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herbal medicine

We share traditional, scientific and practical insights written by experienced herbalists and health experts from the world of herbal medicine and natural health

  • Herb overview

    Safety

    Safe for adults and children
    Very few documented adverse side effects
    No contraindications
    Minimal interactions

    Sustainability

    Status: Lower risk

    Key constituents

    Flavonoids
    Tannins
    Minerals
    Carbohydrates

    Quality

    South Africa, Lesotho and Eswatini
    Wild harvested
    Adulteration risk with Pelargonium reniforme

    Key actions

    Expectorant
    Antiviral
    Immunomodulator
    Antimicrobial

    Key indications

    Rhinitis
    Influenza
    Bronchitis
    Sinusitis

    Key energetics

    Cool
    Dry
    Bitter

    Preperation and dosage

    Root
    >90 mg dried extract per day
    ~4.5 ml tincture per day

  • How does it feel?

    An infusion or decoction (strong herbal tea) made from the root is bitter, woody and earthy, and strongly aromatic. It has an intense, robust flavour, and feels drying on the tongue.

    African geranium (Pelargonium sidoides)
    African geranium (Pelargonium sidoides)
    African geranium root (Pelargonium sidoides)

  • Into the heart of African geranium

    African geranium (Pelargonium sidoides)
    African geranium (Pelargonium sidoides)

    With a clear affinity for the respiratory system due to its immunomodulator, antimicrobial, expectorant and antiviral actions, and one with few known safety cautions or contraindications, this herb has developed a reputation for being particularly important in the treatment of children with upper respiratory tract infections and catarrh (1,2,5).

    Several trials have conducted research using African geranium for this purpose — and results have shown it is both a well tolerated and safe remedy for children over the age of one year old, who are experiencing coughs, colds, sinusitis and sore throats (2). It also shows activity against some strains of Herpes virus (2).

    Cooling and drying in nature due to its bitterness and astringency, it can be considered a relaxant, qi regulating herb, although there is little documented information available on the traditional energetic qualities of this plant across traditional Chinese medicine (TCM), Ayurveda, Unani or Western herbal medicine, since it is a herb from the South African Muti system of medicine, which does not classify plants in the same way as other traditional medicine systems (6).

    The South African Muti traditional medicine system is more experiential and deals with ‘functional energetics’ as opposed to fixed temperatures or categories that exist in other traditional medicine systems (i.e., hot/cold, damp/dry) (6–8).

  • What practitioners say

    Respiratory systemRespiratory system

    Complete patient recovery or major improvements in bronchitis have been widely documented by researchers and practitioners in the treatment of acute bronchitis in adults and children in several studies (9–11). Patients with rhinosinusitis, otitis media and tuberculosis have also shown improvements in various studies (12).

    However, many of the clinical trials and studies focus on an isolated extract of the herb (EPs 7630) and not the whole-plant extract. Isolating single compounds or using standardised extracts can limit results or have different risks compared to whole-plant extracts, since whole-plant extracts often work synergistically and many of the “secondary” compounds may be very supportive to the action of the “primary” active compound, for example, enhancing immunomodulator activity (13,14).

    Some promising research was conducted in 2021, with the herb demonstrating efficacy in prevention and treatment of COVID-19 (15).

    As such, more high-quality clinical trials are needed to understand the full spectrum of actions of whole-plant extracts of Pelargonium sidoides in addition to studies of single isolates in order to understand this plant’s healing potential.

  • African geranium research

    African geranium (Pelargonium sidoides)
    African geranium (Pelargonium sidoides)

    Treatment with EPs 7630, a Pelargonium sidoides root extract, is effective and safe in patients with the common cold: Results from a randomized, double blind, placebo-controlled clinical trial

    This study randomly prescribed 105 adults with common cold symptoms administration of 40 mg oral EPs 7630 or a placebo, for 10 days. The aim was to measure differences in cold intensity score (CIS) between day one to five. Treatment with EPs 7630 demonstrated higher impact than a placebo in patients. It demonstrated a faster reduction of symptom intensity which supports existing data on efficacy and safety of EPs 7630 (11).

    Pelargonium sidoides preparation (EPs 7630) in the treatment of acute bronchitis in adults and children

    2099 patients (between ages 0 to 93 years) with a productive cough lasting fewer than six days were studied as part of this multi-centre, prospective, open observational study. Its main aim was to monitor the mean change in the Bronchitis Severity Score (BSS). The markers included — cough, sputum, rale, rhonchi, chest pain when coughing, and dyspnoea. Patients were given an age-dependent dose of EPs 7630 for 14 days.

    In adults, the average bronchitis severity scores dropped from 7.1 to 1.0, showing major symptom improvement, from moderate illness to very mild symptoms by the final assessment. In children, scores decreased from 6.3 to 0.9, and children under three years old decreased from 5.2 to 1.2. These results indicate good symptom reduction across age groups (10).

    The Pelargonium sidoides extract EPs 7630 drives the innate immune defense by activating selected MAP kinase pathways in human monocytes

    In this in vitro study, researchers administered EPs 7630 to cultured human peripheral blood mononuclear cells (PBMCs) at intervals of concentrations: 0.1 μg/ml; 1 μg/ml; 3 μg/ml; 10 μg/ml and 30 μg/ml. The aim was to evaluate dose‑dependent response in cytokine production and signalling activation in the cells. EPs 7630 improved immune responses via influencing immune signals that modulate inflammatory responses. EP 7630 therefore demonstrates in vitro efficacy in infection prevention — suggesting that administering the extract in vivo before full symptom presentation could reduce respiratory infection symptoms at onset (16).

    These findings indicate that further study of P. sidoides for effects on the immune system could lead to identification of chemical structures that novel therapeutic agents could be developed from, as well as lending further insight into molecular mechanisms of action (17).

  • Historical use of African geranium

    Historically, in its native South Africa, Lesotho and Eswatini, it has been used — by the Xhosa people in particular — to treat digestive conditions such as dysentery (a severe form of gastroenteritis) diarrhoea and liver conditions (1–3).

    It has also been used in the treatment of wounds, menstrual pain, fatigue, fevers and weakness (2,3). One source cites it as having been used to treat “stinging breast pain”(8).

  • African geranium’s herbal actions

    Herbal actions describe therapeutic changes that occur in the body in response to taking a herb. These actions are used to express how a herb physiologically influences cells, tissues, organs or systems. Clinical observations are traditionally what have defined these actions: an increase in urine output, diuretic; improved wound healing, vulnerary; or a reduction in fever, antipyretic. These descriptors too have become a means to group herbs by their effects on the body — herbs with a nervine action have become the nervines, herbs with a bitter action are the bitters. Recognising herbs as members of these groups provides a preliminary familiarity with their mechanisms from which to then develop an understanding of their affinities and nuance and discern their clinical significance.

    Western actions

    Ayurvedic actions

    Chinese actions

  • African geranium’s energetic qualities

    Herbal energetics are the descriptions Herbalists have given to plants, mushrooms, lichens, foods, and some minerals based on the direct experience of how they taste, feel, and work in the body. All traditional health systems use these principles to explain how the environment we live in and absorb, impacts our health. Find out more about traditional energetic actions in our article “An introduction to herbal energetics“.

  • What can I use African geranium for?

    African geranium (Pelargonium sidoides)
    African geranium (Pelargonium sidoides)

    African geranium can be a useful remedy in the treatment of acute upper respiratory tract, ear and chest inflections such as colds, bronchitis, rhinosinusitis — predominantly in the treatment of coughs (1,2). It has also been used to treat fevers, colds and tuberculosis (2,3).

    The Committee on Herbal Medicinal Products of the European Medicine Agency (EMA)  supports this use, stating that “the effectiveness of these herbal medicines is plausible… and there is evidence that they have been used safely… for at least 30 years” (4).

    Whilst there is clinical research to support its medicinal use, evidence is patchy — yet due to its proven long history of traditional use, it has been accepted by the EMA as a key, safe herbal remedy in the EU, and is listed in the European Pharmacopoeia, making it a strong ‘advocate herb’ and ally for herbalists and communities; its official acceptance by regulatory bodies helps bolster the case for herbal medicine use globally (1,4).

  • Did you know?

    Umckaloabo means “severe cough” in Zulu, nodding to its primary medicinal use (3).

  • Botanical description

    A hardy, aromatic evergreen plant with a compact, bushy rosette of soft, greyish green, aromatic leaves.

    It has delicate dark purple flowers, and reaches a maximum height of 30 cm (18,19).

  • Common names

    • African geranium
    • South African geranium
    • Amckaloabo (3,20)

  • Habitat

    Prefers full sun, and well-drained loamy soil. Its native habitat in Southern Africa is dry and hot, and as such it will need to be brought inside for the winter in the northern hemisphere if cultivated (19).

  • How to grow African geranium

    Grow in a sheltered, sunny location in frost-free environments; propagate from cuttings in spring or summer, and deadhead flowers or yellow leaves to ensure good growth and flowering (19).

  • Herbal preparation of African geranium

    • Tincture (21)
    • Tablets (dry extract) (21)

  • Plant parts used

    Root (2)

  • Dosage

    • Tincture (1:8–10, 11–15% ABV)
      • Adults, the elderly, and children over 12: 30 drops three times per day
      • Thomsen advises 20–40 ml per week (3)
      • Chevallier advises 5 ml, two to three times per day, diluted in water (2)
      • Use with children under six is not recommended  (21)
    • Fluid extract (indicated primarily for children with URT infections, 1:1 ABV% unknown) (2)
      • Children 6 to 12: 20 drops three times  per day
      • Use with children under six is not recommended (21)
    • Tablets (dry extract): 4–25:1 (21)
      • Adults, elderly and adolescents above 12: One tablet three times per day
      • Use with children under 12 is not recommended (21)

    These dosages are based on UK whole-plant extracts and not EPs 7630 (21).

  • Constituents

    The following constituents are root only:

    • Oligoprodelphinadins (~40%)
      • Flavonoids
        • Proanthocyanidins
      • Tannins
    • Minerals (~12%)
    • Carbohydrates (~12%)
    • Amino acids and peptides (~10%)
      • DNA/RNA
      • GMP
      • AMP
    • Benzopyranones  (~2%)
      • Coumarins
    • Purines (2%) (22)

  • African geranium recipe

    Umckaloabo tea

    This delicious tea is an infusion of African geranium root to address coughs and colds.

    Ingredients

    • 1tsp dried root per cup of tea 
    • 300 ml boiled water per cup of tea

    How to make African geranium tea

    • Cover the root in a teapot with boiled water.
    • Steep for 15–20 minutes.
    • Strain.
    • Drink 2/3 cups a day of the infusion (23).
Acknowledging and protecting African medicinal herbs: From baobab to pelargonium

Acknowledging and protecting African medicinal herbs: From baobab to pelargonium

  • Safety

    Information on safety and efficacy in pregnancy and lactation is lacking; some sources recommend caution if used during pregnancy, and some side effects have been documented although these are reportedly rare.

    Documented side effects include:

    • Allergies
    • Gastrointestinal upset
    • Ear or inner ear disorders
    • Fever
    • Diarrhea
    • Restlessness (24–26)

  • Interactions

    Possible severe interaction with immunosuppressants, although this is based on pharmacology theory only (27).

    Minor, unlikely interaction with anticoagulant medication based on coumarin content of P. sidoides although umckalin (7-hydroxy-5,6-dimethoxycoumarin), the coumarin present in P. sidoides, does not show anticoagulant effects and is unlikely to cause an interaction with warfarin or other anticoagulant pharmaceuticals (22,28).

  • Contraindications

    None known (3,24–26).

  • Sustainability status of African geranium

    Pelargonium sidoides was last assessed for The IUCN Red List of Threatened Species (IUCN) in 2022 and is listed as Least Concern (29).

    Species+, Conservation Evidence do not have data for this species, however a biodiversity management plan released in 2024 by the South African government indicates that the plant is facing increased pressure from humans, who harvest wild plant populations for traditional and commercial phytomedicines (30).

    Although the herb is still abundant, local overharvesting and environmental degradation have prompted government action to manage the species sustainably so it can continue to be a viable economic crop as well as a traditional medicine – as well as preserve it from an environmental standpoint (30).

    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.

  • Quality control

    The plant is primarily wild harvested in its native range (30). The roots of P. sidoides are frequently adulterated with or substituted by Pelargonium reniforme which is problematic because P. reniforme have lower concentrations of the bioactive compounds that are effective in treating URTs in P. sidoides so may not be as effective (31).

Meet our herbal experts

Ellen Rowland
- Herbalist, Aromatherapist

Ellen Rowland is a Medical Herbalist and Aromatherapist. She is the founder of AmberLuna Apothecary, a social enterprise making natural wellbeing accessible.

Read Ellen's articles

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Aromatic
An ‘aromatic’ remedy, high in volatile essential oils, was most often associated with calming and sometimes ‘warming’ the digestion. Most kitchen spices and herbs have this quality: they were used both as flavouring and to ease the digestion of sometimes challenging pre-industrial foods. Many aromatics are classed as ‘carminatives’ and are used to reduce colic, bloating and agitated digestion. They also often feature in respiratory remedies for colds, chest and other airway infections. They are also classic calming inhalants and massage oils, and are the basis of aromatherapy for their mental benefits.
Astringent
The astringent taste you get with many plants (the most familiar is black tea after being stewed too long, or some red wines) is produced by complex polyphenols such as tannins. Tannins are used in concentrated form (e.g. from oak bark) to make leather from animal skins. The process of ‘tanning’ involves the coagulation of relatively fluid proteins in living tissues into tight clotted fibres (similar to the process of boiling an egg). Tannins in effect turn exposed surfaces on the body into leather. In the case of the lining of mouth and upper digestive tract this is only temporary as new mucosa are replenished, but in the meantime can calm inflamed or irritated surfaces. In the case of open wounds tannins can be a life-saver – when strong (as in the bark of broadleaved trees) they can seal a damaged surface. One group of tannins, the reddish-brown ‘condensed tannins’ are procyanidins, which can reduce inflammation and oxidative damage.
Bitter
Bitters are a very complex group of phytochemicals that stimulate the bitter receptors in the mouth. They were some of the most valuable remedies in ancient medicine. They were experienced as stimulating appetite and switching on a wide range of key digestive functions, including increasing bile clearance from the liver (as bile is a key factor in bowel health this can be translated into improving bowel functions and the microbiome). Many of these reputations are being supported by new research on the role of bitter receptors in the mouth and elsewhere round the body. Bitters were also seen as ‘cooling’ reducing the intensity of some fevers and inflammatory diseases.
Bland
Blandness refers to a mild, plain, non-stimulating taste and an energetic action that neither irritates nor strongly activates physiological processes. In traditional Chinese medicine, bland substances gently drain dampness and promote urination, relieving excess fluid whilst also preserving qi and yin. Western traditional medicine similarly associates healing with bland substances that avoid extremes of heat or cold and promote restoration of balance. Blandness signifies regulation by supporting elimination and normal tissue function without forceful stimulation, helping to create a gentle and balanced state of homeostasis.
Cooling
Traditional ‘cold’ or cooling’ remedies often contain bitter phytonutrients such a iridoids (gentian), sesiquterpenes (chamomile), anthraquinones (rhubarb root), mucilages (marshmallow), some alkaloids and flavonoids. They tend to influence the digestive system, liver and kidneys. Cooling herbs do just that; they diffuse, drain and clear heat from areas of inflammation, redness and irritation. Sweet, bitter and astringent herbs tend to be cooling.
Hot

Traditional ‘hot’ or ‘heating’ remedies, often containing spice ingredients like capsaicin, the gingerols (ginger), piperine (black or long pepper), curcumin (turmeric) or the sulfurous isothiocyanates from mustard, horseradish or wasabi, generate warmth when taken.

In modern times this might translate as thermogenic and circulatory stimulant effects. There is evidence of improved tissue blood flow with such remedies: this would lead to a reduction in build-up of metabolites and tissue damage.

Heating remedies were used to counter the impact of cold, reducing any symptoms made worse in the cold.

Mucilaginous
Mucilages are complex carbohydrate based plant constituents with a slimy or ‘unctuous’ feel especially when chewed or macerated in water. Their effect is due simply to their physical coating exposed surfaces. From prehistory they were most often used as wound remedies for their soothing and healing effects on damaged tissues. Nowadays they are used more for these effects on the digestive lining, from the throat to the stomach, where they can relieve irritation and inflammation such as pharyngitis and gastritis. Some of the prominent mucilaginous remedies like slippery elm, aloe vera and the seaweeds can be used as physical buffers to reduce the harm and pain caused by reflux of excess stomach acid. Mucilages are also widely used to reduce dry coughing. Here the effect seems to be by reflex through embryonic nerve connections: reduced signals from the upper digestive wall appear to translate as reduced activity of airway muscles and increased activity of airway mucus cells. Some seed mucilages, such as in psyllium seed, flaxseed (linseed) or guar bean survive digestion to provide bulking laxative effects in the bowel. These can also reduce rate of absorption of sugar and cholesterol.
Neutral
Neutral herbs are characterised as by balanced temperature and energetics — neither warming nor cooling, nor strongly dispersing nor consolidating, and are, therefore, used across a wide spectrum of constitutional and pathological states. In Chinese medicine, this level, calm quality supports the centre, and gently strengthens digestion, regulates fluids, and resolves damp without provoking too much heat or cold. In Western medicine, neutral herbs are regarded as equal in relation to hot/cold or damp/dry and capable of maintaining a state of equilibrium. Neutral herbs can be seen as moderating reactivity, and supporting homeostasis rather than forcing change.
Pungent
The pungent flavour refers to the powerful taste of hot spices including mustard (Brassica spp.), ginger (Zingiber officinale), horseradish (Amoracia rusticana), chilli (Capsicum spp.), and garlic (Allium sativum). These herbs act to enliven and invigorate the senses, and they often also have heating qualities. Unlike other tastes, the effect is not linked to a specific receptor on the tongue and instead acts through direct irritation of tissues and nerve endings. Energetically, pungent herbs are known to disperse energy (qi) throughout the body. Pharmacologically, pungent herbs dry excess moisture and mucus, as well as stimulate digestion and metabolism.
Resinous
Resins are most familiar as tacky discharges from pine trees (and as the substance in amber, and rosin for violin bows). They were most valued however as the basis of ancient commodities like frankincense and myrrh (two of the three gifts of the Three Wise Men to the baby Jesus) and getting access to their source was one benefit to Solomon for marrying the Queen of Sheba (now Ethiopia). Resins were the original antiseptic remedies, ground and applied as powders or pastes to wounds or inflamed tissues, and were also used for mummification. With alcohol distillation it was found that they could be dissolved in 90% alcohol and in this form they remain a most powerful mouthwash and gargle, for infected sore throats and gum disease. They never attracted much early research interest because they permanently coat expensive glassware! For use in the mouth, gums and throat hey are best combined with concentrated licorice extracts to keep the resins in suspension and add extra soothing properties. It appears that they work both as local antiseptics and by stimulating white blood cell activity under the mucosal surface. They feel extremely effective!
Salty
The salty flavour is immediately distinctive. A grain dropped onto the tongue is instantly moistening and a sprinkle on food enkindles digestion. This easily recognisable flavour has its receptors right at the front of the tongue. The salty flavor creates moisture and heat, a sinking and heavy effect which is very grounding for the nervous system and encourages stability. People who are solid and reliable become known as ‘the salt of the earth'.
Sharp
The sharp taste of some fruits, and almost all unripe fruits, as well as vinegar and fermented foods, is produced by weak acids (the taste is generated by H+ ions from acids stimulating the sour taste buds). Sour taste buds are hard-wired to generate immediate reflex responses elsewhere in the body. Anyone who likes the refreshing taste of lemon or other citrus in the morning will know that one reflex effect is increased saliva production. Other effects are subjective rather than confirmed by research but there is a consistent view that they include increased digestive activity and contraction of the gallbladder.
Sour
The sour taste occurs because of the stimulation of hydrogen ions which trigger the sour taste receptors on the tongue. The more acidic a substance, the more hydrogen ions will be released. The sour taste comes from acidic substances including citrus, fermented foods, tannins, and vinegars. Sour foods and herbs absorb excess moisture, whilst also increasing the production of saliva. Energetically, sour substances tonify the lungs, playing a role in disease prevention. Excessive use, however, can result in malabsorption of nutrients. Examples of sour herbs include, rosehips (Rosa canina), raspberry (Rubus idaeus), rhubarb (Rheum palmatum), schisandra (Schisandra chinensis), hawthorn (Crataegus monogyna) and ginkgo (Ginkgo biloba).
Sweet
In the days when most people never tasted sugar, ‘sweetness’ was associated with the taste of basic foods: that of cooked vegetables, cereals and meat. In other words sweet was the quality of nourishment, and ‘tonic’ remedies. Describing a remedy as sweet generally led to that remedy being used in convalescence or recovery from illness. Interestingly, the plant constituents most often found in classic tonics like licorice, ginseng are plant steroids including saponins, which also have a sweet taste.
Umami
The umami taste was originally discovered in 1985 in Japan and is directly translated from the Japanese as a ‘pleasant savoury taste’. It is referred to as the ‘fifth taste’ and is a salty, rich, and meaty flavour. The umami flavour is produced by amino acids (glutamic acid and aspartic acid) found in many food and plant sources including tomatoes, mushrooms, seaweeds and soy-based foods. Umami foods can improve nutritional absorption and digestion as there are also umami receptors in the gut as well as the mouth. Examples of umami herbs include green tea (Camellia sinensis), reishi (Ganoderma lucidum), nettle (Urtica dioica), cordyceps (Ophiocordyceps sinensis), shitake (Lentinula edodes) and bladderwrack (Fucus vesiculosus).

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