Ingredient Type: Botanical, Extract
Also Known As: Salicis cortex, Salix fragilis L, Salix alba L, Salix purpurea L., Crack willow, basket willow, White willow, Weidenrinde, Willow, European willow, Purple osier willow, Gray willow, Dusky willow, Sandbar willow, Narrow-leaf willow, Golden willow
There are a number of various species of shrubs and trees in the willow family which are native to Asia, Europe, and some North American parts. White willow bark is one of the most common specie of the willow family. The leaves of white willow are paler than other kinds of willow due to silky white and fine hair covering, specifically on the underside. This white tone decides the name of the bark, for example, white willow bark. In catkins, the flowers are produced in early spring and are rich in salicylic acid.
Traditionally, willow dates were used medicinally around 6000 years back. In the time of Hippocrates (400 BC), ancient civilizations utilized the extracts of the willow tree to relieve pain and treat musculoskeletal conditions and inflammation. Archaeologists document the uses of willow for the treatment of fever. Egyptians purportedly used willow to treat joint pain.
The white willow bark contains salicin, identified by French Pharmacist H Leroux in 1829, which is a similar chemical to acetylsalicylic acid, or better known as aspirin. In the late 19th century, willow bark was replaced with salicylic acid, and aspirin was considered less irritating to the stomach and mouth. There are several components in the white willow bark, including flavonoids and polyphenols, that present antioxidant effects and antiseptic, fever-reducing, and immune-boosting properties.
White Willow Bark and Pain
Pain is an unpleasant sensation and/or emotion that is typically brought on by tissue damage. It enables the body to respond to and stop further tissue destruction. When a signal is transmitted by nerve fibers to the brain for interpretation, people can experience pain. Each person’s experience of pain is unique, and there are numerous ways to feel and communicate suffering. In some circumstances, this diversity might make it difficult to define and manage pain. Long-term or temporary, localized or generalized, pain can occur anywhere on the body.
In an observational study, an extract of willow bark was taken in Switzerland to learn the scope and efficacy of its use. Adult patients were taken for the trial. The study was observed for a 6 to 8-week duration, with an intermediate control visit after three to four weeks. Several variables were assessed, including impairment of daily activities, pain intensity, and a global assessment of tolerability and efficacy. 877 patients were tested by 204 participating doctors. All of these patients had various types of rheumatologic pain. Out of 877, 763 patients completed the study. Results have shown that treatment with willow bark showed efficacy with no adverse effects. It was quite well tolerated. It was concluded that patients with rheumatologic pain can be treated with willow bark (1).
In this study, the clinical effectiveness of a willow bark extract that had been chemically standardized for the treatment of osteoarthritis was evaluated. A two-week, double-blind, randomized controlled trial comparing willow bark extract with a placebo used a dose of the extract equal to 240 mg of salicin per day. The WOMAC Osteoarthritis Index’s pain dimension served as the major outcome indicator. The WOMAC stiffness and physical function dimensions, daily visual analog scales (VAS) for pain and physical function, and absolute comprehensive examinations by both researchers and patients were used as secondary end measures. The trial involved 78 individuals, in total (39 placeboes and 39 willow bark extract). The WOMAC pain dimension showed a statistically significant difference between the active treatment and placebo group, the active treatment group’s pain score decreased by 14% from baseline after two weeks, while the placebo group’s pain score increased by 2%. This result was corroborated by the patient diary, and the final investigation also supported this finding. It was concluded that willow bark extract can be highly efficacious in osteoarthritis pain and is well tolerated. It showed a reasonable analgesic effect for the treatment of osteoarthritis (2).
In an article, it was described that white willow, Salix alba (L.) leaves and bark contain phenolic compounds, cytotoxic potential, and antioxidant activity. A total of 34 phenolic compounds in bark and 29 phenolic compounds in leaves were analyzed by UPLC-PDA-Q/TOF-MS. In the dry weight of leaves, the total content of phenolic compounds was estimated as 5575.96 mg/100 g, and 2330.31 mg/100 g of dry weight was assessed in the bark. It was observed that both extracts contain a strong potential for the anti-oxidant activity that helps fight osteoarthritis pain. Radical scavenging activity was assessed against 2,2′-azinobis (3-ethylbenzothiazoline-6-sulfonic acid (ABTS), and 1,1-diphenyl-2-picrylhydrazyl (DPPH). However, the bark was way too strong than the standard, which was ascorbic acid. A Presto Blue cell viability assay was used to assess the cytotoxicity of both extracts against human epidermal keratinocytes cell lines and skin fibroblasts. It was concluded that the leaf extract of white willow has a promising nontoxic, antioxidant activity which can be used in remedies for pain. Also, it was concluded that white willow bark is a rich source of bioactive secondary metabolites (3).
Migraines, Headaches and White Willow Bark
Usually characterized by throbbing pain on one side of the head, a migraine is a moderate to severe headache. Additionally, a lot of people experience symptoms like feeling or being unwell, as well as increased sensitivity to light or sound. Around 1 in 5 women and 1 in 15 men suffer from migraines, making it a widespread medical concern.
According to a study, Salix alba l is one of the most significant therapeutic compounds to treat headaches and migraines. In this study, 12 patients with headaches and migraines were investigated and treated for 12 weeks. They were given Salix Alba L (white willow) in 300 mg and T. Parthenium in 300 mg. These were administered twice per day to investigate the efficacy of compounds in the treatment of migraine. The results analyzed noted a 57.2% of attack frequency was reduced at 6 weeks and 61.7% at 12 weeks in 9 out of 10 patients. At the end of the study, it was observed that anxiety and stress were also reduced. Moreover, memory and physical performance were improved as well with the use of white willow. It was concluded that Salix Alba L not just has the potential to improve migraines but is efficient in overall pain relief and the enhancement of overall health (4).
An article described the significance of white willow bark for headaches. In this article, logical information banks were used such as Elsevier, Scopus, Medline, and PubMed to identify the benefits of various restorative herbs. The herbs identified in the study include White Willow Bark, Ashwagandha, Brahmi, Coriander, Latjira, Jatamansi, Nagarmotha, Guduchi, and Imli. It was observed that white willow bark contains fever-reducing, anti-inflammatory, analgesic, and anti-rheumatic effects. It possesses a higher quantity of salicylate precursors. It was identified that Gut flora hydrolyzed the compounds, including salicin and Salicortin, in the upper digestive tract by administering them orally. It does not harm the stomach but is highly impactful to relieve pain and improve headaches. It was concluded that the right dosage of white willow bark relieves headache and enhance overall health (5).
Low Back Pain and White Willow Bark
The part of the back that begins below the ribs is known as the low back, sometimes known as the lumbar region. Most people experience low back discomfort at some point in their lives. It ranks among the most common reasons for missed work in the US. Fortunately, things frequently improve on their own. In the event that it doesn’t, individuals may seek treatment from herbal remedies like white willow bark.
According to review research, white willow bark is highly productive in relieving low back pain. In a randomized controlled trial study, databases were used, including Embase, Cochrane Controlled Trials Register, Medline, and Cochrane Complementary Medicine (CM) field Trials Register. Moreover, guidelines, reference lists, and retrieved trials were analyzed. In this study, >18 years of adults were the participants who suffered from subacute, acute, and chronic low back pain. Among the different types of interventions were herbal remedies, which included any plant utilized medicinally. Pain and function were the main outcome indicators. J.J.G. and M.W.T., two reviewers, carried out electronic searches across all databases. One reviewer (J.J.G.) made contact with subject matter experts and collected pertinent citations. The separated studies’ authors, titles, publication types, subject headings, and abstracts were downloaded or retrieved on paper. Clinical relevance and methodological quality were evaluated independently by two people (J.J.G. and M.W.T.). Conflicts were settled through consensus. In this review, 10 trials were included. An experiment showed a relative equivalent to 12.5 mg of rofecoxib per day, while two moderate-quality trials using Salix alba (White willow bark) indicated moderate evidence for short-term benefits in pain and rescue medication for daily dosages standardized to 120 mg or 240 mg salicin. This study concluded that Salix Alba (white willow bark) is one of the most significant herbal medicines that help to reduce low back pain better than a placebo (6).
Another study was designed to investigate the effectiveness of European willow (an alternate name of white willow bark) for the treatment of low back pain. In this study, 210 patients were included with chronic low back pain. They had current pain on a visual analog scale. They were given randomly the low dose (120 mg) of willow bark extract or high dose (240 mg) of salicin or placebo, in a 4-week blinded trial. At the baseline, the placebo groups and treatment were similar in 114 of 120 patients. However, 191 patients completed the research. In the final week of treatment, there were 15 (21%) of 67 patients in the low-dose extract group, 27 (39%) of 65 patients in the high-dose extract group, and 4 (6%) of 59 patients in the placebo group (P 0.001). After just one week of treatment, the high-dose group had already shown a response. During each week of the research, a significantly higher number of patients in the placebo group needed tramadol (P 0.001). A significant allergic reaction occurred in one patient, possibly as a result of the extract. It was concluded that European willow extract could potentially be used as an alternative treatment for low back pain (7).
Salix Alba and Menstrual Cramps
Dysmenorrhea, or menstrual cramps, are sharp or stabbing pains in the lower abdomen to pelvic region. Before and during menstrual periods, many women experience menstrual cramps. Some females may only find the discomfort irritating. Others may experience menstrual cramps that are so bad that they prevent them from going about their normal lives for a few days each month. Menstrual cramps can be brought on by conditions, such as endometriosis or uterine fibroids. The key to minimizing pain is to treat the underlying cause. When they are not brought on by another illness, menstrual cramps often become better with age and often stop altogether after delivering birth.
Dysmenorrhea (menstrual cramps) is the most painful part of a woman’s life, after childbirth. In a randomized crossover clinical trial study, 96 female students were included, with a scaled two or three level of primary dysmenorrhea. 48 among them were considered group 1 followed by the control and 48 students in the control group followed the treatment. Salix capsule (400 mg daily) was given as the intervention, and the active control was 75 mg mefenamic acid capsule daily. A visual analog scale (VAS) was used to measure the amount of bleeding, pain intensity, and severity of dysmenorrhea symptoms. Data analysis was performed by estimating questions. Menstrual characteristics and demographics of the females were homogenous. The results indicated that the students in the group with mefenamic acid have a higher VAS level than the other group based on salix. However, the bleeding level in the mefenamic acid group and salix was not significantly different. Students who used to experience mild symptoms showed no symptoms in the salix group. However, females with moderate symptoms in the mefenamic acid group experienced mild symptoms. It was concluded that dysmenorrhea was significantly decreased by salix (white willow bark) compared to mefenamic acid (8).
Diabetic Retinopathy and White Willow Extract
In people of working age, diabetic retinopathy, a consequence of diabetes, is the main factor in blindness and visual impairment. The chronic condition known as diabetic retinopathy rarely manifests in the first few years of diabetes and progresses in stages. After 10 years of diabetes, the disease’s incidence rises to 50%, and after 25 years, it reaches 90%.
In an article, white willow bark was used to assess its efficacy in early diabetic retinopathy. Early alterations in the retina and plasma of streptozotocin-induced diabetic rats were attributed to red berries, Ginkgo biloba, and white willow bark that contained carnosine and -lipoic acid. A single dose of streptozotocin caused diabetes in Sprague Dawley rats. For 10 days, the fortified extract was administered daily to diabetic and nondiabetic (control) rats. TNF- and VEGF levels in retinal samples were measured and examined. Furthermore, thiobarbituric acid reactive components evaluated the plasma oxidative stress (TBARS). Rats with diabetes have higher amounts of TNF- and VEGF in their retina. Treatment with the strengthened extract dramatically reduced retinal cytokine levels and inhibited lipid peroxidation brought on by diabetes. These findings show that in early diabetic rats, the fortified extract reduces the level of retinal inflammation and plasma lipid peroxidation while still protecting the retina. The current findings demonstrate that red berries, white willow bark, and Ginkgo biloba which contain -lipoic acid and L-carnosine, may mitigate some of the adverse effects of hyperglycemia, including inflammation, oxidation, and VEGF expression, which are the primary causes of diabetic retinopathy (9).
As a precaution, due to the similarities in activity of white willow bark and aspirin, it is highly recommended to consult with your healthcare provider prior to taking white willow bark. Especially if you are currently taking any medications (see below) to ensure that there are no contraindications.
- Anticoagulants (drugs that thin the blood): Willow bark may enhance the effects of medications and herbs that thin the blood (10).
- Atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL), and propranolol are examples of beta blockers (Inderal, Inderal LA): Willow bark may lessen certain medications’ effectiveness (10).
- Willow bark may lessen the efficiency of diuretics (water tablets).
- Nonsteroidal anti-inflammatory medications, such as ibuprofen (Motrin, Advil), naproxen, and others (Aleve). Combining willow bark with certain medications may make stomach bleeding more likely (11).
- Methotrexate and phenytoin (Dilantin) levels may rise in the body as a result of Willow, reaching dangerous levels (10, 12).
Research has shown that there are a few side effects with white willow bark. For instance, individuals having diabetes, liver problems, and gastrointestinal complications should consult a physician before using white willow bark. Those who already take acetazolamide, anticoagulants, and anti-inflammatory and anti-hypertensive drugs can have severe interaction with willow bark. Other side effects may include increased blood pressure, stomach upset, and allergic reactions. Overdose of white willow bark may lead to bleeding or stomach ulcers (13).
- Saller, R., Melzer, J., & Felder, M. (2008). Pain relief with a proprietary extract of Willow bark in rheumatology. An Open Trial. Schweizerische Zeitschrift für Ganzheitsmedizin/Swiss Journal of Integrative Medicine, 20(3), 156-162.
- Schmid, B., Lüdtke, R., Selbmann, H. K., Kötter, I., Tschirdewahn, B., Schaffner, W., & Heide, L. (2001). Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: randomized placebo‐controlled, double blind clinical trial. Phytotherapy Research, 15(4), 344-350.
- Piątczak, E., Dybowska, M., Płuciennik, E., Kośla, K., Kolniak-Ostek, J., & Kalinowska-Lis, U. (2020). Identification and accumulation of phenolic compounds in the leaves and bark of Salix alba (L.) and their biological potential. Biomolecules, 10(10), 1391.
- Shrivastava, R., Pechadre, J. C., & John, G. W. Tanacetum parthenium and Salix alba (Mig-RL9) Combination in Migraine Prophylaxis.
- WAL, A., WAL, P., SHUKLA, S., & SRIVASTAVA, A. (2021). A Comprehensive Review on the Medicinal Plants for the Treatment of Headache. International Journal of Pharmaceutical Research, 13(3).
- Gagnier, J. J., van Tulder, M. W., Berman, B., & Bombardier, C. (2007). Herbal medicine for low back pain: a Cochrane review. Spine, 32(1), 82-92.
- Chrubasik, S., Eisenberg, E., Balan, E., Weinberger, T., Luzzati, R., & Conradt, C. (2000). Treatment of low back pain exacerbations with willow bark extract: a randomized double-blind study. The American journal of medicine, 109(1), 9-14.
- Dehkordi, Z. R., Rafieian-Kopaei, M., & Hosseini-Baharanchi, F. S. (2019). A double-blind controlled crossover study to investigate the efficacy of salix extract on primary dysmenorrhea. Complementary therapies in medicine, 44, 102-109.
- Bucolo, C., Marrazzo, G., Platania, C. B. M., Drago, F., Leggio, G. M., & Salomone, S. (2013). Fortified extract of red berry, Ginkgo biloba, and white willow bark in experimental early diabetic retinopathy. Journal of Diabetes Research, 2013.
- Basnet, S., Adhikary, P., & Aryal, B. (2013). Drug interactions with complementary and alternative medicine and dietary supplements. Journal of Chitwan Medical College, 3(2), 1-3.
- ALTINTERİM, B. (2013). EFFECTS OF WILLOW BARK Salix alba AND ITS SALICYLATES ON BLOOD COAGULANT. Karaelmas Fen ve Mühendislik Dergisi, 3(1), 37-39.
- Setty, A. R., & Sigal, L. H. (2005, June). Herbal medications commonly used in the practice of rheumatology: mechanisms of action, efficacy, and side effects. In Seminars in arthritis and rheumatism(Vol. 34, No. 6, pp. 773-784). WB Saunders.
Vickers, A., & Zollman, C. (1999). Herbal medicine. Bmj, 319(7216), 1050-1053.