Pelargonium sidoides (Umckaloabo)

Introduction:
For hundreds of years the Zulu, Basuto, Xhosa and Mfengi cultures have used Pelargonium sidoides as a curative for coughs, upper respiratory tract irritations and gastrointestinal concerns. Today, with the advantages of modern science and clinical research, we are able to better understand what makes this traditional remedy work so effectively.

Pelargonium sidoides has been successfully used for the treatment of:

General:
Pelargonium sidoides occurs throughout the eastern Cape, Lesotho, Free State and southern and south-western Gauteng in the Republic of South Africa.

Pelargonium sidoides is called by Kalwerbossie or Rabassamin South Africa. However, the name Umckaloabo is most commonly known and originates from the Zulu language "heavy cough".

The Englishman Charles Stevens already acknowledged the successful treatment of tuberculosis with umckaloabo in the early 1920’s. Extracts of the root have been available in German pharmacies since 1983 without prescription and have found widespread usage against infections of the sinus, throat and respiratory tract.

The traditional use of Pelargonium sidoides for coughs and chest troubles may be explained by the presence of essential oils. It has not yet been established which ingredients contribute to its antibacterial properties.

Extracts of Pelargonium sidoides have clear antibacterial characteristics against Streptococci, Staphylococci and Bacillus cereus.

Pelargonium sidoides is also rich in phytochemicals, vitamins, minerals and amino acids that enhance the body’s functioning and protects it against diseases. Treatment with Pelargonium sidoides rapidly improves the typical symptoms associated with infections such as cough, fever, sore throat, fatigue and weakness.

How a Zulu remedy became a best-selling new medicine:
With phenomenal growth, it's gone from being an obscure herbal remedy to become one of Germany's top new medicines. In the past two years sales have jumped over 700%--growing faster than any other brand. It's success is attributed to impressive clinical results, high consumer satisfaction and a fascinating history.

A Fascinating Story:
In 1897, an Englishman named Charles Stevens went to South Africa hoping to cure himself of tuberculosis. He consulted with a Basuto tribal healer who gave him a decoction of a local medicinal plant. Fully recovered, Charles Stevens returned to England with his mysterious remedy--which became popular throughout Europe as "Steven's Consumption Cure". In 1920, a former missionary doctor, Adrien Sechehaye, learned of Steven's cure. During the next nine years he treated over 800 patients in Switzerland with a homeopathic preparation of the medicine. In 1929 he published the medical case studies.

But with the introduction of synthetic tuberculosis drugs, Steven’s remedy became largely forgotten in Western medicine--until its recent "rediscovery" by European researchers.

What the Basuto healer gave Charles Stevens was a traditional remedy made from the roots of Pelargonium sidoides - a species of geranium unique to South Africa. Among the Zulu, the medicine was described as "umKhulkane' (denoting respiratory infection) + 'uHlabo' (roughly meaning chest pain).

Works Differently:
While most other cough, cold and sinus medications simply mask outward symptoms, the mechanisms and actions of Pelargonium sidoides actually support faster recovery.

Shortens Duration and Reduces Severity:
Clinical trials show that Pelargonium sidoides shortens the duration and reduces the severity of upper respiratory irritations.

High Satisfaction:
In a physician assessment of adults and children suffering from common cold, chest and throat irritations, was rated effective in nearly 90% of cases!

Its success is attributed to impressive clinical results, high consumer satisfaction and a fascinating history that has its roots in South African heritage and culture.

Chemistry & Pharmacology:
The bioactive ingredients in P.sidoides are the tri- and tetra-oxygenated coumarins, gallic acid and gallic acid methyl ester (polyphenols), various flavonoids, as well as significant levels of calcium and silica. P.sidoides contains two distinct coumarins: umckalin and its 7-O-methyl ester, together with four other methoxycoumarins and three unique coumarin sulphates. Scopoletin and 6,7,8-trihydroxycoumarin are also found. Most of the coumarins contain a methoxy function at the C7 position and an OH group at either the C6 or C8 positions; functionality that is responsible for their antibacterial activity.

Gallic acid and its methyl ester are present in large amounts. These were identified as the prominent immunomodulatory principle for this herbal medicine. Macrophage activation was confirmed by an in vitro study based on Leishmania parasites (Phytother Res 2001 Mar; 15(2): 122-6). The same authors, Kayser, O. and Kolodziej, H. (Planta Medica 63, 508-510) also studied the antibacterial performance of the various coumarins and gallic acid compounds found in Pelargonium sidoides and found that with the exception of the ineffective (+)-catechin, all the potentially active compounds exhibited antibacterial activities with minimum inhibitory concentrations (MICs) of 200-1000 micrograms/ml. These results provide for a rational basis of the traditional use of umckaloabo.

Studies:
Double-blind, placebo-controlled studies on patients with acute bronchitis confirmed that extracts of p.sidoides were effective in treating this ailment. Similar studies have also shown the effectiveness of p.sidoides extracts for treating tonsillopharyngitis in children in the age group 6-10 years (Phytopharmaka VII, October 2001). Encouraging results have also been achieved with children, especially those who have not responded well to repeated treatment with antibiotics.

The alcoholic extract of the root has been shown to have a three-way effect:

1.) Anti-bacterial: The p.sidoides extract prevents bacteria from attaching to cells in the mucous membranes.
2.) Antiviral effect: Similarly, p.sidoides prevents viruses from attaching to the mucous membrane cells and stimulates the body’s immune system in such a way that both bacteria and viruses are prevented from multiplying.
3.) Expectorant: the extract acts as an expectorant, allowing the body to expel contaminated mucous making conditions less suitable for the multiplication of the bacteria and viruses.

The three-way effect attacks the acute infection at its root, the stabilization of the immune system prevents a re-infection and the vicious circle of infection, short recovery phase and new infection is broken. Due to its bacteriostatic and immune-modulating characteristics p.sidoides appears to be a good alternative to the conventional therapy of treating respiratory illnesses with antibiotics.

Efficacy of extract of Pelargonium sidoides in children with acute non-group A beta-haemolytic streptococcus tonsillopharyngitis: a randomized, double-blind, placebo-controlled trial.
Bereznoy VV, Riley DS, Wassmer G, Heger M.
Paediatric Department II, Academy for Continuing Medical Education, Kiev, Ukraine.
Background: Clinical trial data suggest that antibiotics are not indicated for the treatment of acute non-group A beta haemolytic strep (non-GABHS) tonsillopharyngitis. Nevertheless patients are symptomatic and effective alternatives for its treatment are needed that have been evaluated in clinical trials.
Objective: To confirm that treatment with an extract of Pelargonium sidoides (EPs 7630) is superior to placebo for the treatment of non-GABHS tonsillopharyngitis in children.
Design: Randomised, double-blind, placebo-controlled trial.
Setting: Six study sites in 4 paediatric and ENT primary care outpatient clinics.
Patients: One hundred forty-three children aged 6-10 years with non-GABHS tonsillopharyngitis present < or = 48 h, a negative rapid strep screen, a Tonsillopharyngitis Severity Score (TSS) > or = 8 points, and informed consent.
Intervention: EPs 7630 or placebo (20 drops tid) for 6 days.
Measurement: The primary outcome criterion was the decrease of the TSS from baseline (day 0) to day 4. RESULTS: The decrease of the TSS from baseline (day 0) to day 4 was 7.1 +/- 2.1 points under EPs 7630 (n = 73), and 2.5 +/- 3.6 points under placebo (n = 70). The covariate adjusted decrease was 7.0 +/- 2.4 points under EPs 7630, and 2.9 +/- 2.4 points under placebo. The 95% RCI for the difference between the groups was [2.7; 4.9] demonstrating a significant difference in efficacy of EPs 7630 compared to placebo (P < 0.0001). Adverse events (AEs) occurred in 15/143 patients (EPs 7630: 4/73 patient, placebo: 44/70) and were not related to the investigational medication.
Conclusions: EPs 7630 was superior compared to placebo for the treatment of acute non-GABHS tonsillopharyngitis in children. Treatment with EPs 7630 reduced the severity of symptoms and shortened the duration of illness by at least 2 days.

Immunomodulatory principles of Pelargonium sidoides.
Kayser O, Kolodziej H, Kiderlen AF.
Institut fur Pharmazie,Pharmazeutische Biologie, Freie Universität Berlin, Germany.
Extracts and isolated constituents (coumarins and phenols) of Pelargonium sidoides DC, a plant species used in folk medicine by the Southern African native population, were evaluated for their effects on nonspecific immune functions.
Although this herbal medicine is also successfully employed in modern phytotherapy in Europe to cure infectious diseases of the respiratory tract, the scientific basis of its remedial effects is still unclear. Thus, functional bioassays including an in vitro model for intracellular infection with Leishmania parasites, an extracellular Leishmania growth assay, a fibroblast-virus protection assay (IFN activity), a fibroblast-lysis assay (TNF activity) and a biochemical assay for inorganic nitric oxides (iNO) were employed.
None of the test samples revealed significant activity against extracellular, promastigote Leishmania donovani, the causative agent of human visceral leishmaniasis.
In contrast, apart from the coumarin samples, all the Pelargonium extracts (EC(50) <0.1-3.3 microg/mL), gallic acid (EC(50) 4.4 microg/mL) and its methyl ester (EC(50) 12.5 microg/mL) significantly reduced the intracellular survival of L. donovani amastigotes within murine macrophages.
These data indicate that the samples acted indirectly on Leishmania parasites, possibly by activating leishmanicidal macrophage functions. Macrophage activation was confirmed by detection of tumour necrosis factor (TNF-alpha) and inorganic nitric oxides (iNO) in supernatants of sample-treated macrophage cultures. Synthesis of iNO is a well-known effector mechanism of macrophages against microorganisms such as Leishmania. Interestingly, blocking iNO-synthase with L-NMMA had no substantial effect on sample-induced intracellular Leishmania kill.

From bioassay-guided fractionation, gallic acid and its methyl ester present in large amounts in P. sidoides and in its active extracts, were identified as the prominent immunomodulatory principle for this herbal medicine.
The results, when taken together with recent reported antibacterial activity, provide a rational basis for both the traditional and the present utilization of P. sidoides in the claimed conditions.
Copyright 2001 John Wiley & Sons, Ltd.

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