Agrimony

Metadata

• Common Names: Agrimony, Church Steeples, Sticklewort, Cocklebur (English); Odermennig, Gemeiner Odermennig, Ackerkraut (German); Common Agrimony
• Botanical Name: Agrimonia eupatoria L.
• Plant Family: Rosaceae
• Part Used: Aerial parts / Herb (Agrimoniae herba)
• Evidence Quality Rating: Very Preliminary (regulatory approvals based on traditional use; no clinical trial data for monotherapy)

Approved Indications

Commission E

• Mild, nonspecific, acute diarrhea
• Mild inflammation of the mucous membranes of the mouth and throat (used as gargle/rinse)

ESCOP

• No ESCOP monograph has been published for agrimony

EMA/HMPC

• Traditional use: Mild diarrhea
• Traditional use: Symptomatic treatment of minor inflammations of the oral mucosa
• Traditional use: Minor inflammations of the skin
• The EMA classified agrimony as a traditional herbal medicinal product, recognizing long-standing use but noting insufficient clinical evidence for well-established use status

Agreement/Disagreement Between Bodies

• Commission E and EMA agree on mild diarrhea and oral mucosal inflammation as primary indications
• The EMA additionally includes minor skin inflammation, which is not explicitly covered in the Commission E monograph
• Neither body grants well-established use status; all approvals rest on traditional use documentation and pharmacological plausibility
• ESCOP has not assessed agrimony
• Both bodies recognize the astringent (tannin-based) mechanism as the pharmacological basis for the approved indications

Conditions Treated

Primary

• Mild, nonspecific, acute diarrhea
• Mild inflammation of the oral and pharyngeal mucosa (stomatitis, pharyngitis, gingivitis)

Secondary

• Minor skin inflammations (mild dermatitis, minor wounds)
• Sore throat (gargle)

Traditional/Historical

• In European folk medicine, agrimony has been used for liver and gallbladder complaints, though this indication is not supported by modern regulatory assessments
• Traditional use as a wound-healing herb (topical application of decoctions and poultices)
• Historical use in European herbal medicine for urinary complaints and as a mild diuretic
• In the British herbal tradition, agrimony was used for “debility of the digestive organs” and catarrh
• Anglo-Saxon herbals (notably the Lacnunga) list agrimony as a healing herb

Mechanism of Action

• Tannins (3-10% of dried herb, catechin/condensed type):
  • Agrimoniin: A dimeric ellagitannin unique to Agrimonia species; the principal pharmacologically active tannin. Demonstrates astringent, anti-inflammatory, and antimicrobial activity
  • Catechin and epicatechin: Condensed tannin precursors; contribute to overall astringent action
  • Mechanism of astringency: Tannins precipitate proteins on the surface of mucous membranes and inflamed tissue, forming a protective barrier that reduces secretion, inflammation, and microbial penetration. This protein-precipitating action is the pharmacological basis for both the antidiarrheal and anti-inflammatory indications
• Flavonoids:
  • Apigenin, luteolin, quercetin glycosides (including quercitrin, kaempferol-3-O-glucoside): Anti-inflammatory activity through inhibition of pro-inflammatory mediators; antioxidant effects
  • Contribute to overall mucosal protective action
• Triterpenes:
  • Ursolic acid: Anti-inflammatory and antimicrobial properties demonstrated in preclinical studies
• Silicic acid: Present in small amounts; may contribute to connective tissue support in wound healing (traditional rationale)
• Essential oil (trace amounts only): Minor contribution to antimicrobial activity
• Phenolic acids: Including caffeic acid, chlorogenic acid, ellagic acid; antioxidant and mild anti-inflammatory effects
• Antidiarrheal mechanism: The tannin-mediated astringent action reduces intestinal mucosal secretion and permeability, inhibits intestinal motility to a mild degree, and forms a protective layer on inflamed intestinal mucosa
• Anti-inflammatory mechanism (oral/topical): Tannin protein precipitation forms a protective film on inflamed mucous membranes, reducing contact with irritants and pathogens; flavonoids and ursolic acid provide additional anti-inflammatory support

Clinical Evidence Summary

• No modern RCTs have been identified for agrimony as a single-herb preparation for any indication
• Pharmacological studies: In vitro studies have confirmed the astringent, antimicrobial, and anti-inflammatory properties of agrimoniin and the total tannin fraction. Animal studies have demonstrated antidiarrheal effects consistent with the tannin-mediated mechanism
• Agrimoniin research: This unique ellagitannin has been studied for antitumor and immunomodulatory properties in preclinical models, but these investigations are at a very early stage and unrelated to the approved digestive indications
• EMA assessment: Concluded that clinical evidence is insufficient for well-established use but that the therapeutic use is plausible based on the well-characterized astringent pharmacology of tannins and documented traditional use over at least 30 years within the EU
• Commission E assessment: Based on pharmacological rationale (tannin astringency is a well-understood mechanism) and traditional use documentation
• Combination products: Agrimony may appear in European combination products for diarrhea and oral inflammation, but controlled clinical studies of these combinations are also lacking
• The evidence for agrimony rests entirely on the well-established pharmacology of tannin-rich herbs and extensive traditional use documentation

European vs US/Anglophone Consensus

• In Germany and continental Europe, agrimony is recognized as a traditional tannin-based astringent herb for diarrhea and mucosal inflammation, available in pharmacies
• The European tradition of using tannin-rich herbs (agrimony, tormentil, oak bark) for mild diarrhea is well established and reflected in multiple Commission E and EMA monographs
• In the UK, agrimony has historical significance in the British herbal tradition but is not commonly used in modern clinical practice
• In the US, agrimony is essentially unknown in clinical medicine; it is not available as a mainstream dietary supplement
• US gastroenterology does not recognize tannin-based astringent herbs as a therapeutic category for diarrhea management
• The herb is more familiar to British and European herbalists than to American practitioners
• Agrimony is not listed in the US Pharmacopeia and has no FDA-evaluated therapeutic claims

Safety Profile

Contraindications

• Known hypersensitivity to agrimony or other Rosaceae plants
• No specific organ-based contraindications identified in the regulatory literature
• Use with caution in individuals with chronic constipation (astringent tannins may exacerbate)

Drug Interactions

• No significant drug interactions have been reported or identified
• Theoretical concern: High-tannin preparations may reduce absorption of concomitantly administered oral medications through tannin-drug binding; as a general precaution, separate intake by at least one hour
• No known CYP enzyme interactions

Side Effects

• Generally very well tolerated at recommended doses
• Mild GI discomfort, constipation (rare, dose-dependent, related to tannin content)
• Nausea (rare)
• No significant adverse effects reported in traditional use documentation or pharmacovigilance data
• Allergic reactions are theoretically possible but not documented in the literature

Pregnancy/Lactation

• Insufficient data to establish safety during pregnancy or lactation
• EMA advises against use during pregnancy and lactation due to lack of adequate safety data
• Not recommended for children under 12 years without medical advice (EMA)
• No specific teratogenic or reproductive toxicity concerns have been raised, but the precautionary principle applies

Clinical Dosage

Forms and Ranges

• Dried herb (tea/infusion): 1.5-4 g of dried herb per 150-250 mL boiling water, steeped 10-15 minutes; 2-4 times daily (internal use for diarrhea)
• Decoction (for gargle): 10% decoction (10 g per 100 mL water); use as gargle or mouth rinse several times daily for oral mucosal inflammation
• Tincture (1:5 in 45% ethanol): 1-3 mL, 3 times daily
• Liquid extract (1:1 in 25% ethanol): 1-3 mL, 3 times daily
• External use: Infusion or decoction applied as compress or wash for minor skin inflammations
• Timing: Internal doses can be taken between meals; no specific pre-meal timing required (unlike bitter herbs, the tannin mechanism does not depend on gustatory stimulation)
• Duration: For acute diarrhea, short-term use only (a few days); consult a physician if symptoms persist beyond 3-4 days. For oral mucosal inflammation, use until symptoms resolve

Key Standardized Products

• Agrimoniae herba preparations per European Pharmacopoeia
• Odermennigtee / Agrimony herb tea — traditional German pharmacy product
• Available in European combination herbal teas for diarrhea and digestive complaints
• Less commonly available as a single-herb standardized extract product

Sources

• EMA/HMPC European Union Herbal Monograph on Agrimonia eupatoria L., herba
• EMA/HMPC Assessment Report on Agrimonia eupatoria L., herba
• Commission E Monograph: Agrimoniae herba
• European Pharmacopoeia Monograph: Agrimony (Agrimoniae herba)
• Granica S, et al. Qualitative and quantitative analyses of secondary metabolites in Agrimonia eupatoria L. and Agrimonia procera Wallr. herbs. Acta Pol Pharm. 2015;72(3):533-541
• Miyamoto K, et al. Antitumor activity of agrimoniin, a tannin of Agrimonia pilosa. Chem Pharm Bull. 1985;33(11):5126-5128
• Wichtl M (ed). Herbal Drugs and Phytopharmaceuticals, 3rd ed. Medpharm/CRC Press, 2004
• Arzneipflanzenlexikon: Agrimony (arzneipflanzenlexikon.info)

Connections

• Closely related to Tormentil as a fellow tannin-rich astringent herb used for diarrhea in European phytotherapy; both rely on the same protein-precipitating mechanism
• Compare with German Chamomile for overlapping oral mucosal inflammation indications; chamomile acts through anti-inflammatory flavonoids (bisabolol, chamazulene) rather than tannin astringency
• Contrasts with Psyllium which treats both diarrhea and constipation through a bulk-forming fiber mechanism entirely different from tannin astringency
• Compare with Calendula for overlapping skin and wound-healing indications in European phytotherapy
• Agrimony exemplifies the European tradition of using tannin-based herbs for mucosal protection, a therapeutic approach with limited recognition in US/Anglophone medicine