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Commission E versus Herbal PDR

"They represent the most accurate information available in the whole world on the safety and efficacy of herbs and phytomedicines … Ignorance of Commission E monographs is ignorance of a substantial segment of modern medicine … Without question, their ready availability will benefit all of us, consumers and health care practitioners alike." (Varro Tyler, writing of the foreword of The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines).

I join Prof. Tyler in assigning a score of E for Excellence to Blumenthal et al., and Gruenwald et al. for giving us English translations of Germany’s Commission E. In this review I will cursorily compare and contrast four English interpretations of the commission, focusing upon two herbs. Since these texts are multi-authored, I assign them three-digit alpha or alphanumeric abbreviations, KOM, BGB, PHR, and PH2.

KOM = Blumenthal M, et al. (Eds.) The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin, Texas: American Botanical Council, Newton, Massachusetts: and Integrative Medicine Communications; 1998. (ABC Catalog #B181)

BGB = Blumenthal M, et al. (eds.). Herbal Medicine: Expanded Commission E Monographs. Austin, Texas: American Botanical Council, Newton, Massachusetts: and Integrative Medicine Communications; 2000. (ABC Catalog #B181E)

PHR = Gruenwald, J. et al. PDR for Herbal Medicine. 1st ed. Montvale, New Jersey: Medical Economics Co.; 1998.

PH2 = Gruenwald, J. et al. PDR for Herbal Medicines. 2d ed. Montvale, New Jersey: Medical Economics Co.; 2000. (ABC Catalog #B474)

If you want a lot of accurate information about some hundred of the most important herbs on the American market, then BGB is the best buy for the money. If you want more superficial coverage on some 600 more herbs, many not sold here in America, PH2 is the best buy for the money. These are just four of more than a dozen English books including information on Germany’s Commission E. The good news is that all these publications bring to us anglophones the deliberations of the distinguished panel of Commission E, the German Commission that has been likened by some to our FDA. The bad news is that there are confusing variations in the various translations, many trivial but a few serious. The following comparisons highlight a few variations.

Devil’s claw, discussed elsewhere in this HerbalGram, the differences are not significant; BGB seems to have done a better job than PH2 overall. Here are summaries of the indications in these two books, with Commission E approval indicated in capital letters, unproven uses in lower case.

BGB: allergy, ANOREXIA, arrhythmia, arthrosis, backache, blood disease, "DEGENERATIVE DISORDERS OF THE LOCOMOTOR SYSTEM," DYSPEPSIA, edema, fever, gout, headache, high blood pressure, inflammation, lesion, lumbago, neuralgia, pain, rheumatism, skin lesions, sore, tendonitis, ulcer, wound.

PH2: allergy, ANOREXIA, arthritis, cholestocystosis, cystosis, degenerative central nervous system disorders, DYSPEPSIA, fever, hepatosis, metabolic disorders, nephrosis, pain, pregnancy, RHEUMATISM, skin, wound.

KOM: approved devil’s claw root for "Loss of appetite, dyspepsia, supportive therapy of degenerative disorders of the locomotor system." PH2 translates this to approval for "dyspeptic complaints, loss of appetite, and rheumatism."

BGB provides more chemical data than PH2 for devil’s claw, including three COX-2 inhibitor compounds (kaempferol, oleanolic acid, and ursolic acid) that might contribute to furthering the synergistic activities. The whole extract has been shown to be more active than isolated phytochemicals studied to date.

Secondly, let’s look at similarities (and differences) between KOM and PD2 on elderberry. Both approve 10—15 g elder flowers (Sambucus nigra, not American elderberries, S. canadensis) in teas, sipped throughout the day, for colds. In the Herbal PDRs (PHR and PH2), Commission E approval is indicated by a square black bullet. PH2 indicates "Approved by Commission E – cough/bronchitis – fevers and colds. The drug is used for colds and coughs. It is a sweat producing remedy for the treatment of feverish colds." Then follows this almost contradictory sentence, "Unproven uses: In folk medicine, Elder flowers are used internally as a sudorific tea and for colds and other feverish conditions." Then PH2 lists several other folk indications, not approved (or disapproved) by Commission E: flu, head cold, laryngitis, short breath, antiedemic, antiinflammatory, and lactagogue.

One big problem here is that the intended target audience, American physicians, will not know whether these indications accrue to the bark, air-dried flowers, fresh or dried leaves, fresh or dried ripe fruits, dried roots, or a mix of fresh leaves and inflorescences which PH2 lists as the Medicinal Parts.

KOM is much more specific in this regard, suggesting, correctly I presume, that Commission E approved only the flowers. Both KOM and PH2 note that the elder has diaphoretic activity and increases bronchial secretions.

Here are summaries of the indications in the later books BGB and PH2, with Commission E approval indicated by all uppercase letters.

BGB: catarrh, COLD; fever, inflammation, virus, water retention.

PH2: alactea, BRONCHITIS, COLD, COUGH, FEVER, flu, head cold, inflammation, laryngitis, short breath, swelling, water retention.

Regarding elder flowers, KOM notes "none known" for its section, "Contraindications, Side Effects and Interactions with Other Drugs." PH2 reads, "No health hazards or side effects are known in conjunction with the proper administration of designated therapeutic dosages."

To their credit, both BGB and PH2 added chemical data and are generous with references, but, unfortunately, other than by comparing the dates of the original monographs with research citations, we’ll never know which the Commission E consulted.

Commission E approved a few poisonous plants, including belladonna (Atropa belladonna), autumn crocus (Colchicum autumnale), broom (Cytisus scoparius), henbane (Hyoscyamus niger), Scopolia carniocola, and Solanum dulcamara – all wisely dropped by BGB but still included in PHR and PH2. These powerfully active medicinal plants have a place, comparable to powerful prescription pharmaceuticals, but their place belongs in a practitioner-mediated setting, not in over-the-counter type dietary supplements.

Both of PH2 and BGB books are great buys for the money, BGB better for Americans interested in the major herbs on the American market, PH2 better for Europeans interested in major and minor herbs of the world, whether on the American market or not.

The unhappy conclusion to this story is that no one, including myself, should cite Commission E without being very specific. Commission E has been translated and interpreted in many different ways, some contradictory. There are at least 11 more books on herbs in English that include some information attributed to the Commission E. I’ve failed to be as specific as I should in the past, as have most of the authors of these other, unnamed books. As with the game Simon Says, without a source author’s name, we should necessarily believe what we read when encountering in English, "Commission E says … ." Before authors and lecturers pass on this gravely ambivalent citation to their readers and listeners, they must specify which version of translation and interpretation they draw from. As with the Bible – and there are those who wish to make Commission E into the Bible of the Phytomedicinal World – which author, which edition, which testament, which translation, which version makes all the dogmatic difference in the world. – James A. Duke, Ph.D.