Gaining popularity in modern times as a cold and flu medicine, elder flower has been an important folk remedy for centuries. The Roman naturalist Pliny wrote about the therapeutic value of this flowering tree in the first century A.D. Native Americans used elder as a treatment for respiratory infections and constipation as well as an herbal pad for healing wounds. Black elder (Sambucus nigra) is the most popular variety of the plant, though there are other species known to have similar chemical ingredients. Elder grows in Europe, Asia, North Africa, and the United States. Most medicinal elder is obtained from the former Soviet Union, Eastern Europe, and the United Kingdom. The Latin word sambucus is thought to be derived from the Greek sambuca, which refers to a stringed musical instrument popular among the Ancient Romans. In fact, some modern day Italians still make a primitive pipe called a sampogna from the branches of the tree, which also produces fragrant, cream-colored flowers and deep-violet berries. The flowers and berries are used most often in the drug of commerce, though the leaves, bark, and roots are also considered to have therapeutic effects. The berries traditionally have been used to make elder-berry wine as well as pies and jellies, although no value has yet been found in these products.

The German Commission E, considered an authoritative source of information on alternative remedies, determined that elder has the ability to increase bronchial secretions as well as perspiration. These properties can be useful in helping to alleviate symptoms of the common cold or the flu. Even more interesting is the possibility that elder, like another herbal remedy called echinacea, may have the power to shorten the duration of colds by up to a few days. While it is not known exactly how elder produces its therapeutic effects, study has focused on several naturally occurring chemicals in the plant. Elder's flavonoids and phenolic acids are thought to be responsible for its ability to increase perspiration. The triterpenes in elder may also be potential "active ingredients," though more study is required to confirm this. The remaining chemical constituents of medicinal elder usually include potassium and other minerals; sterols;

Elderflowers. (© PlantaPhile, Germany. Reproduced by permission.)

volatile oils containing linoleic, linolenic, and palmitic acid; mucilage; pectin; protein; sugar; and tannins.

A number of other properties have been ascribed to elder as well, including anti-inflammatory, diuretic, antiviral, and antispasmodic activities. A 1997 study published in the Journal of Ethnopharmacology, which studied black elder in the test tube, indicates that the herb has some activity as an anti-inflammatory. While this may help to partially explain elder's success in treating colds, it also suggests that the herb may have potential as a treatment for inflammatory diseases such as rheumatism. Elder has also been described in the history of folk medicine as a laxative and a sedative.

General use

While not approved by the FDA, black elder flower is primarily used in the United States and Europe for colds and the flu. When taken internally, elder flower is approved by the Commission E for colds. In Germany, elder flower tea is licensed by the government to treat the common cold and other upper respiratory problems. By increasing bronchial secretions as well as perspiration, elder is believed to help ease symptoms such as cough and fever and may even shorten a cold's duration. In the United States and Canada, elder is often combined with peppermint leaf and yarrow flower in preparations intended to alleviate cold-related fever.

In a study published in the Journal of Alternative and Complementary Medicine in 1995, use of a standardized elderberry extract shortened the duration of the flu by about three days. The placebo-controlled, double-blind study involved the residents of an Israeli kibbutz. "A significant improvement of the symptoms, including fever, was seen in 93.3% of the cases in the SAM-treated group [elder-treated group] within 2 days," the researchers reported, "whereas in the control group 91.7% of the patients showed an improvement within 6 days." About 90% of the people treated with elder were considered flu-free in two to three days, while the majority of patients in the placebo group only got well after about 6 days. The authors of the study recommended elder as a possible treatment for influenza A and B based on the herbal remedy's effectiveness, lack of side effects, and low cost. By way of comparison, over-the-counter synthetic drugs may offer some measure of symptomatic relief for a cold but have not been proven to actually speed recovery. Elder is also being investigated as a treatment for other viral infections such as human immunodeficiency virus (HIV) and herpes.

Throughout its long history, elder has been used to treat a variety of other diseases and medical problems. These include liver disease, kidney disorders, rheumatism, insomnia, toothaches, measles, asthma, cancer, chafing, epilepsy, gout, headaches, neuralgia, psoriasis, syphilis, and laryngitis. It has also been used topically as an herbal pad to reduce external swelling and heal wounds. Some women have used elder to increase the amount of milk produced during breastfeeding. However, as of early 2000, sufficient scientific evidence to support these additional uses is lacking. While elder has been used as a folk remedy for treating diabetes, studies in rodents suggest that it has no effects on blood sugar regulation.


Dosage of elder generally ranges from 10-15 g per day, divided into three equal doses. The drug, which is recommended for internal use only, is usually taken as a tea or liquid extract. Elder tea can be prepared by steeping 3-4 g (2 teaspoonfuls) of dried elder flower in 150 ml of hot (not boiling) water. The mixture should be strained after about 5 minutes. The tea works best when it is consumed at a temperature as hot as can be safely tolerated. Dosage is several cups of tea a day (do not exceed the daily maximum of 15 g of elder), taken in the afternoons and evenings. When using a standardized liquid extract of elder, follow the package directions for proper use.


Taken in recommended dosages, elder is not known to be harmful. It should be used with caution in children, women who are pregnant or breastfeeding, and people with kidney or liver disorders because its effects in these groups have not been sufficiently studied.

Be careful not to confuse black elder with a more toxic species of the plant called dwarf elder (Sambucus ebulus). Dwarf elder is generally not recommended for medical purposes and may cause vomiting and diarrhea in large dosages.

Side effects

Side effects are considered rare. Mild abdominal distress or allergic reactions may occur.


Elder is not known to interact adversely with other medications or herbal remedies. Preparations that combine elder with yarrow flower and peppermint leaf have been used without apparent harm.



Fetrow, Charles W. and Avila, Juan R. Professional's Handbook of Complementary and Alternative Medicine. Pennsylvania: Springhouse, 1998.

Gruenwald, Joerg. PDR for Herbal Medicines. New Jersey: Medical Economics, 1998.

Sifton, David W. PDR Family Guide to Natural Medicines and Healing Therapies. New Jersey: Medical Economics, 1999.


Yesilada E., Ustun O., Sezik E., et al. "Inhibitory effects of Turkish folk remedies on inflammatory cytokines: inter-leukin-1alpha, interleukin-1beta and tumor necrosis factor alpha." J Ethnopharmacol (1997) 58(1):59-73.

Zakay-Rones Z., Varsano N., Zlotnik M., et al. "Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama." J Altern Complement Med (1995) 1(4):361-9.


American Botanical Council. PO Box 144345, Austin, TX 78714-4345.

Herb Research Foundation. 1007 Pearl Street, Suite 200, Boulder, CO 80302.


Herb Research Foundation. http://www.herbs.org (January 17, 2001).

OnHealth. http://www.onhealth.com (January 17, 2001).

Discovery Health. http://www.discoveryhealth.com (January 17, 2001).

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