Birch

Birch may be used to treat urinary Infections, and inflammation of the urinary passage (1). The diuretic action is further known for aiding elimination of uric acid, so is of benefit to those suffering from gout. This herb is especially indicated for arthritic disease as it can relieve rheumatic and arthritic pain and reduce swelling (2). Fibromyalgia can also respond well to the inclusion of birch in the prescription, with birch easing both myalgia and neuralgia (3).

In promoting detoxification, the herb releases retained metabolic waste thereby helping to improve cellulitis (4). Birch bud can be given to reduce swollen lymph glands, whereas the bark is considered more active on the liver, stimulating bile flow and relieving constipation (5).

The diuretic, diaphoretic and anti-inflammatory actions of birch are also of value in the treatment of skin conditions such as eczema and psoriasis (5). External applications can accelerate healing of wounds and sores. With stimulant properties aiding hair growth, birch is included in treatments for alopecia (6). 

The bright, clean appearance of the young silver bark is fitting for revealing the tree’s cleansing properties. Yet, the patterns of darker markings which over time, often develop into diamond shapes suggest a complexity of action. This is borne out by different uses and variations for the sap, resinous buds, elegant triangular, tooth-edged young leaves, delicate twigs and inner bark. The tree has proved itself to be adaptable, often growing quickly as a pioneer tree in challenging situations. Betula alba is a tree of youth giving spring harvests but is generally not long-lived, reaching only 80–100 years (7). Betula lenta may live for twice that time (8). 

Birch is more often seen as cooling, especially with use of the leaves in cooling eruptive and inflammatory conditions. The catkins and bark, however, are noted to have more heating qualities (9). The bark of Betula lenta is distilled to make wintergreen essential oil known for its anti-inflammatory properties especially for joint pain, muscle aches and inflammatory skin conditions. The oil also has potent antimicrobial actions and can be used for helping to treat infections (10).

Traditional use has emphasised the importance of the sap for urinary diseases and conditions including stones, gravel and dropsy. This was to be tapped from the tree in February or early March. Precise details on the method of tapping and ways to preserve the sap, such as pouring olive oil over the surface, are given in traditional herbals. The sap from the branches was often recommended in place of the trunk. This instruction was further refined to branches not thicker than three inches, by the nineteenth century (11,12). Wine from the sap has been valued for centuries and was made by adding sugar, honey or raisins and bringing the liquor to the boil, before cooling a little and adding yeast (11). 

In the 17th and 18th centuries, both the juice of the leaves and the sap were recommended as effective for dissolving kidney and bladder stones. The sap was also recommended for relieving scurvy and jaundice. It was noted that large doses of the sap were laxative (11,13). The distilled sap was specifically valued for dissolving kidney and bladder stones (9,12). Enthusiasm for the cleansing action through diuresis extended to appreciation of birch as beneficial for dropsy, the itch (used both internally and externally), gravel, blood in the urine and inability to pass urine (14). The leaves and bark were decocted to be used as a wash to cleanse skin eruptions (11,13).

Traditional use for the urinary system and skin is strong in Britain, but the wider applications of birch for treating rheumatism, arthritis and gout appear to be adopted from Eastern Europe in the twentieth century (7). Alma Hutchens records the Russian use of the steam bath with leaves set over hot rocks using the cleansing properties of the moist vapour, followed by thrashing the body with birch twigs. Birch buds were preserved in vodka to treat colds, liver and gall stones and rheumatism (15). Various birch species were used by Native Americans and the black birch twigs, sap and inner bark by Canadian First Nations (5,16). It has recorded use in the nineteenth century for colds, scrofula and sores (17). 

Circulatory system

Birch has lipid-lowering and antioxidant effects that are thought to lower high cholesterol (6). 

Digestive system

By stimulating the flow of bile and dissolving deposits, birch relieves liver congestion and constipation (5). This additionally benefits chronic skin conditions and coupled with diuresis acts as a systemic detoxifier. 

Musculoskeletal system

The salicylates in birch offer short term analgesia and further cleansing effects through its diuretic action and stimulation of digestion. It is thought that rather than simply clearing excess fluid, birch also removes accumulated waste products from the body. This indicates birch in the treatment of rheumatic diseases. Birch helps to clear uric acid and is often incorporated into a herbalist’s treatment programme for osteoarthritis (1,18).

Urinary system

An infusion of birch leaf extracts has been found to be effective as a diuretic which produces both increased urine excretion and increased electrolyte elimination. Aqueous extracts of the leaves were found to be more effective than alcoholic extracts. Additionally, birch also acts as a urinary antiseptic (1). 

Skin andhair

The depurative, anti-inflammatory, antimicrobial and antiparasitic properties of birch have long encouraged use for treating skin conditions ranging from eczema and psoriasis to scabies. Dandruff and alopecia have also benefited from birch treatment as it promotes and strengthens hair growth (3,5). More recently, research has been carried out to explore the role of betulinic acid in supporting various types of cancer including breast, bladder and gastric.

Limited clinical studies have been carried out on the effect of birch, a review of its uses has been included below. Leaves of Betula pendula, B. pubescens and B. verrucosa have a positive assessment in the Commission E statement for treating bacterial and inflammatory diseases of the efferent urinary passages, renal gravel, and rheumatic complaints (1). 

Medicinal plants of the genus Betula—traditional uses and a phytochemical-pharmacological review

A review of medicinal plants of the genus Betula, looking at the traditional uses, and phytochemical-pharmacological aspects has been undertaken. Rastogi, Pandey and Rawat found that seven different Betula species have been documented for their traditional uses. Several of these have been found to be potentially useful in treating degenerative joint disease. Antiarthritic and anticancer actions are the two major areas of research conducted on these species. There is convincing evidence in experimental animal models to support their anticarcinogenic effects. It was concluded that further investigation of biochemical and physiological mechanisms, bioavailability, pharmacokinetics and pharmacodynamics of active extracts is worthwhile (19).  

An aqueous birch leaf extract of Betula pendula inhibits the growth and cell division of inflammatory lymphocytes

An in vitro study was undertaken to investigate the efficacy of birch leaf extract in the traditional role of treating rheumatoid and osteoarthritis (RA and OA, respectively). Activated lymphocytes play a major role in the initiation and maintenance of RA. Aqueous leaf extracts of Betula pendula were used on human primary lymphocytes in this in vitro study to determine whether these extracts would inhibit the growth and cell division of inflammatory lymphocytes. Results showed that leaf extracts inhibited the growth and cell division of activated, but not of resting T lymphocytes in a significant dose-dependent manner. It was concluded that there is a rational basis for the use of Betula pendula leaf extract for the treatment of immune disorders, like RA r, by diminishing proliferating inflammatory lymphocytes (20). 

Betulinic acid restricts human bladder cancer cell proliferation in vitro by inducing caspase-dependent cell death and cell cycle arrest, and decreasing metastatic potential

Betulinic acid found in the bark of birch has been found to exhibit anti-tumour effects which have been explored in studies with several cancers. This in vitro study aims to identify the underlying mechanism of action for the antiproliferative effect of the acid in human bladder cancer cell lines. Betulinic acid was prepared as a 10 mg/mL solution in dimethyl sulfoxide (DMSO) and applied to bladder cancer cell lines at concentrations of 5–30 μg/mL for between 24–72 hours. Findings included observations of betulinic acid decreasing the expression of cell cycle regulators and causing loss of mitochondrial membrane potential. These led to the conclusion that betulinic acid suppresses proliferation of human bladder cancer cells by inducing apoptosis, necrosis and cell cycle arrest, thus decreasing migration and invasion (21).

Treatment of actinic keratoses with birch bark extract: A pilot study

A pilot study was carried out on treatment of actinic keratoses using birch bark extract by Huyke and colleagues. Twenty-eight patients were enrolled on this controlled study, using either birch bark ointment as a monotherapy, or birch bark ointment with cryotherapy for 50% of the patients. The bark contains betulinic acid, betulin, oleanolic acid and lupeol. These are known to be apoptosis-inducing and contain anti-inflammatory constituents. More than 75% of lesions cleared for 79% of patients with birch bark ointment alone. The combined treatment gave a 93% success rate. It was concluded that standardised birch bark ointment was effective and had no side effects (22).

From a traditional medicinal plant to a rational drug: Understanding the clinically proven wound healing efficacy of birch bark extract

A preclinical study combined of both in vitro and ex vivo research was carried out to examine the  traditional use of birch bark for wound healing. The aim was to explore the molecular mechanism of this proven effect. Birch bark was prepared in sunflower oil at a ratio of 10% or dissolved in phosphate-buffered saline (PBS) at a concentration of between 1–10 μg/mL over a period of 24–48 hours.. The triterpene extract and botulin were shown to cause transient up-regulation of several pro-inflammatory mediators, including cytokines, chemokines and cyclooxygenase-2 on gene and protein level. They were also shown to enhance migration of keratinocytes, essential for the second phase of wound healing. It was concluded that the results, together with proven clinical efficacy, identify birch bark as having a high potential to improve wound healing (23).

The fungus Fomes fomentarius is commonly found growing on birch trees in Britain. It contains polyporic acid which is active against certain mycobacteria (24). Sweet birch oil from Betula lenta has been used in dentistry products for the large amounts of methyl salicylate it contains. Betula alba is associated with the youthful form of the white goddess, who presides over birth and initiation in Welsh tradition (7).

Silver birch (Betula alba), is native to the British Isles and prefers sandy, acid soil, although it can be grown in almost any soil. It grows naturally on open heaths and high ground and has long been regarded as a successful pioneer tree where other trees are not yet established. Silver birch provides food for over 300 Insect species as well as being host to seven fungi (32).

Black, or cherry birch (Betula lenta), is native to the north-eastern United States, growing with upland hardwoods and eastern hemlock. The range is from Maine to Alabama and west as far as Ohio. The tree prefers moist, well-drained soils (8).

Although in the past, Betula lenta was almost wiped out by overharvesting for distillation of wintergreen oil, it was saved by the production of synthetic oil (8). It was classified as Least Concern in 2013. The IUCN European forest genetic resources programme lists threats to silver birch as low because the natural regeneration is common, and the species is widely planted (33).

Habitat loss and over-harvesting from the wild are two of the biggest threats faced by medicinal plant species. There is an increasing number of well-known herbal medicines at risk of extinction. We must, therefore, ensure that we source our medicines with sustainability in mind.

The herb supplement industry is growing at a rapid rate and until recent years a vast majority of medicinal plant produce in global trade was of unknown origin. There are some very real and urgent issues surrounding sustainability in the herb industry. These include environmental factors that affect the medicinal viability of herbs, the safety of the habitats which they are taken from, as well as the welfare of workers in the trade.

The botanical supply chain efforts for improved visibility (transparency and traceability) into verifiably sustainable production sites around the world is now certificated through the emergence of credible international voluntary sustainability standards (VSS). 

Read our article on Herbal quality & safety: What to know before you buy and Sustainable sourcing of herbs to learn more about what to look for and questions to ask suppliers about sustainability.

Herbal medicines are often very safe to take; however, their safety and efficacy can be jeopardised by quality issues. So, it is important to buy herbal medicines from a reputable supplier, from sources known to test their herbs to ensure there is no contamination, adulteration or substitution with incorrect plant matter, as well as ensuring that recognised marker compounds are at appropriate levels in the herbs.

Some important quality assurances to look for are certified organic labelling, the correct scientific/botanical name, and the availability of information from the supplier about ingredient origins. A supplier should be able to tell you where the herbs have come from, what contaminants are not in the herb, and what the primary compounds are.

Birch can be grown from seed, cuttings are more difficult to nurture. The young tree may be planted early in the year in a sunny or partially shaded position preferably into sandy, or well-drained soil. Birch is a very hardy tree which historically has often achieved success as a pioneer in open sites. It grows quickly and can reach a height of 30 metres. Since the roots are shallow this leaves the tree vulnerable to dry periods followed by strong winds. When planting in a garden, care should be taken to place the young tree well away from the house.  Protection from weeds and the attention of deer and small animals when young and drought when newly planted is important. Pruning should not be necessary (34).

Recipe birch ointment*

This birch ointment recipe is a soothing and healing salve for wounds and skin conditions.

Ingredients

• Dried birch leaves, birch bark 
• 600 ml Organic virgin cold-pressed olive oil
• 50 g Organic Beeswax

Method

• Pour the oil into an ovenproof container
• Add equal quantities of the cut dried leaf and powdered bark to fill the oil.
• Place in the middle of the oven with the temperature set to 100 degrees.
• Heat gently for 4–5 hours.
• Strain the herb through a muslin cloth.
• Add chopped beeswax to the oil and return to the oven for a few minutes.
• Once the wax has melted, pour into amber glass screw top jars and label.                         

* Adapted from James Green The Herbal Medicine-Makers Handbook (24)

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