Comfrey [Symphytum officinale]

Renowned for its powerful ability to support tissue repair and recovery, Comfrey is a cornerstone of traditional Western herbalism. At the heart of our formulations, we use carefully infused oils and therapeutic salves made from Comfrey root and sometimes leaf—designed to naturally ease muscle strain, bruises, sprains, and support the body’s healing process from the outside in.

Comfrey has a long history of use in traditional medicine for treating fractures, sprains, and other injuries. The name “knitbone” reflects its perceived ability to promote bone healing. Comfrey is typically applied topically in the form of ointments, creams, or poultices to the affected area. When applied directly to the affected area, comfrey’s nutrients and compounds can penetrate deep into the skin, providing targeted relief and support. 

Short Monograph

Category	Details
Characteristics:	Comfrey (Symphytum officinale) is a perennial shrub native to Europe it grows 2 to 5 feet tall with a thick, hairy stem, dull purple, blue, or whitish flowers, and oblong leaves.
Varieties / Cultivars:	Symphytum × uplandicum (Russian comfrey) is a low-PA hybrid used in topical applications. It offers similar therapeutic effects to S. officinale with reduced toxicity risk. Bocking 14 is a commonly used cultivar in Europe.
Parts used:	Leaf, root
Constituents:	Allantoin, rosmarinic acid, tannins, polysaccharides, unsaturated pyrrolizidine alkaloids (PA). Comfrey contains allantoin, rosmarinic acid, and tannins, which promote skin regrowth. However, it also contains toxic pyrrolizidine alkaloids.
Actions:	Vulnerary, demulcent, anti-inflammatory, relaxing expectorant
Indications:	Topical: wounds, bruises, sprains, fractures, dermatitis, osteoarthritis Internal (restricted): dry cough, GIT/UT inflammation (with caution)
Contraindications:	Pregnancy, breastfeeding, young children, allergy to Asteraceae family
Adverse effects:	Hepatotoxicity (especially from PAs); avoid broken skin
Toxicity:	Internal use linked to hepatic veno-occlusive disease (HVOD); oral forms banned in several countries
Interactions:	None well documented; caution with hepatotoxic drugs
Additional info:	External use only; avoid long-term application or use on open wounds
Daily Therapeutic Dose:	Internal use not recommended due to toxicity Topical use is restricted to creams or ointments. Caution should be exercised to avoid application on broken skin, pregnancy and breastfeeding.

🌿 Comparison of Symphytum officinale vs. S. × uplandicum (Russian Comfrey)

Feature	S. officinale (Common Comfrey)	S. × uplandicum (Russian Comfrey)
Species	Native wild species	Hybrid of S. officinale × S. asperum
PA Content	Higher (internally toxic)	Lower (still not safe internally)
Therapeutic Use	External use only	External use only
Effectiveness	High for topical pain, inflammation	Comparable—high for topical use
Cultivation	Variable PA levels	Bocking 14 is widely used, standardized PA
Common Use in Products	Traditionally used in folk medicine	Common in European herbal products

References:

Barna M, Kucera A, Hladíkova M, Kucera M. Randomized double-blind study: wound-healing effects of a Symphytum herb extract cream (Symphytum×uplandicum Nyman) in children. Arzneimittelforschung. 2012 Jun;62(6):285-9. doi: 10.1055/s-0032-1308981.

Bleakley CM, McDonough SM, MacAuley DC. Some conservative strategies are effective when added to controlled mobilisation with external support after acute ankle sprain: a systematic review. Aust J Physiother. 2008;54(1):7-20.

D’Anchise R, Bulitta M, Giannetti B. Comfrey extract ointment in comparison to diclofenac gel in the treatment of acute unilateral ankle sprains. Arzneimittelforschung. 2007;57(11):712-6.

Frost R, MacPherson H, O’Meara S. A critical scoping review of external uses of comfrey (Symphytum spp.). Complement Ther Med. 2013;21(6):724-45.

Frost R, O’Meara S, MacPherson H. The external use of comfrey: a practioner survey. Complement Ther Clin Pract. 2014;20(4):347-55.

Grube B, Grunwald J, Krug L, Staiger C. Efficacy of comfrey root (Symphyti offic. radix) extract ointment in the treatment of patients with painful osteoarthritis of the knee: results of a double-blind randomised, bicenter, placebo-controlled trial. Phytomedicine. 2007;14(1):2-10.

Koll R, Klingenburg S. Therapeutic characteristance and tolerance of topical comfrey preparations. Results of an observational study of patients. Fortschr Med Orig. 2002;120(1):1-9.

Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1998;158(20):2200-2211.

Miskelly FG, Goodyer LI. Hepatic and pulmonary complications of herbal medicines. Postgrad Med J. 1992;68:935-936.

Pabst H, Schaefer A, Staiger C, Junker-Samek M, Predel HG. Combination of Comfrey Root Extract Plus Methyl Nicotinate in Patients with Conditions of Acute Upper or Low Back Pain: A Multicentre Randomised Controlled Trial. Phytother Res . 2012 Aug 8. doi:10.1002/ptr.4790.

Ridker PM, Ohkuma S, McDermott WV, Trey C, Huxtable RJ. Hepatic venocclusive disease associated with the consumption of pyrrolizidine-containing dietary supplements. Gastroenterology. 1985;(88):1050-1054.

Smith DB, Jacobson BH. Effect of a blend of comfrey root extract (Symphytum officinale L.) and tannic acid creams in the treatment of osteoarthritis of the knee: randomized, placebo-controlled, double-blind, multiclinical trials. J Chiropr Med . 2011 Sep;10(3):147-56. doi: 10.1016/j.jcm.2011.01.003.

Staiger C. Comfrey: a clinical overview. Phytother Res. 2012 Oct;26(10):1441-8. doi: 10.1002/ptr.4612.

Staiger C. Comfrey root: from tradition to modern clinical trials. Wien Med Wochenschr. 2013;163(3-4):58-64.

Stickel F, Seitz HK. The efficacy and safety of comfrey. Public Health Nutr. 2000;3(4A):501-508.

Weston CFM, Cooper BT, Davies JD, et al. Veno-occlusive disease of the liver secondary to ingestion of comfrey. Br Med J. 1987;295:183.

Yeong ML, Swinburn B, Kennedy M, Nicholson G. Hepatic veno-occlusive disease associated with comfrey ingestion. J Gastroenterol Hepatol. 1990;5(2):211-214.