Many different plants in the genus Artemisia are used as medicine. Some aspects of them are similar while others are different. This article will attempt to succinctly differentiate between some of the major forms available. Often these are called “sage” but this is highly confusing as plants in the genus Salvia are also known as sage and there is very little similar about them medicinally. I will focus here on native western species and those readily cultivated in the western US, and on species I have experience using with patients.
All Artemisia species are antimicrobial and stimulate digestion to some degree. They vary more widely in that some are distinctly nootropic (enhance memory and cognitive function) and inflammation modulating. All species are also emmenagogue to some extent. This means they should be avoided in women trying to get pregnant, or who already are, but may be useful as part of preventing implantation of a recently fertilized ovum (but there are no guarantees).
All Artemisia species are antimicrobial and stimulate digestion to some degree. They vary more widely in that some are distinctly nootropic (enhance memory and cognitive function) and inflammation modulating. All species are also emmenagogue to some extent.
|Species||Major Uses||Typical Tincture Dose||Typical Crude Herb Dose|
|Artemisia tridentata (big sagebrush)||Antimicrobial, inflammation modulator||0.5-2 ml 5-6 x/d (acutely for 7 d max)||1-2 g up to 6 x/d|
|Artemisia ludoviciana (Mexican white sagebrush)||Bitter digestive stimulant, nootropic||1-2 ml tid||1-2 g tid|
|Artemisia absinthium (wormwood)||Antiparasitic, inflammation modulator||0.5-1 ml tid||250-1,000 mg tid|
|Artemisia annua (sweet Annie)||Antimalarial, antineoplastic, immunosuppressant||2-3 ml tid||up to 20 g qd (300 mg tid of pure artemisinin every other week)|
Artemisia tridentata (big sagebrush) is perhaps one of the most overlooked herbs in this genus. This large shrub is a dominant species in the Great Basin (from west-central Canada through eastern Washington and Oregon and beyond). It is known by the Diné as ts’ah ch’il, by the Havasupai as maqwapta, by the Paiute as sah-wavvy, by the Shoshone as boh-ombe, and by the Washoe as da-bel. In Spanish is it known as chamiso hediondo (“stinky chamiso”) and estafiate (“mugwort”).
As its species name suggests, big sagebrush leaves have three tips. These leaves contain terpenoids that are potent, broad-spectrum antimicrobials and that modulate inflammation. It does taste very strong, but luckily small doses are effective. Pairing it with Zingiber officinale (ginger), Alpinia galanga (galangal), Cinnamomum spp (cinnamon), and similar pungent herbs or diluting it in water before taking will best help to handle taste problems. A typical dose of fresh-plant tincture is 0.5—2 ml three times a day for chronic problems and up to 5—6 times a day for acute problems (for no more than a week).
A cold infusion of the plant is a very effective treatment for an atonic digestive tract and hypochlorhydria, especially when accompanied by chronic gastritis. I follow the late, great herbalist Michael Moore’s recommendation to soak (wrapped in cloth) 1 part of herb to 32 parts of water overnight at room temperature, and then have the patient sip 1—3 oz of that liquid before meals. Though initially quite unpleasant, it grows on people and is sufficiently diluted in this application to be tolerable.
A hot tea of the herb (just a tsp in 1 cup of water is sufficient, steeped in recently boiled water for 10–15 min with a lid) will also promote sweating and coughing early in infectious processes.
Mexican White Sagebrush and Mugwort
Artemisia ludoviciana (Mexican white sagebrush) is medicinally quite close to the famed Chinese herb Artemisia vulgaris (mugwort, ai ye). Both of these species are abundant and readily cultivated. Mexican white sagebrush is a relatively small herbaceous plant, unlike the robust shrub of big sagebrush. Mexican white sagebrush is found just about everywhere in the western US and Canada but generally not on the wet side of the Cascades and Sierra Nevadas. The term mugwort is believed to have arisen either because Artemisia spp were frequently used to flavor beers (served in mugs) before hops was introduced, or from the old English moughte, moth, because of Dioscorides’ statement that mugwort was a useful moth repellant.
Mexican white sagebrush and mugwort are definitely nootropic. Various species in the genus inhibit acetylcholinesterase after oral administration which would help explain this property. However, antioxidant and inflammation modulating properties also likely contribute. A typical dose of fresh-plant tincture for this purpose is 1—2 ml tid. Of dried herb, the dose would be 1,000-2,000 mg tid. Teas of this herb can be used just like big sagebrush, but they are not as strong.
Mugwort and other artemisias are also of interest because of their use as burned medicine. In acupuncture, moxa is made from wormwood. Mexican white sagebrush, other local Artemisia spp, and true mugwort (all often called “sage”) are the basis of many smudging rituals. Mexican white sagebrush infusions can be inhaled to effectively fight bronchitis.
My late mentor Silena Heron, ND used to say that if it or mugwort were harvested at midnight at the full moon it had the greatest physiological potency and if picked at the new moon it had the greatest energetic potency. Hopefully a clinical trial of this will soon be launched.
Artemisia absinthium (wormwood) is a Eurasia native that grows well in many parts of the west including western Washington, Oregon, and British Columbia. It is a shrub more like big sagebrush. It is well known as potent bitter (an action proven in older clinical studies in humans) and antimicrobial, particularly attacking intestinal parasites.
More recently, several clinical trials on a standardized (meaning quality control is guaranteed by monitoring constituent levels) extract of wormwood have been shown to have clinically-relevant TNF-alpha inhibited properties. This has led to improvement in Crohn’s disease and IgA nephropathy in preliminary studies to date.
The irrational fears and misunderstandings about the wormwood-containing beverage known as absinthe should not be applied to medicinal uses of this plant. This has been borne out clinically again and again. Dr. Heron and I published a case series showing that at a dose of 0.5—1 ml tid, fresh-plant tincture of wormwood is safe and actually lowers liver enzyme levels. Aqueous extracts of wormwood have also been shown hepatoprotective in mice.
Artemisia annua (Sweet Annie, qing hao), a prolific weed, yields the sesquiterpene lactone artemisinin, which, along with several semi-synthetic variants, has revolutionized the treatment of malaria in the past 20 years. Unfortunately, these agents are being used incorrectly, just like all prior drugs: indiscriminately, without combination therapy in many cases, and often without even being present due to corruption in the developing world resulting in sales of adulterated products. The result has been a rapid rise in artemisinin resistance. This is particularly sad given that crude herbal infusions of whole sweet Annie have been shown to be antimalarial in humans. Once again the profit-driven pharmaceutical model has trumped the low technology, locally-controlled, complex herbal model, to the detriment of the people who actually need help. It should be noted that sweet Annie and artemisinin are not effective at preventing malaria as they only attack a form of malaria (the schizont) that develops after infection has occurred.
Sweet Annie and artemisinin are gaining new respect as antineoplastic agents. After a case study was published in 2002 regarding a patient with laryngeal squamous cell carcioma successfully treated with artesunate injections and oral supplements, interest grew. Many preclinical studies suggest artemisinin is active against a range of cancer types, but clinical research is lacking. My own experience in prostate cancer has been promising, and a case study involving 18 patients has been submitted for publication. The usual dose of purified artemisinin is 300 mg tid every other week.
Despite its common name (probably related to its pleasant odor), sweet Annie is quite bitter and a digestive stimulant. It is also historically used to treat discoid and systemic lupus erythematosus at doses of 20-30 g per day (providing 200-600 mg artemisinin). Some evidence suggests it is actually immunosuppressive.
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