Kathy Abascal, B.S., J.D., R.H. (AHG)
and Eric Yarnell, N.D., R.H. (AHG)
nxiety is a common ailment in our society. However, the
drugs available to treat mild-to-moderate anxiety, partic-
ularly benzodiazepines, are problematic because they can
cause injury, produce side-effects, and create dependence.
Nervine herbs have been widely used historically to treat mild-
to-moderate cases of anxiety, and these herbs appear to be very
safe, nonaddictive but their properties as anxiolytics have been
This article discusses the clinical uses of a number of nervines:
oat seed (Avena spp.), hawthorn (Crataegus spp.), California
poppy (Eschscholzia californica), lavender (Lavandula spp.),
chamomile (Matricaria recutita), lemonbalm (Melissa officinalis),
passionflower (Passiflora spp.), skullcap (Scutellaria lateriflora),
and verbena (also called vervain; Verbena spp.).
Botanical practitioners often prescribe nervine herbs to help
their patients cope with stress, anxiety, insomnia, mild depres-
sion, and similar problems. These herbs have a long history of
traditional use and appear to be safe and effective. Unfortunate-
ly, they have received little to no scientific attention.
A recent French clinical study pointed out the great need for
serious research on the use of nervines. The authors explained
that patients frequently consult their physicians about anxiety
disorders, and estimated that 25 percent of adult French patients
suffer from some type of anxiety disorder.
The statistics also
show that anxiety disorders are common in American patients.
Typically, anxiolytics or hypnotics, most commonly benzodi-
azepines, are prescribed for these patients. However, the use of
these drugs is problematic.
With short-term use, because of their sedative nature, they can
cause loss of memory, may disturb balance in elderly patients,
may produce degradation of sleep quality, and may diminish
alertness in drivers, leading to accidents and injuries. These
agents can also cause rebound insomnia and anxiety after discon-
tinuation or paradoxical worsening of anxiety during use. With
long-term use, the drugs can lead to dependence and withdrawal
symptoms as well as such-side effects such as somnolence,
fatigue, gastrointestinal (GI) upset, and vertigo.
If traditional wisdom and the current professional evaluation
of nervines are correct, botanicals may provide a much better ini-
tial prescription for most of these patients, allowing practitioners
to reserve the stronger pharmaceuticals for more difficult and
persistent cases of anxiety. It follows that research to evaluate the
clinical effectiveness and safety of these herbs in mild-to-moder-
ate anxiety disorders should be made a much higher priority
than at present.
In fact James A. Duke, Ph.D., the renowned botanist and eth-
nobotanist (formerly with the U.S. Department of Agriculture,
and now at Green Farmacy, Fulton, Maryland) has proposed that
all drug trials funded by the National Institutes of Health should
be required to compare drugs not just to placebo but also to an
herbal medicine (personal communication with Dr. Duke, June
In the meantime, this article explains how nervines are com-
monly used in practice and attempts to clarify some of their clini-
cal distinctions. When relevant research is available, this is noted
but, because such research is limited, the article mainly describes
present clinical pictures.
A few botanicals—such as St. John’s wort (Hypericum spp.) for
mild-to-moderate depression, kava (Piper methysticum) for mild-
to-moderate anxiety, and valerian (Valeriana spp.) for insomnia—
have a substantial amount of research support and those uses are
not discussed. Instead coverage includes some commonly used
but less well-known nervines. Tables 1 and 2 provide additional
information on most of the nervines in use, including some of
their specific uses and dosages and include these three herbs.
Hawthorn and California Poppy
In the French study mentioned above, researchers administered
a tablet combining 75 mg of dried hydroalcoholic extract of
hawthorn flower (Crataegus oxyacantha, now known as C.
laevigata), 25 mg of dried aqueous extract of California poppy
flower and 75 mg of elemental magnesium. Patients took 2 tablets
twice daily for 3 months. Two hundred and sixty-four (264)
patients participated in this multicenter study, which measured a
change in Hamilton anxiety scale, change in patient self-assess-
ment, number of responsive subjects (defined as at least 50-per-
cent reduction on the Hamilton or self-assessment scale), and the
physician’s clinical global impression. Only physicians specializ-
ing in the evaluation of drugs in mental disorders participated.
As in most anxiety studies, the placebo response was high (40
percent). However, the decrease in Hamilton anxiety scale results
and the self-assessment of anxiety results were both significantly
for Treating Anxiety
GJ 10_6_toc2-351 11/23/04 12:41 PM Page 309
greater in the herb group than in the placebo group. The physi-
cians rated the combination formula, with 90 percent in favor of
the study drug as opposed to 80 percent for placebo. The
researchers elected not to include a benzodiazepine arm as they
were looking for a clinical solution to mild-to-moderate anxiety
rather than a substitute for those drugs. The researchers conclud-
ed that the combination formula was an effective and safe alter-
native, symptomatic treatment for mild-to-moderate anxiety
states in clinical practice.
Interestingly, hawthorn is not typically considered a nervine.
Instead, this herb is primarily viewed as a heart medicine and is
fairly well-researched as such. However, many herbal practition-
ers have noted that hawthorn has a calming effect and that it can
also help alleviate cardiac symptoms of anxiety such as palpita-
tions and increased blood pressure.
Unlike hawthorn, the lovely California poppy is primarily
used as a nervine. The California and the opium poppy (Papaver
somniferum) are in the Papaveraceae family although only opium
is narcotic. California poppy will not produce a high and helps to
normalize psychologic function. This herb has mild analgesic
effects and is a lighthearted calmer.
Surprisingly, low-dose opium appears to have similar effects
to California poppy, being described as an antidepressant and
hypnotic in older herbals.
Only at high doses or as purified
heroin or morphine, does opium dull consciousness, cause
euphoria, and induce sleep.
There are anecdotal reports that California poppy used alone
has helped individuals overcome their fear of flying or of pub-
lic speaking. Nonetheless, most clinicians seldom use Califor-
nia poppy alone, instead using it to harmonize and boost the
actions of other nervines. In a lower dose in a mood formula,
California poppy makes life seem a little better, a little more
manageable, to patients. In a higher dose in a sleep formula,
the herb makes the patient more ready to fall asleep. Mixed
with valerian or other herbs, California poppy creates a sleep
mixture that works if pain, say from a sprained ankle, is inter-
fering with sleep.
Studies show that California poppy tea reduces anxiety, acts as a
mild analgesic, and helps prevent drug-induced memory loss in
Animal studies confirm that an aqueous–alcoholic extract of
California poppy has sedative effects at higher doses and anxiolytic
effects at lower doses.
California poppy contains protopine, a com-
310 ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2004
Ta b l e 1. Other Common Clinical Uses for Nervines
Herb Easily Sleep Other
Common name fatigued; Anger Trouble with problems Heart major
(Latin binomial) mildly depressed issues concentrating (Nonorganic) palpitations Panic indications
California poppy X X Pain
Chamomile X X X Indigestion;
(Matricaria recuita) inflammation
(Crataegus spp.) X disease
Kava X X X Pain;
(Piper methysticum) addiction
Lavender X X Infections
Lemonbalm X X X Viral
(Melissa officinalis) infections
Linden X X Viral
(Tilia spp. ) infections
Motherwort X X X Uterine
(Leonuris cardiaca) weakness
Oats X X X X Addiction
Passionflower X X X X Pain
Skullcap X Pain
St. John’s wort X X Neuropathy;
(Hypericum spp.) viral infections
Valerian X X Pain
Verbena X Hormonal
(Verbena spp.) imbalance;
Notes: X = Indication for use; each herb is used as a nervine to address general anxiety and irritability.
GJ 10_6_toc2-351 11/23/04 12:41 PM Page 310
pound that is suggested to have both antiacetylcholinesterase and
The extracts injected i.p. did not induce
any acute toxic effects and its LD
was more than 5000 mg/kg.
Native Americans claimed that even the scent of California
poppy was poisonous to pregnant women, and it is contraindi-
cated in pregnancy because its constituent allocryptopine (and
possibly other alkaloids) have an oxytocic effect.
There are no
other known adverse effects, contraindications, or interactions.
Immature Oat Seed
One of the safest and most popular nervines is the immature
seed of oats. It is prescribed for acute and chronic anxiety, stress
and excitation, neurasthenic and pseudoneurasthenic syndromes,
skin diseases, connective tissue deficiencies, weakness of the
bladder, and as a tonic and roborant. The German Commission E,
however, concluded that its effectiveness for these conditions
had not been established.
The Eclectics considered tincture of oat seed to be a mild stim-
ulant and nerve tonic and many Eclectics considered it to be of
some importance for treating nervous debility and afflictions bor-
dering closely upon nervous prostration. The herb was deemed
useful for treating headaches resulting from exhaustion or over-
work or the nervous headache sometimes associated with men-
struation. But the Commission cautioned that oat seed was not a
remedy of great power and would not always be useful. The
Eclectics did not consider this herb’s use for addressing mor-
phine addiction to be substantiated.
Many Western herbalists prefer to use oat seed tincture as a
simple to quiet temporary, mild anxiety or to take the edge off
moods that might otherwise be expressed as angry outbursts or
losses of self-control. We have also used it for dogs to calm them
and avert seizures.
Oat seed tincture is frequently included as an ingredient in for-
mulas intended to help patients quit smoking. This aspect of oats
has been the subject of some research, mostly with negative
These results mirror the conclusion of the Eclectics: Oat seed is
not strong enough to have a substantial effect on serious addic-
tions such as cigarette smoking, although the herb’s calming
effect may be somewhat helpful as a component of a treatment
for these addictions. Oat seed is, however, safe for use in essen-
tially anyone, with no known contraindications, adverse effects,
Passionflower leaf may be more useful in formulas for treating
addiction. The herb is frequently used in herbal sleep formulas as
well as in calming formulas for treating anxiety. The German
Commission E has approved the use of passionflower for
addressing nervous restlessness.
According to the Eclectics, pas-
sionflower was specifically indicated for irritations of the brain
and nervous system with atony, insomnia from worry or over-
work or from febrile excitement, sleeplessness of young or aging
patients, convulsive movements, hysteria, infantile nervous irri-
tability, dyspnea, or heart palpitations from excitement or
Passionflower was considered to be a very effective rem-
edy for whooping cough and spasmodic asthma.
In patients who are addicted to heroin, passionflower signifi-
cantly enhanced the effect of clonidine for reducing withdrawal
In this study, 65 patients who were addicted to an
opiate were randomly assigned to take either clonidine and 60
drops of passionflower extract (further details were not provid-
ed) or clonidine and 60 drops of placebo liquid, 3 times daily, for
14 days. The Short Opiate Withdrawal Scale was used to assess
the benefit of adding passionflower to the regimen.
Passionflower was as effective as oxazepam in the treatment
of 36 patients with generalized anxiety disorder and was pre-
ferred over the drug by the researchers because the herb did not
impair job performance.
The patients (20 women and 16 men)
who met the Diagnostic and Statistical Manual of Mental Disorders
IV criteria for a diagnosis of generalized anxiety disorder with a
duration of at least 6 months participated in this 4-week-long
trial. A proprietary liquid extract of P. incarnata (45 drops/day)
was used in the study, and a psychiatrist assessed the patients,
using the Hamilton Anxiety Scale (HAM-A) on 6 occasions dur-
ing the study.
A passionflower constituent (a trisubstituted benzoflavone
moiety) reversed tolerance and dependence on several psy-
chotropic drugs in rats, including morphine, nicotine, ethanol,
diazepam, and delta-9-tetrahydrocannabinol.
enhanced libido and reduced the libido-depressing action of the
psychotropic drugs in animals.
The herb had an anxiolytic
effect in mice at doses of 50–150 mg/kg.
ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2004 311
Passionflower (Passiflora spp.). Drawing ©2004. Kathy Abascal, B.S.,
J.D., R.H. (AHG).
GJ 10_6_toc2-351 11/23/04 12:41 PM Page 311
Passionflower had a synergistic effect when administered with
kava to mice.
Kava had a more pronounced effect on reducing
amphetamine-induced hypermotility while passionflower pro-
longed barbiturate-sleeping time more than kava did. However,
another study revealed that passionflower reduced the hexobar-
bital sleeping time of mice.
One pharmacologic study failed to show that passionflower
bound to benzodiazepine, dopaminergic, or histaminergic recep-
tors in vitro.
Numerous species of Passiflora have been considered for use as
medicine, primarily P. incarnata and P. edulis. One animal study
found that while P. incarnata was active as an anxiolytic, P. edulis
was devoid of any activity.
P. incarnata is also the species most
commonly referenced by older herbals. Therefore, until and
unless P. edulis is shown to be as or more effective than P. incar-
nata, P. incarnata should be used preferentially.
There are reports of passionflower causing tachycardia but the
herb’s overall safety profile is very high and passionflower can be
used in pregnancy.
There are lingering concerns that aqueous
passionflower extracts can increase serum amylase levels, pre-
sumably because of pancreatic damage, as has been observed in
Actual pancreatitis has only been reported very
rarely so these laboratory changes are of unknown importance.
Lemonbalm leaves have a long history of use as anxiolytics
and memory support. The German Commission E has approved
the use of lemonbalm for addressing nervous sleeping disorders
and functional GI complaints. Clinicians often prescribe lemon-
balm as a mild mood elevator and calming herb for patients who
312 ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2004
Table 2. Doses for Nervines and Possible Safety Considerations
(Latin binomial) Adult dose, tincture Negative drug interactions Safety concerns
California poppy` 0.5–1 mL qid Theoretical concern that it may
(Eschscholzia californica) potentiate monoamine oxidase– None known;
inhibitors Considered safe in pregnancy
Chamomile 4–6 mL tid — None known; Considered safe
(Matricaria recuita) in pregnancy
Hawthorn 4–5 mL tid — None known; considered safe
(Crataegus spp.) in pregnancy
Kava (Piper methysticum) 3–5 mL tid Theoretical concern that it may Not safe in pregnancy; not for
increase toxicity of hepatotoxic use in patients with liver
drugs ailments, patients on drugs that
tax the liver, or patients who
frequently consume alcohol;
not for long-term use.
Lavender 1–2 mL tid — None known; considered safe
(Lavandula spp.) in pregnancy
Lemonbalm 2–5 mL tid — None known; considered safe
(Melissa officinalis) in pregnancy
Linden 3–5 mL tid — None known; considered safe
(Tilia spp.) in pregnancy
Motherwort 1–2 mL qid — None known; considered safe
(Leonuris cardiaca) in pregnancy
Oats Tincture — None known; considered safe
(Avena spp.) 1–5 mL qid in pregnancy
Passionflower 3–5 mL tid — None known; considered safe
(Passiflora incarnata) in pregnancy; isolated reports
of tachycardia and pancreatitis
Skullcap 3–5 mL tid — None known; considered safe
(Scutellaria lateriflora) in pregnancy
St. John’s wort Tincture Can decrease blood levels of many Possible photosensitization but
(Hypericum spp.) 2–5 mL qid prescription medications, including likely to be rare; otherwise
birth control pills, protease none known; considered safe
inhibitors, warfarin, and digoxin in pregnancy
Valeriana spp. (valerian) 4–8 mL qd–tid — None known; considered safe
Verbena 1–3 mL tid — None known; not safe in
(Verbena spp.) pregnancy
Note: Most nervines are poorly studied and their possible interactions with drugs are not fully known.
GJ 10_6_toc2-351 11/23/04 12:41 PM Page 312
In a randomized, placebo-controlled, double-blinded crossover
trial of 20 healthy volunteers, lemonbalm produced a sustained
improvement in accuracy of attention and calmness at the lowest
dose (300 mg/day) and a reduction
of alertness and memory decre-
ments at the highest dose (900
The study failed to con-
firm a significant effect on choliner-
The researchers noted that the
lowest dose of lemonbalm
appeared to be most efficacious
and also noted that the low cholin-
ergic-binding properties might
have been a result of the loss of volatile components in the
product used. We, and many other practitioners, prefer to use
only products made from fresh lemonbalm to preserve these
In a double-blinded, randomized, placebo-controlled trial, 42
patients with mild-to-moderate Alzheimer’s disease were given a
daily dose of 60 drops of lemonbalm tincture over a 4-month
Lemonbalm significantly improved cognitive function
compared to placebo, with significant improvement in cognition
seen after 16 weeks of treatment. In addition, agitation was more
frequent in the placebo group. This correlated with another clini-
cal trial that indicated that lemonbalm essential oil had a calming
effect on patients with Alzheimer’s disease.
At low doses, lemonbalm was said to have a sedative effect on
mice (it increased their comfort with being in open spaces, which
is interpreted as an anxiolytic effect); at higher doses, the extract
had a peripheral analgesic effect and potentiated the sedative
effect of pentobarbital.
Lemonbalm does have a thyroid-inhibiting action (by acting
both on thyroid-stimulating hormone [TSH] and on the cellular
TSH receptor) in vitro.
Today, lemonbalm is sometimes used
clinically to treat hyperthyroidism based on these in vitro stud-
ies. Yet, the general practitioner consensus is that the herb can be
used safely in patients with low thyroid function. It may be that
other constituents in the plant offset the effects of the isolated
constituent in vitro.
Lemonbalm is also useful for treating herpes and other viral
infections, and its pleasant lemony flavor often makes it useful as
a taste enhancer in formulations.
Lemonbalm is exceedingly safe and is often used in children.
There are no known drug interactions or contraindications. A
typical adult dose of the fresh herb tincture is 2–5 mL, 3 times
Verbena (or vervain) has a widespread and very long histo-
ry of use. The Druids considered this herb to be sacred and
used it in ceremonies and religious rites. The name “vervain”
comes from the Celtic ferfaen, which meant “to drive away a
stone,” referring to a traditional use of verbena for treating
bladder problems and urinary stones. The physicians of
Myddfai in thirteenth-century Wales recommended verbena
for addressing all diseases but especially those of the liver,
lungs, and kidneys.
It was widely used in various traditions
for treating colds, dyspepsia,
weak nerves, and liver disorders.
In South America, the herb contin-
ues to be used to stimulate milk
production, especially in over-
stressed new mothers.
As a nervine, the leaves and flow-
ers of Verbena species are often used
when there is a component of anger
or agitation present in the patient.
Herbalist Michael Moore, director
of the Southwest School of Botanical Medicine, Bisbee, Arizona,
gives the following clinical picture of a patient who is likely to
benefit from the use of verbena:
Verbena is useful in a flushed, red faced or angry person, it is a
menopausal nervine that chills and calms, allowing sleep; it also
quiets those sudden angry outbursts that frequently occur in peri-
menopause. It will have the same effect on younger women with
outbursts related to premenstrual syndrome.
Dr. Moore also considers verbena to be a great occasional
herb to use for children who are worked up, red in the face,
overexcited, and unable to calm down (personal communica-
tion with Dr. Moore).
The German Commission E concluded that there was not
enough evidence to establish the effectiveness of verbena for
treating ailments of the oral and pharyngeal mucosa (angina,
sore throats), of the respiratory tract (coughs, asthma,
whooping cough), pain, spasms, exhaustion, nervous condi-
tions, digestive disorders, liver and gallbladder diseases,
jaundice, diseases and ailments of the kidneys and lower
urinary tract, menopausal complaints, irregular menstrua-
tion, or lactation.
The Commission does consider verbena to
Verbena’s use as a nervine has not been researched. Several
constituents in V. littoralis H.B.K. enhanced the activity of
nerve growth factor–mediated neurite outgrowth in vitro.
The various verbena species are considered to be largely inter-
changeable in clinical practice.
Verbena, in vitro, displayed a higher degree of binding to
progesterone receptors and increased the progestin activity of
saliva to a greater degree than did 150 other herbs and spices.
Information on whether this activity constituted a significant
effect was not available.
In an abstract, it was reported that verbena combined with
many other herbs (black cohosh [Acatea racemosa], red clover [Tri-
folium spp.], wild yam [Dioscorea villosa], sage [Salvia spp.], chaste-
berry [Vitex agnus-castus], astragalus [Astragalus membranaceus],
motherwort [Leonurus cardiaca]) and soy isoflavones in an open-
labeled study dramatically decreased menopausal symptoms of
tiredness, absent-mindedness, and lack of energy as well as the
typical menopausal symptoms of hot flashes, heart palpitations,
and night sweats.
ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2004 313
Lemonbalm essential oil had a
calming effect on patients with
GJ 10_6_toc2-351 11/23/04 12:41 PM Page 313
Lavender and Linden
Lavender leaf and linden (Tilia spp.) flower are two nervines
with more pronounced sedative effects. Lavender is a mint native
to the Mediterranean region while linden, sometimes slightly
confusingly called lime flower, is in the Tiliaceae family and is
not in any way related to true lime.
The German Commission E has approved the use of laven-
der flowers for addressing mood disturbances, such as restless-
ness or insomnia, functional abdominal complaints (nervous
stomach irritations, intestinal gas), and nervous intestinal dis-
The Eclectics considered lavender to be an agreeable and
soothing lotion for treating headaches related to debility and
The herb was an ingredient in a soothing syrup pre-
scribed for nervous irritability in children.
Practitioners today often add lavender as a component in a
nervine formula, and consider the herb to be helpful but tend not
to use it as a stand-alone treatment. The essential oil is commonly
used as a calmative, to relieve mild headaches, as an antimicro-
bial, and to treat minor burns.
Historically, linden flowers were used in many parts of the
world as sedatives, tranquilizers, and diuretics. Today, the flowers’
primary use is as a treatment for colds and flu. Herbalists and
other natural medicine practitioners also use linden flowers to
relax blood vessels, and the herb is often used in small doses to
calm older, nervous people and reduce high blood pressure. In
larger doses, the flowers are used to encourage good, restful sleep.
Animal studies tend to confirm these uses as they show that
linden flowers reduce anxiety in mice, reduce blood pressure,
and have a sedative effect at higher doses. The flowers contain
mucilages, flavonoids, phenolic carbon acids, and essential oils.
It has been reported that fresh infusions of linden prolonged the
swimming time of mice in a forced swimming test, which is
interpreted to indicate an antistress effect.
A flavonoid complex injected i.p. in mice produced a clear anx-
Another study reported that a freeze-dried aque-
ous extract of linden produced sedative effects in mice at doses
ranging from 10 to 100 mg/kg.
Linden extracts injected into rabbits produced a hypotensive
effect with a large drop in diastolic arterial pressure, indicating
An aqueous extract of linden flowers stimulated
lymphocyte production in vitro, with an action mimicking that of
two drugs that act as agonists of the peripheral benzodiazepine
receptor, perhaps suggesting that linden also is an agonist of this
Some concerns have been raised that, because linden contains
vitamin K, it may lessen the effect of warfarin or related anticoagu-
lant therapy. However, the usual doses of linden are far too low to
contain and deliver sufficient vitamin K to interfere. Generally, lin-
den is considered to be a safe herb that can be used in pregnancy.
The nervines discussed in this article have a long history of
use in many different folk traditions for improving mental func-
tioning, moods, and sleep. These herbs continue to be widely
used in a similar fashion by most botanical practitioners and
appear to be very safe and effective for addressing mild-to-mod-
erate anxiety and its many symptoms. Further research into the
clinical effectiveness of these plants as a first-line treatment for
anxiety should be made a high priority, reserving pharmaceuti-
cal drugs such as benzodiazepines for more persistent or diffi-
cult cases of anxiety. ■
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Kathy Abascal, B.S., J.D., R.H. (AHG), is executive director of the Botan-
ical Medicine Academy, Vashon, Washington. Eric Yarnell, N.D., R.H.
(AHG), is president of the Botanical Medicine Academy, a specialty
board for using medicinal herbs, and is an adjunct faculty member mem-
ber at Bastyr University, Kenmore, WA.
To order reprints of this article, write to or call: Karen Ballen, ALTERNA-
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