian pain, in dysmenorrhoea and pains of that class, and is more often depended upon for prevention of abortion whether accidental or habitual.' The mechanism involves scopoletin and viopudial acting on smooth muscle calcium channels and contractile mechanisms. The British Herbal Pharmacopoeia classifies cramp bark's action as 'antispasmodic, sedative (uterine).' NOTE: 'Uterine sedative' is a traditional pharmacological term meaning a substance that calms excessive uterine contractility -- it does not imply general CNS sedation.
[1, 2, 5, 7]Cramp bark has a gentle nervine-relaxant quality that is clinically relevant when muscle spasm is accompanied by or exacerbated by nervous tension and anxiety. This is distinct from its direct smooth muscle relaxant effect and refers to a calming influence on the nervous system that reduces the neuromuscular tension component of spasm. The presence of valerianic acid may contribute to this mild nervine effect. Hoffmann (2003) classifies Viburnum opulus as having secondary nervine-relaxant activity, recommending it for conditions where muscle spasm and nervous tension coexist. In practice, cramp bark is often combined with primary nervine herbs (Valeriana, Passiflora, Scutellaria) when the nervous component is prominent.
[2, 3]Tightens and tones tissue, reduces secretions
The significant catechic tannin and proanthocyanidin content gives cramp bark a meaningful astringent action. This is therapeutically relevant in menorrhagia (excessive menstrual bleeding), where the astringent effect on uterine and vascular tissue complements the antispasmodic action. The astringent quality also supports its traditional use in gastrointestinal complaints with diarrhea. The British Herbal Pharmacopoeia notes the astringent taste and action. In traditional Eclectic practice, the astringent property was valued alongside the antispasmodic action.
[1, 2, 5]Reduces inflammation
Multiple constituent classes contribute anti-inflammatory activity: triterpenes (oleanolic acid, ursolic acid), phenolic acids (chlorogenic acid, gallic acid), flavonoids (quercetin, astragalin), proanthocyanidins, and the coumarins (scopoletin, esculetin) themselves have demonstrated anti-inflammatory properties. The anti-inflammatory action complements the antispasmodic effect in conditions where spasm is accompanied by inflammation, such as in dysmenorrhea (where prostaglandin-mediated inflammation drives both pain and uterine contractions) and inflammatory GI conditions.
[3, 10]Cramp bark has mild blood pressure-lowering activity attributed primarily to viopudial (peripheral vasodilation via vascular smooth muscle relaxation) and secondarily to scopoletin and esculetin (coumarin-mediated vasodilation). Nicholson et al. (1972) demonstrated the hypotensive activity of viopudial in pharmacological studies. The effect is mild at therapeutic doses and manifests primarily as peripheral vasodilation. In traditional use, cramp bark was occasionally employed for mild hypertension, though it is not considered a primary antihypertensive herb. The hypotensive effect is more pronounced in V. prunifolium (Black Haw). Patients on antihypertensive medications should be aware of potential additive effects.
[2, 5, 8]Stimulates digestive secretions via bitter taste receptors
The viburnin glycoside and iridoid compounds (including viopudial) contribute a discernible bitter taste to cramp bark preparations, particularly decoctions and tinctures. This bitterness, though less intense than dedicated bitter herbs (Gentiana, Artemisia), stimulates digestive secretions through the bitter reflex pathway and may contribute to gastrointestinal tonic effects. King's American Dispensatory noted the 'peculiar bitter, neutral principle (viburnin)' identified by H. Kramer.
[2, 5]Therapeutic Indications
Reproductive System
Dysmenorrhea (menstrual cramps)
The primary and best-documented indication for cramp bark. Both spasmodic (primary) and congestive dysmenorrhea respond to cramp bark, though it is most specifically indicated for spasmodic dysmenorrhea characterized by sharp, cramping pains in the lower abdomen and pelvis. The British Herbal Pharmacopoeia (1983, 1996) lists dysmenorrhea as a specific indication. David Hoffmann (2003) identifies it as a primary herb for menstrual cramping. The Eclectics (Felter & Lloyd, 1898) considered it 'most useful in uterine and ovarian pain, in dysmenorrhoea and pains of that class.' Pharmacological basis is the smooth muscle relaxant activity of scopoletin, viopudial, and esculetin on the uterine myometrium. Cramp bark is often combined with Viburnum prunifolium (Black Haw) for enhanced efficacy, and with Zingiber officinale (Ginger) to address the congestive component. Typically taken for 2-3 days before expected menses and continued through the painful days.
[1, 2, 3, 5, 7]Threatened miscarriage (anti-abortive use)
One of the most extensively documented historical uses in Eclectic medicine. King's American Dispensatory (Felter & Lloyd, 1898) states cramp bark 'is more often depended upon for prevention of abortion whether accidental or habitual.' Eclectic physicians used it when uterine cramping occurred during pregnancy without cervical dilation, to calm excessive uterine contractility and reduce the risk of spontaneous abortion. Typically combined with V. prunifolium for this indication. Native American tribes also employed Viburnum species as anti-abortive remedies. IMPORTANT MODERN CAVEAT: While traditionally used during pregnancy for threatened miscarriage, modern clinical safety data in pregnancy is insufficient. No controlled clinical trials have evaluated this use. Modern practitioners who employ this herb in pregnancy do so under direct clinical supervision and with informed consent. This indication should not be self-treated. The British Herbal Pharmacopoeia recognizes the traditional use but modern regulatory guidance urges caution.
[1, 2, 4, 5]Ovarian pain and ovarian cysts (functional)
Traditional indication from both Eclectic and British herbal traditions. Cramp bark is used for ovarian pain (Mittelschmerz, ovulatory pain) and the pain associated with functional ovarian cysts. The smooth muscle relaxant effect on pelvic structures and the gentle nervine quality address both the physical spasm and the nervous tension that often accompanies pelvic pain. Hoffmann (2003) lists ovarian pain as an indication. Mills and Bone (2013) note its use for pelvic congestion and pain.
[2, 3, 5]Endometriosis-related pain
Used by Western herbalists as part of broader treatment protocols for the chronic pelvic pain and uterine spasm associated with endometriosis. The antispasmodic and anti-inflammatory actions address the cramping and inflammatory components. Typically used as one herb in a multi-herb formula alongside anti-inflammatory, hormonal-modulating, and analgesic herbs. No clinical trials specific to endometriosis, but the pharmacological rationale (smooth muscle relaxation, anti-inflammation) is sound.
[2, 3]Menorrhagia (heavy menstrual bleeding)
The combination of antispasmodic and astringent actions makes cramp bark useful for menorrhagia, particularly when heavy bleeding is accompanied by significant cramping. The tannin-mediated astringent effect helps reduce excessive bleeding while the antispasmodic action relieves the painful spasm. King's American Dispensatory notes its use for uterine hemorrhage. Often combined with other uterine astringent and hemostatic herbs.
[2, 5]After-pains (postpartum uterine cramping)
Traditional use for the cramping uterine pains that occur postpartum as the uterus involutes. The antispasmodic action provides symptomatic relief. Documented in Eclectic and British herbal sources. Caution with lactation: while likely safe, insufficient formal safety data exists for the lactation period.
[1, 5]Musculoskeletal System
Muscle cramps and spasm (skeletal muscle)
Although cramp bark is most famous for smooth muscle (visceral) antispasmodic activity, it also has a clinically observed effect on skeletal muscle cramps and tension. Hoffmann (2003) describes it as 'a very valuable relaxant for muscular tension and spasm.' Used for nocturnal leg cramps, exercise-induced cramps, and generalized muscle tension. The mechanism for skeletal muscle effects is less well-characterized than for smooth muscle but may involve the nervine-relaxant action reducing neural excitability at the neuromuscular junction, combined with peripheral vasodilation improving blood flow to cramping muscles. The common name 'cramp bark' itself reflects this long-recognized application beyond just menstrual cramps.
[1, 2, 5]Low back pain (muscular)
Traditional use for muscular low back pain, particularly when accompanied by spasm. Eclectic physicians noted that V. opulus was indicated for pain radiating into the thighs, while V. prunifolium was more specific for severe low back pain with a bearing-down sensation. In practice, the two species are often combined for back pain with spasm. The Meskwaki (Mesquakie) people of Wisconsin used cramp bark for back pain alongside menstrual cramps. Modern Western herbalists include cramp bark in formulas for acute low back spasm.
[2, 5]Neck and shoulder tension
Clinically used by Western herbalists for chronic neck and shoulder tension, particularly stress-related muscular tension. The combined antispasmodic and nervine-relaxant actions address both the physical spasm and the underlying nervous tension. Typically used in combination with primary nervine herbs (Scutellaria, Passiflora) and circulatory stimulants.
[2]gastrointestinal
Intestinal colic and abdominal cramping
The smooth muscle relaxant action extends to the gastrointestinal tract, making cramp bark useful for intestinal colic, abdominal cramping, and spasmodic abdominal pain. The British Herbal Pharmacopoeia lists 'intestinal colic' as an indication. Eclectic sources noted the use for 'cramping, colicky pains.' The combined antispasmodic, astringent, and mild bitter actions provide multi-faceted support for GI complaints involving spasm. The proanthocyanidin-mediated gastroprotective effect (Zayachkivska et al. 2006) provides additional support for GI use.
[1, 2, 5, 9]Irritable bowel syndrome (IBS) with cramping
Used by modern Western herbalists for the spasmodic subtype of IBS, where abdominal cramping and altered bowel motility are prominent features. The smooth muscle relaxant effect on intestinal muscle is pharmacologically comparable (though milder) to pharmaceutical antispasmodics used for IBS (e.g., hyoscine, mebeverine). No clinical trials for this specific indication, but the pharmacological rationale is well-supported. Typically used as one component in an IBS-supportive formula alongside carminatives, nervines, and mucilage herbs.
[2, 3]Infantile colic
Historical Eclectic indication. King's American Dispensatory mentions the use for colic in infants. The gentle antispasmodic action is appropriate for pediatric use at reduced doses. Modern pediatric use requires practitioner supervision and appropriate dose reduction. Typically given as a very dilute decoction or glycerite rather than alcohol-based tincture for infants.
[5]Urinary System
Bladder spasm and urinary urgency
The smooth muscle relaxant action extends to the bladder detrusor muscle, making cramp bark useful for bladder spasm, urinary urgency, and the spasmodic component of overactive bladder. King's American Dispensatory specifically lists 'spasm of the bladder' among the indications. The arbutin content may provide an additional mild urinary antiseptic effect. Used clinically for bladder spasm accompanying urinary tract infections (as supportive therapy alongside antimicrobial treatment), for functional bladder spasm, and in some cases for the urinary urgency and spasm of interstitial cystitis.
[2, 5]Enuresis (bedwetting) in children
Historical Eclectic indication. King's American Dispensatory lists 'infantile enuresis' as an indication for V. opulus. The rationale is reduction of nocturnal bladder spasm that triggers involuntary urination. This is a minor, historical indication and not a primary modern use. Pediatric use requires practitioner supervision.
[5]Cardiovascular System
Mild hypertension support (adjunctive)
Viopudial has demonstrated hypotensive activity through peripheral vasodilation (vascular smooth muscle relaxation). The Eclectics noted blood pressure-lowering effects. Cramp bark is not used as a primary antihypertensive herb but may offer supportive benefit as part of a broader cardiovascular herbal protocol. The hypotensive effect is mild and should be considered in patients already on antihypertensive medications due to potential additive effects. V. prunifolium is considered more hypotensive than V. opulus.
[2, 5, 8]Palpitations with anxiety (nervous heart)
Traditional Eclectic indication for palpitations associated with nervous tension and anxiety rather than structural heart disease. King's American Dispensatory includes 'palpitations' among the indications. The combined nervine-relaxant, antispasmodic, and mild hypotensive actions address the functional palpitations and sense of cardiac constriction that accompany anxiety states. Not indicated for organic cardiac arrhythmias.
[5]Respiratory System
Asthma and bronchospasm (adjunctive)
The smooth muscle relaxant activity extends to bronchial smooth muscle, providing a pharmacological basis for the traditional use as a mild bronchospasmolytic. Listed as an indication in some herbal references. Used as an adjunctive herb in formulas for asthma, particularly when spasm is a prominent feature. The effect is mild compared to dedicated bronchospasmolytic herbs (Lobelia, Ephedra) and cramp bark is best used as a supporting rather than primary herb for respiratory indications.
[1, 2]Energetics
Temperature
cool
Moisture
slightly dry
Taste
Tissue States
wind/tension, heat/excitation
In Western herbal energetics, cramp bark is classified as cool to neutral in temperature and slightly drying in moisture due to its significant tannin content. The primary tastes are astringent (from condensed tannins and proanthocyanidins) and bitter (from viburnin and iridoids). The cooling, relaxing quality makes it most specifically indicated for conditions of excess tension, spasm, and constriction -- the 'wind/tension' tissue state in the Physiomedicalist framework. The astringent quality also addresses excessive fluid loss or tissue laxity (e.g., menorrhagia). Cramp bark is particularly well-suited for individuals presenting with a tense, constricted constitution manifesting as muscle spasm, cramping pains, and nervous tension. The herb's action is primarily one of relaxation and release of tension rather than tonification or stimulation. In the Eclectic tradition, cramp bark was considered specific for 'cramping, colicky pains, with tendency to spasms, especially of the pelvic organs.' The energetic profile distinguishes it from warming antispasmodics (like Zingiber or Cinnamomum) and positions it as the remedy of choice when spasm occurs in a context of excess heat, tension, or irritability. CAVEAT: Herbal energetics are interpretive frameworks within Western herbalism and are not standardized across all practitioners.
Traditional Uses
Eclectic medicine (American, 19th-early 20th century)
- Prevention of miscarriage (habitual and accidental) -- considered one of the most reliable anti-abortive remedies
- Dysmenorrhea and uterine pain, especially with pain radiating into the thighs
- Ovarian pain and afterpains (postpartum uterine cramping)
- Spasm of the bladder and infantile enuresis (bedwetting)
- Cramping, colicky pains of the abdomen and pelvis
- Palpitations and angina associated with nervous tension
- Leg cramps and general muscular spasm
- Hysterical convulsions and lockjaw (historical use -- extreme spasmodic conditions)
"King's American Dispensatory (Felter & Lloyd, 1898) states: 'High Cranberry bark is a powerful antispasmodic, and, in consequence of this property, it is more generally known among American practitioners by the name of Cramp bark. It is most useful in uterine and ovarian pain, in dysmenorrhoea and pains of that class, and is more often depended upon for prevention of abortion whether accidental or habitual.' Felter further notes: 'The dose of the decoction or vinous tincture of cramp bark is 2 fluid ounces, 2 or 3 times a day.' The bark was made official in the U.S. Pharmacopeia in 1894 and included in the National Formulary in 1916, reflecting its widespread acceptance among Eclectic and regular physicians alike. The Eclectics considered cramp bark specific for 'all conditions where cramping and spasmodic contraction of muscular tissue is a prominent factor.'"
Native American medicine
- Menstrual cramps and body pains (Meskwaki/Mesquakie tribe of Wisconsin)
- Anti-abortive remedy and support during pregnancy complications (multiple tribes)
- Remedy for uterine prolapse
- General analgesic for aches, pains, and arthritic complaints
- Bark decoction for cramping conditions
"Multiple Native American tribes utilized Viburnum species medicinally. The Meskwaki (Mesquakie) people of Wisconsin used Viburnum opulus primarily for body pains and menstrual cramps. Other tribes employed Viburnum species as anti-abortive remedies and for uterine prolapse. The widespread Indigenous use of Viburnum bark for cramping and gynecological complaints predates and likely influenced the Eclectic medical adoption of cramp bark. Note: much of the ethnobotanical record conflates V. opulus with V. trilobum (the native American species) and V. prunifolium, as all three were used similarly."
British and European herbal medicine
- Dysmenorrhea (menstrual cramps) -- primary indication in the British Herbal Pharmacopoeia
- Threatened miscarriage and false labor pains
- Intestinal colic and abdominal cramping
- Muscular cramps and spasm
- Prevention of miscarriage (United Kingdom herbal practice)
"Cramp bark is included in the British Herbal Pharmacopoeia (1983, 1996) with actions listed as 'spasmolytic, sedative (uterine)' and specific indications for 'muscular cramp and ovarian and uterine pain.' The BHP dosage is listed as 4-8 mL of liquid extract (1:1) or 2-4 g of dried bark three times daily. Gerard (1597) described the Guelder Rose in his Herball. Mrs. Grieve's A Modern Herbal (1931) noted: 'The bark is employed in herbal medicine. It was formerly used as a specific for cramps and spasms of all kinds, in asthma and in hysteria, and played an important role as an antispasmodic.' European herbalists have maintained continuous use from at least the 16th century."
Russian and Ukrainian folk medicine (Kalina)
- Berry preparations for hypertension and cardiovascular support
- Decoctions of berries for colds, flu, and cough
- Berry infusions for atherosclerosis and vasospasm
- Bark decoctions as a hemostatic (to stop bleeding) and astringent
- Treatment of neurosis and nervous conditions
- Support for liver and gastrointestinal diseases
- Berry preparations as a restorative and choleretic (bile-stimulating) tonic
"In Russia and Ukraine, Viburnum opulus is known as 'kalina' (kalyna) and holds deep cultural significance, appearing in folk songs, embroidery, national symbolism, and traditional medicine. The Ukrainian national plant. Unlike Western herbal practice, which focuses on the bark, Eastern European folk medicine extensively uses the berries. The fruits are considered to have restorative, antiseptic, astringent, hemostatic, and choleretic properties, and to lower blood pressure, stimulate the heart, and strengthen blood vessels. Berry preparations -- juices, preserves, decoctions, and infusions -- are used for hypertension, colds and flu, cardiovascular support, liver conditions, and general debility. The bark is also used traditionally as a hemostatic and antispasmodic. V. opulus berries are a traditional food in these regions, made into preserves, syrups, and beverages despite their bitter taste."
[10]
Homeopathic medicine
- Viburnum opulus is used in homeopathic preparations for uterine cramping and dysmenorrhea
- Threatened miscarriage with cramping pains
- Bearing-down pains in the pelvis
- Cramping of the lower extremities
"Viburnum opulus has a homeopathic monograph and is prepared as a homeopathic mother tincture and serial dilutions (potencies). Constantine Hering's Guiding Symptoms describes its symptom picture centered on uterine and pelvic cramping, bearing-down sensations, and spasmodic pains. It is available as a homeopathic DailyMed-listed preparation in the United States. The homeopathic use, while based on different therapeutic principles than herbal medicine, reflects the same historical recognition of Viburnum opulus's affinity for uterine and muscular spasm."
[13]
Modern Research
Uterine relaxant properties of Viburnum (foundational pharmacological study)
Foundational pharmacological study investigating the uterine relaxant properties of Viburnum opulus and Viburnum prunifolium. Published in Nature (1966), this work provided the first modern scientific confirmation of the traditional use of Viburnum species as uterine antispasmodics.
Findings: Both V. opulus and V. prunifolium extracts demonstrated significant relaxant activity on isolated uterine tissue preparations. The researchers identified scopoletin (a coumarin) as a major antispasmodic component responsible for the observed uterine relaxation. The extracts reduced both the amplitude and frequency of uterine contractions in a dose-dependent manner. This study provided the first identification of a specific active antispasmodic compound in Viburnum species, validating centuries of traditional use.
Limitations: In vitro study using isolated tissue preparations; results do not directly translate to in vivo clinical efficacy. The study identified scopoletin but did not characterize all active constituents. Limited to uterine tissue; other smooth muscle types not tested in this study.
[7]
Viopudial: a hypotensive and smooth muscle antispasmodic from Viburnum opulus
Isolation and pharmacological characterization of viopudial, a novel iridoid dialdehyde compound from Viburnum opulus bark, demonstrating hypotensive and smooth muscle antispasmodic activity.
Findings: Nicholson, Darby, and Jarboe isolated a new compound from V. opulus bark, which they named viopudial (from Viburnum opulus + dialdehyde). Viopudial demonstrated significant hypotensive activity in animal models and potent smooth muscle antispasmodic activity in isolated tissue preparations. The compound relaxed both vascular and visceral smooth muscle. This discovery revealed that V. opulus contains a unique active compound (not present in V. prunifolium) that may account for the traditionally observed differences in potency and clinical application between the two species. The hypotensive mechanism involved peripheral vasodilation through direct vascular smooth muscle relaxation.
Limitations: Animal model and isolated tissue study. The relative contribution of viopudial versus scopoletin to the overall clinical effect was not fully quantified. Pharmacokinetic data (absorption, metabolism, bioavailability) in humans not determined. Published in 1972; no subsequent comprehensive studies have been performed to update these findings.
[8]
Scopoletin as antispasmodic component of Viburnum opulus and prunifolium
Chemical identification and pharmacological characterization of scopoletin (6-methoxy-7-hydroxycoumarin) as a key antispasmodic constituent present in both V. opulus and V. prunifolium.
Findings: Scopoletin was isolated from both Viburnum species and demonstrated dose-dependent smooth muscle relaxant activity. V. opulus was found to contain higher concentrations of scopoletin than V. prunifolium, which was proposed as an explanation for V. opulus being considered the more potent uterine antispasmodic. The coumarin structure of scopoletin was confirmed, and its mechanism of action was attributed to interference with calcium-dependent smooth muscle contraction. This study established scopoletin as a chemically defined pharmacological marker for the antispasmodic quality of Viburnum preparations.
Limitations: In vitro pharmacological study. Quantitative comparison of scopoletin content between species based on limited sample numbers. The clinical significance of the concentration difference between V. opulus and V. prunifolium was inferred rather than clinically demonstrated.
[7]
Comprehensive review of Viburnum opulus phytochemistry and biological effects
Extensive review published in Nutrients (2020) covering the complete phytochemistry, biological activities, and health-promoting properties of V. opulus, including phenolic compounds, antioxidant activity, anti-inflammatory effects, and metabolic activities.
Findings: Documented the extensive phenolic compound profile of V. opulus, including chlorogenic acid (dominant in fruits), proanthocyanidins, catechins, quercetin glycosides, anthocyanins, and gallic acid. Reviewed evidence for antioxidant, anti-inflammatory, gastroprotective, hepatoprotective, cardioprotective, antimicrobial, and anti-diabetic activities. Confirmed that V. opulus is one of the richest botanical sources of chlorogenic acid. Identified proanthocyanidins from bark as potent alpha-amylase inhibitors. Reviewed the traditional use spectrum across European and Eastern European traditions. Noted the relative lack of clinical trials despite strong pharmacological and ethnobotanical evidence.
Limitations: Narrative review, not a systematic review with formal quality assessment. Much of the evidence reviewed is from in vitro and animal studies. Clinical evidence is limited to ethnobotanical reports and traditional use documentation.
[10]
Gastroprotective effects of Viburnum opulus proanthocyanidins
Investigation of the gastroprotective effects of proanthocyanidins isolated from Viburnum opulus fruits against stress-induced gastrointestinal mucosal damage in rats.
Findings: Viburnum opulus proanthocyanidins (VOPA) administered orally at doses of 25, 50, and 75 mg/kg body weight significantly protected gastroduodenal mucosa against water immersion and restraint stress-induced damage in male Wistar rats. The protective mechanism involved: (1) increased endogenous nitric oxide generation in gastric mucosa; (2) enhanced antioxidant enzyme activity -- superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) levels were significantly increased; (3) suppression of lipid peroxidation (reduced malondialdehyde levels); (4) changes in glycoconjugate content of the gastroduodenal mucosa. The effects were dose-dependent. These findings provide a pharmacological basis for the traditional use of V. opulus for gastrointestinal complaints.
Limitations: Animal study (rats); results may not directly translate to human clinical outcomes. Used fruit-derived proanthocyanidins rather than whole bark preparations. Single stress model tested. Short-term observation period. No human clinical data for gastroprotective effects.
[9]
Alpha-amylase and alpha-glucosidase inhibitory activity of Viburnum opulus extracts
Investigation of the inhibitory effects of V. opulus bark and flower extracts on carbohydrate-digesting enzymes, relevant to blood sugar management.
Findings: V. opulus bark extracts demonstrated significant inhibitory activity against alpha-amylase and alpha-glucosidase enzymes, with procyanidins identified as the primary compounds responsible for alpha-amylase inhibition and catechin identified as the primary alpha-glucosidase inhibitor. The bark extract showed stronger enzyme inhibitory activity than flower extracts. These findings suggest potential application in blood sugar regulation and type 2 diabetes prevention, though clinical studies are needed.
Limitations: In vitro enzyme assay study. Activity of purified compounds does not necessarily reflect the bioavailable effect of whole bark preparations after oral consumption. No in vivo or clinical follow-up data. Relevance to therapeutic dosing in humans not established.
[10]
Cytoprotective effects of Viburnum opulus fruit phenolics on intestinal cells
Investigation of V. opulus fruit phenolic compounds for their ability to protect intestinal epithelial cells (Caco-2) from oxidative damage and modulate glucose and fatty acid uptake.
Findings: V. opulus fruit phenolic compounds demonstrated significant cytoprotective activity on Caco-2 intestinal cells, reducing oxidative stress markers and decreasing both free fatty acid and glucose uptake. The most active phenolic fractions included those rich in chlorogenic acid and proanthocyanidins. These findings suggest potential metabolic benefits relevant to obesity and type 2 diabetes prevention.
Limitations: In vitro cell culture study. Caco-2 cells are an intestinal model but may not fully reflect in vivo intestinal physiology. Concentrations used may not be achievable through dietary or supplemental intake. No in vivo or clinical confirmation.
[10]
State of clinical evidence and research gaps
Assessment of the overall evidence base for Viburnum opulus as a medicinal herb, noting the significant gap between robust traditional evidence and limited modern clinical research.
Findings: Despite centuries of well-documented traditional use across multiple medical traditions (Eclectic, Native American, British herbal, Eastern European folk medicine) and a well-characterized phytochemical and pharmacological profile, Viburnum opulus has remarkably few modern clinical trials. The primary evidence base consists of: (1) extensive ethnobotanical and traditional documentation; (2) pharmacopeial recognition (BHP, USP historical, National Formulary); (3) in vitro and animal pharmacological studies confirming smooth muscle relaxant, hypotensive, and gastroprotective activities; (4) chemical identification of active constituents (scopoletin, viopudial, esculetin). No large-scale randomized controlled trials have been conducted for any indication. This represents a significant research gap for an herb with such strong traditional credibility and identified pharmacological mechanisms.
Limitations: The absence of clinical trials reflects under-investment in herbal medicine research rather than negative evidence. The herb's long safety record and well-characterized pharmacology support its continued traditional use while clinical studies are lacking.
Preparations & Dosage
Decoction
Strength: 2-4 g dried bark per 250 mL water; standard decoction ratio approximately 1:60 to 1:120
Place 2-4 grams of dried, coarsely chopped or powdered cramp bark in 250-300 mL of cold water. Bring to a boil, then reduce to a gentle simmer for 10-15 minutes. Strain while hot. The resulting liquid will be reddish-brown to dark amber with a distinctly astringent, slightly bitter taste. A longer decoction (up to 20 minutes) may be used for a stronger preparation. Decoction is the traditional and preferred method of preparation from the crude bark because the hard, woody bark requires prolonged heat to efficiently extract the active coumarins, tannins, and iridoids.
2-4 g dried bark, decocted, three times daily. British Herbal Pharmacopoeia specifies 2 g three times daily.
Three times daily, or as frequently as every 2-3 hours during acute cramping episodes (short-term)
For acute conditions (dysmenorrhea): use for 2-3 days before expected menses through the painful period. For chronic conditions: may be used for several weeks under practitioner guidance. Reassess periodically.
Half adult dose for children over 6 years under practitioner supervision. Very dilute preparations for younger children only under direct clinical guidance.
Decoction is the primary traditional preparation method endorsed by both the British Herbal Pharmacopoeia and Eclectic sources. King's American Dispensatory specified 'the dose of the decoction or vinous tincture of cramp bark is 2 fluid ounces, 2 or 3 times a day.' The astringent taste is characteristic and indicates tannin extraction. Adding honey or combining with more palatable herbs (Matricaria, Mentha, Zingiber) can improve palatability. The decoction efficiently extracts the water-soluble tannins and phenolic acids; for maximal extraction of all active principles including lipophilic coumarins, a hydroalcoholic preparation (tincture) is preferred.
Tincture
Strength: 1:5 in 40% ethanol (dried bark). Some manufacturers use 1:3 for a stronger tincture.
Use dried, finely chopped or coarsely powdered cramp bark. Standard maceration: 1:5 ratio in 40% ethanol (vodka strength). Place the bark in a glass jar, add the menstruum (40% ethanol) at the 1:5 ratio (e.g., 100 g dried bark to 500 mL of 40% ethanol). Seal tightly and macerate for 2-4 weeks with daily agitation (shaking). Press and filter through muslin or fine filter. The tincture will be reddish-brown to dark brown with a bitter-astringent taste.
5-10 mL (1-2 teaspoons) three times daily. British Herbal Pharmacopoeia specifies 5-10 mL of 1:5 tincture. During acute cramping: 5 mL every 2-3 hours as needed.
Three times daily for chronic use; every 2-3 hours during acute episodes
For acute dysmenorrhea: use for 2-5 days around menses. For chronic conditions: may be taken daily for weeks to months under practitioner supervision.
2-5 mL three times daily for children over 12, under practitioner guidance. Not recommended for young children due to alcohol content.
The tincture is the most commonly used preparation in modern Western herbal practice. The 40% ethanol efficiently extracts both the water-soluble tannins/proanthocyanidins and the more lipophilic coumarins (scopoletin, esculetin) and iridoids (viopudial), providing a more complete chemical extraction than decoction alone. The BHP tincture dose (5-10 mL) is relatively generous compared to many herbal tinctures, reflecting the need for adequate dosing of this herb. Tincture can be taken in a small amount of warm water to improve absorption and palatability. The relatively large dose volume can be reduced by using a 1:3 ratio tincture at proportionally lower volume.
fluid-extract
Strength: 1:1 in 40-45% ethanol (per BHP specification)
A concentrated liquid preparation at 1:1 ratio (1 mL of extract equivalent to 1 g of dried bark). Professionally prepared using percolation or maceration-press methods with hydroalcoholic menstruum. Fluid extracts are more concentrated than tinctures and allow smaller dose volumes.
4-8 mL three times daily. British Herbal Pharmacopoeia specifies 4-8 mL of fluid extract (1:1).
Three times daily; more frequently during acute episodes
As per tincture guidelines
Not typically used in pediatric practice due to alcohol content and concentration
The fluid extract is the strongest liquid preparation and the form specified in the British Herbal Pharmacopoeia. It provides the most concentrated extraction of all active constituents. The BHP dose of 4-8 mL is equivalent to 4-8 g of dried bark per dose, making this a substantial therapeutic dose. Fluid extracts are professional pharmacy preparations and less commonly prepared by home herbalists. They offer convenience of smaller dose volume compared to the standard 1:5 tincture.
Capsule / Powder
Strength: Crude powder: 500 mg per capsule. Concentrated extracts vary by manufacturer.
Dried cramp bark, finely powdered (ground to pass through a 60-80 mesh sieve), filled into vegetarian or gelatin capsules. Alternatively, concentrated bark extract powder can be encapsulated for higher potency per capsule.
Crude powder: 2-4 g (4-8 capsules of 500 mg) three times daily. Extract powder: according to manufacturer's concentration ratio and practitioner recommendation.
Three times daily
May be used as an alternative to liquid preparations for patients who dislike the bitter-astringent taste
Not well-established. Adolescents: half adult dose under practitioner guidance.
Capsules of powdered bark are available commercially and offer a convenient, taste-free administration method. However, the relatively high dose requirement (2-4 g per dose) means a significant number of capsules per dose. Liquid preparations (tincture, fluid extract) are generally preferred by herbal practitioners for cramp bark because they allow more flexible and rapid dosing during acute cramping episodes, and the bitter-astringent taste itself has therapeutic value (stimulating digestive and reflex pathways). Capsules may be more practical for chronic, preventive use rather than acute episodes.
[2]
combined-formula
Strength: Variable by formula. Classic equal-parts combination with V. prunifolium is common.
Cramp bark is frequently combined with related herbs for enhanced therapeutic effect. Classic combinations include: (1) Cramp Bark + Black Haw (V. prunifolium) -- equal parts tincture combined for synergistic uterine antispasmodic effect, considered the gold standard combination for dysmenorrhea and threatened miscarriage in the Eclectic tradition. (2) Cramp Bark + Ginger (Zingiber officinale) -- cramp bark addresses the spasm while ginger provides warming circulatory stimulation and anti-inflammatory (anti-prostaglandin) support; particularly effective for congestive dysmenorrhea. (3) Cramp Bark + Valerian (Valeriana officinalis) + Skullcap (Scutellaria lateriflora) -- combines the muscular antispasmodic action with strong nervine relaxation for conditions where muscle spasm and anxiety/nervous tension coexist. (4) Eclectic compound tincture of Viburnum: King's American Dispensatory includes a formula for Tinctura Viburni Composita.
Combined formula dosing varies by specific combination and proportions. General guideline: maintain the equivalent of 5-10 mL cramp bark tincture (1:5) within the combined formula, three times daily.
Three times daily; more frequently during acute episodes
Varies by condition and practitioner protocol
Under practitioner supervision only
The combination of V. opulus with V. prunifolium is one of the most time-honored synergistic pairings in Western herbal medicine. The Eclectics routinely combined the two species, noting that they complemented each other: V. opulus for pain radiating into the thighs and general cramping, V. prunifolium for severe low back pain with bearing-down sensation. For dysmenorrhea, the combination is considered more effective than either herb alone. Addition of warming circulatory herbs (Zingiber, Cinnamomum) is particularly useful when cramping is accompanied by cold, pallor, and poor peripheral circulation. Addition of nervine herbs addresses the nervous tension that often accompanies and exacerbates muscle spasm.
Safety & Interactions
Class 1
Can be safely consumed when used appropriately (AHPA Botanical Safety Handbook)
Contraindications
Individuals with confirmed allergy to Viburnum opulus or other Viburnum species should not use cramp bark preparations. Allergic reactions are very rare but should be considered.
Large quantities of raw Viburnum opulus berries contain oxalates that could theoretically exacerbate kidney stone formation in susceptible individuals. This concern is specific to raw berry consumption (not to stem bark preparations) and to large quantities. Normal medicinal use of the bark does not pose this risk.
Drug Interactions
| Drug / Class | Severity | Mechanism |
|---|---|---|
| Anticoagulant and antiplatelet medications (warfarin, heparin, aspirin, clopidogrel) (Anticoagulants and antiplatelets) | theoretical | Cramp bark contains simple hydroxycoumarins (scopoletin, esculetin) which are structurally distinct from anticoagulant coumarins (dicoumarol, warfarin) and do NOT have direct anticoagulant activity. The minor salicin content could theoretically contribute a very mild antiplatelet effect. Some references urge caution due to the coumarin content, though this appears to be based on chemical class concern rather than demonstrated clinical interaction. |
| Antihypertensive medications (Antihypertensives) | minor | Additive blood pressure-lowering effect. Viopudial has demonstrated hypotensive activity through peripheral vasodilation. Combined use with pharmaceutical antihypertensives could theoretically result in enhanced hypotensive effects. |
| Sedative and CNS depressant medications (benzodiazepines, barbiturates) (CNS depressants) | theoretical | Cramp bark has mild nervine-relaxant properties. Some references list a theoretical additive sedative interaction with CNS depressant medications. The clinical significance of this interaction is very low given the mild nature of cramp bark's sedative effect. |
| Lithium (Mood stabilizers) | theoretical | Some sources mention potential interaction based on the herb's mild diuretic properties (from arbutin), which could theoretically affect lithium clearance. The arbutin content in cramp bark is low and this interaction has no clinical documentation. |
Pregnancy & Lactation
Pregnancy
insufficient data
Lactation
insufficient data
PREGNANCY: Cramp bark occupies a unique position in herbal safety discussions because it has been traditionally used DURING pregnancy (specifically for threatened miscarriage and excessive uterine contractility) by Eclectic physicians, British herbalists, and Native American practitioners. King's American Dispensatory describes it as a primary remedy for 'prevention of abortion whether accidental or habitual.' However, no controlled clinical studies have evaluated the safety or efficacy of cramp bark during pregnancy. The pharmacological evidence of uterine smooth muscle relaxation (Jarboe et al. 1966) supports the traditional rationale. Modern professional opinion is divided: some experienced herbal practitioners and midwives continue to use cramp bark in pregnancy under careful supervision for threatened miscarriage with good clinical outcomes reported anecdotally, while regulatory and conservative medical guidance urges avoidance due to insufficient safety data. The AHPA Botanical Safety Handbook classifies it with the note to consult a qualified practitioner during pregnancy. Given the lack of formal safety data, self-medication during pregnancy is strongly discouraged; use should be under the guidance of a qualified herbal practitioner or midwife who can assess the individual clinical situation. LACTATION: No specific safety data. The herb has been traditionally used in the postpartum period (for after-pains) without noted adverse effects on breastfeeding, but formal lactation safety studies are lacking. Use during lactation should also be under practitioner guidance.
Adverse Effects
References
Monograph Sources
- [1] British Herbal Medicine Association. British Herbal Pharmacopoeia (BHP). British Herbal Medicine Association, Bournemouth (1983)
- [2] Hoffmann D. Medical Herbalism: The Science and Practice of Herbal Medicine. Healing Arts Press, Rochester, Vermont (2003)
- [3] Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone/Elsevier, Edinburgh, 2nd edition (2013)
- [4] Gardner Z, McGuffin M (eds). American Herbal Products Association's Botanical Safety Handbook. CRC Press, Boca Raton, 2nd edition (2013)
- [5] Felter HW, Lloyd JU. King's American Dispensatory. Ohio Valley Company, Cincinnati, 18th edition (1898)
- [6] Grieve M. A Modern Herbal. Jonathan Cape, London (reprinted Dover Publications) (1931)
Clinical Studies
- [7] Jarboe CH, Schmidt CM, Nicholson JA, Zirvi KA. Uterine relaxant properties of Viburnum. Nature (1966) ; 212 : 837 . DOI: 10.1038/212837a0 . PMID: 5988219
- [8] Nicholson JA, Darby TD, Jarboe CH. Viopudial, a hypotensive and smooth muscle antispasmodic from Viburnum opulus. Proc Soc Exp Biol Med (1972) ; 140 : 457-461 . DOI: 10.3181/00379727-140-36478 . PMID: 5037580
- [9] Zayachkivska OS, Gzhegotsky MR, Terletska OI, Lutsyk DA, Yaschenko AM, Dzhura OR. Influence of Viburnum opulus proanthocyanidins on stress-induced gastrointestinal mucosal damage. J Physiol Pharmacol (2006) ; 57 : 155-167 . PMID: 17218766
- [10] Krauze-Baranowska M, Glod D, Kula M, Majdan M, Halasa R, Matkowski A, Kozlowska W, Kawiak A. Viburnum opulus L. -- A Review of Phytochemistry and Biological Effects. Nutrients (2020) ; 12 : 3398 . DOI: 10.3390/nu12113398 . PMID: 33167421
Traditional Texts
- [11] United States Pharmacopeial Convention. The Pharmacopeia of the United States of America (USP), 7th revision -- Viburnum Opulus. United States Pharmacopeial Convention, Philadelphia (1894)
- [12] Moerman DE. Native American Ethnobotany. Timber Press, Portland, Oregon (1998)
- [13] Hering C. The Guiding Symptoms of Our Materia Medica -- Viburnum Opulus. Estate of Constantine Hering, Philadelphia (1891)
Pharmacopeias & Reviews
- [14] British Herbal Medicine Association. British Herbal Pharmacopoeia (BHP), 4th edition -- Viburnum opulus. British Herbal Medicine Association, Exeter (1996)
Last updated: 2026-03-02 | Status: review
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