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An earlier, different version of this article was published in the Washington Association of Naturopathic Physicians Newsletter in 2011.
Hyoscyamus niger (Henbane)
The leaves and flowers of Hyoscyamus niger, commonly called henbane or black henbane in English, has potent anticholinergic actions that can be taken advantage of to effectively relieves spasms in smooth muscle, particularly the urinary tract. It is in the Solanaceae family and contains tropane alkaloids. It has the lowest ratio of hyoscyamine:scopalamine (0.7–1.9) of any of the medicinal members of this family (Bahmanzadegan 2009). It is also the most potent, for instance being approximately twice as potent as Datura stramonium (thornapple) and five times more potent than Atropa belladonna (belladonna). Some evidence suggests the atropine in these plants is mostly an M1-specific antimuscarinic.
While native to temperate Eurasia, it has become a widespread weed and is cultivated for medicine in many areas. It grows fairly readily in the Pacific Northwest of North America.
Like all anticholinergics, it has the potential to cause serious harm in overdose, heralded by symptoms of dry mucous membranes, blurry vision and confusion. If dosing continues following negative symptoms, or if the overdose is sufficiently high, the patient can develop dangerous arrhythmias or respiratory depression and could, theoretically, die. In addition, Hyoscyamus niger has the potential to cause urinary retention and to stop lactation.
Although this member of the Solanaceae family is often regarded as too dangerous for modern clinical use as a crude herbal extract, I have used henbane tincture repeatedly, showing that it can be dosed in a manner that typically avoids adverse effects and retains efficacy. The following cases highlight the use and safety of this herb in a range of patients.
The tincture is the most available and well understood form used. However, it can certainly be used in infusions and, if they were available, capsules.
While native to temperate Eurasia, it has become a widespread weed and is cultivated for medicine in many areas. It grows fairly readily in the Pacific Northwest of North America.
Like all anticholinergics, it has the potential to cause serious harm in overdose, heralded by symptoms of dry mucous membranes, blurry vision and confusion. If dosing continues following negative symptoms, or if the overdose is sufficiently high, the patient can develop dangerous arrhythmias or respiratory depression and could, theoretically, die. In addition, Hyoscyamus niger has the potential to cause urinary retention and to stop lactation.
Although this member of the Solanaceae family is often regarded as too dangerous for modern clinical use as a crude herbal extract, I have used henbane tincture repeatedly, showing that it can be dosed in a manner that typically avoids adverse effects and retains efficacy. The following cases highlight the use and safety of this herb in a range of patients.
The tincture is the most available and well understood form used. However, it can certainly be used in infusions and, if they were available, capsules.
Case 1. Elderly Man with BPH
This concerns the case of a 78-year-old white cis-man with idiopathic bradycardia, prostate cancer status post external beam radiation, and severe benign prostatic hyperplasia (BPH).
The patient underwent a transurethral incision of the urethra (TURP) that temporarily relieved his BPH symptoms, but within six months he was back to having to urinate urgently every two hours, including during the night, which caused severe sleep disruption. I treated the patient with an herbal formula (see Figure 1), providing him with 32 oz of the tincture to take 5 ml tid, enough for two months. The formula contained strong spasmolytics on the grounds that hyperplasia of smooth muscle cells in the prostate was causing many of his symptoms. The total amount of henbane leaf tincture (1:10 w:v, 70% ethanol) was less than 2–3 drops per dose. The patient experienced no adverse effects, and his BPH symptoms improved to the point where he could sleep four hours at a stretch instead of two. He suffered no adverse effects.
The patient underwent a transurethral incision of the urethra (TURP) that temporarily relieved his BPH symptoms, but within six months he was back to having to urinate urgently every two hours, including during the night, which caused severe sleep disruption. I treated the patient with an herbal formula (see Figure 1), providing him with 32 oz of the tincture to take 5 ml tid, enough for two months. The formula contained strong spasmolytics on the grounds that hyperplasia of smooth muscle cells in the prostate was causing many of his symptoms. The total amount of henbane leaf tincture (1:10 w:v, 70% ethanol) was less than 2–3 drops per dose. The patient experienced no adverse effects, and his BPH symptoms improved to the point where he could sleep four hours at a stretch instead of two. He suffered no adverse effects.
Figure 1. BPH and Prostate Cancer Tincture Formula
Latin name |
Common name and part used |
Percent in formula |
Rationale |
Viburnum prunifolium |
blackhaw fresh bark and leaf |
20% |
Mild prostate spasmolytic, more pelvic specific than V. opulus |
Catharanthus roseus |
Madagascar periwinkle fresh aerial parts |
20% |
Antineoplastic |
Piper methysticum |
kava fresh root |
20% |
Moderate prostate spasmolytic; improves sleep quality |
Artemisia annua |
sweet Annie fresh aerial parts |
10% |
Antineoplastic (note: now it is known that absorption of this stops after about a week, so continuous use is not recommended for cancer) |
Phytolacca americana |
poke fresh root |
5% |
Lymphagogue, antineoplastic |
Rheum palmatum |
rhubarb prepared root |
5% |
Antineoplastic |
Rhus glabra |
smooth sumac fresh aerial parts |
5% |
Antidiuretic, urinary tract tonic |
Taxus brevifolia |
Pacific yew fresh needles |
5% |
Antineoplastic |
Cephalotaxus brevifolia |
Chinese plum yew dry seed |
3% |
Antineoplastic |
Dicentra formosa |
Pacific bleeding heart fresh whole plant |
3% |
Antineoplastic |
Hyoscyamus niger |
black henbane aerial parts |
2% |
Strong prostate spasmolytic |
Trichosanthes kirilowii |
trichosanthes dry root |
2% |
Antineoplastic |
Case 2. Anxious Man with BPH
This case concerns an extremely anxious 65-year-old, French-Canadian cis-man with a urinary tract infection secondary to BPH, hypothyroidism, metabolic syndrome, and an elevated PSA.
The patient had trouble with dribbling, a weak urinary stream, urgency, and frequency. I prescribed that he take 4 oz of a formula containing Piper methysticum root tincture 30%, Ammi visnaga (khella) seed tincture 30%, Viburnum opulus (crampbark) bark tincture 30%, Ceanothus greggii (red root) tincture 5% and henbane tincture 5%, 1 tsp twice per day for his BPH symptoms and anxiety. His symptoms improved significantly, with no adverse effects. The patient has continued to refill the formula but finds he doesn’t need to use it regularly, only on occasions when symptoms flare. He suffered no adverse effects.
The patient had trouble with dribbling, a weak urinary stream, urgency, and frequency. I prescribed that he take 4 oz of a formula containing Piper methysticum root tincture 30%, Ammi visnaga (khella) seed tincture 30%, Viburnum opulus (crampbark) bark tincture 30%, Ceanothus greggii (red root) tincture 5% and henbane tincture 5%, 1 tsp twice per day for his BPH symptoms and anxiety. His symptoms improved significantly, with no adverse effects. The patient has continued to refill the formula but finds he doesn’t need to use it regularly, only on occasions when symptoms flare. He suffered no adverse effects.
Case 3. Self-Catheterizing Patient
This is the case of a 32-year-old white cis-man with severe bladder hypertrophy, apparently due to persistent avoidance of urinating since childhood.
The patient had to self-catheterize to urinate. He found this fairly painful with a lot of urethral spasm. He tried taking henbane tincture (1:10 w:v, 2–3 drops) 15 to 20 minutes before catheterizing to help relieve the pain. While he did not find this effective, he suffered no adverse effects from the treatment. I now suspect the dose was simply insufficient and I would now have him titrate the dose up by 1 drop per dose once per day until he either achieved relief or started to suffer a dry mouth and dry eyes.
The patient had to self-catheterize to urinate. He found this fairly painful with a lot of urethral spasm. He tried taking henbane tincture (1:10 w:v, 2–3 drops) 15 to 20 minutes before catheterizing to help relieve the pain. While he did not find this effective, he suffered no adverse effects from the treatment. I now suspect the dose was simply insufficient and I would now have him titrate the dose up by 1 drop per dose once per day until he either achieved relief or started to suffer a dry mouth and dry eyes.
Case 4. Acute Urinary Retention Patient
A 70-year-old white cis-man had three episodes of acute urinary retention (AUR) secondary to BPH and had to be catheterized in the emergency room on each occasion in order to urinate.
The patient’s bladder was not enlarged. He developed diarrhea when taking tamsulosin, so discontinued it. He also had ongoing hypertension in the 170/95 mmHg range without symptoms. I prescribed 16 oz of an herbal formula, of which he was to take 1 tsp tid (see Figure 2). This helped relieve his symptoms with no adverse effects, and he used a second 16 oz bottle of the formula. I also prescribed 5 mg of finasteride daily to help reduce the size of his very enlarged prostate while recommending major dietary and lifestyle changes to try to treat the causes of his BPH.
The patient’s bladder was not enlarged. He developed diarrhea when taking tamsulosin, so discontinued it. He also had ongoing hypertension in the 170/95 mmHg range without symptoms. I prescribed 16 oz of an herbal formula, of which he was to take 1 tsp tid (see Figure 2). This helped relieve his symptoms with no adverse effects, and he used a second 16 oz bottle of the formula. I also prescribed 5 mg of finasteride daily to help reduce the size of his very enlarged prostate while recommending major dietary and lifestyle changes to try to treat the causes of his BPH.
Figure 2. Herbal Formula for BPH with AUR Episodes
All products were tinctures unless otherwise noted.
Latin name |
Common name and part used |
Percent in formula |
Rationale |
Ammi visnaga |
khella fresh fruit |
25% |
Moderate potency prostatic spasmolytic |
Viburnum prunifolium |
blackhaw fresh bark and leaf |
25% |
See figure 1 discussion |
Nepeta cataria |
catnip fresh aerial parts (glycerite) |
20% |
Nervine, anxiolytic, corrigent, corrective assistant to Oplopanax |
Oplopanax horridum |
devil's club fresh root bark (glycerite) |
15% |
Adaptogen (mildly stimulating but bioregional) |
Fouquieria splendens |
ocotillo fresh bark |
5% |
Pelvic lymphagogue |
Anemone occidentalis |
western pasque flower fresh aerial parts |
4% |
Strong prostatic spasmolytic, anxiolytic |
Zingiber officinale |
ginger dry rhizome |
3% |
Driver, heating (he was always somewhat cold), corrigent |
Rauvolfia serpentina |
Indian snakeroot dry root |
2% |
Antihypertensive |
Hyoscyamus niger |
black henbane fresh aerial parts |
1% |
Strong prostatic spasmolytic |
Case 5. Sensitive Patient with Kidney Stones
This is the case of a 42-year-old white cis-man with recurrent kidney stones. He was at the time of the prescription havingacute renal colic as a stone was passing. He had a history of reacting poorly and unpredictably to many herbs and medications. The patient also had epididymitis, recurrent colon polyps, chronic fatigue syndrome, chronic rectal fissure, migraines and asthma.
His renal colic pain was severe, and he had suffered many adverse reactions to pain drugs trying to treat this. He tried henbane leaf tincture (1:10 w:v, 2–3 drops as needed). While this significantly reduced his pain, it also caused him to have strong burning sensations in his face. The symptom was transient. He also tried taking Anemone occidentalis (Western pasque flower) herb tincture (1:5 w:v, 2–3 drops as needed), which helped his pain significantly but caused bloating and gas. Gelsemium sempervivens (yellow jessamine) root tincture (1:3 w:v fresh, 3–5 drops as needed) caused him to feel depressed and was not effective for his pain. Facial pain is not a reported adverse effect of henbane, and it seems likely this was idiosyncratic to this patient.
His renal colic pain was severe, and he had suffered many adverse reactions to pain drugs trying to treat this. He tried henbane leaf tincture (1:10 w:v, 2–3 drops as needed). While this significantly reduced his pain, it also caused him to have strong burning sensations in his face. The symptom was transient. He also tried taking Anemone occidentalis (Western pasque flower) herb tincture (1:5 w:v, 2–3 drops as needed), which helped his pain significantly but caused bloating and gas. Gelsemium sempervivens (yellow jessamine) root tincture (1:3 w:v fresh, 3–5 drops as needed) caused him to feel depressed and was not effective for his pain. Facial pain is not a reported adverse effect of henbane, and it seems likely this was idiosyncratic to this patient.
Summary of Safe Use
Though all of these cases involved use of a 1:10 w:v tincture, I now exclusively use a 1:3 w:v tincture and still start at an adult dose of 2–3 drops bid-tid generally. I have found this works much better than the older, much lower dose. I believe I was simply being too timid in the past. Elderly people are generally more sensitive to anticholinergics, so start at the 2 drop dose with anyone over the age of 65 for safety.
The dose should be titrated up slowly, one drop at a time, until the patient either has relief or develops the warning signs you are approaching a toxic dose, which are a dry mouth and dry eyes. The dose should not be increased once reaching these signs. If there is still no relief of symptoms, then simply discontinue the tincture.
Signs of overdose would include pupillary dilation, blurry vision (not the same as dry eyes!), hallucinations, confusion, or constipation. Confusion or hallucinations are extremely dangerous signs. Discontinue use of the henbane and call your local poison control center or send a patient to the emergency room if these signs develop.
Henbane is contraindicated in pregnancy and lactation.
The major indications are bladder spasms, pelvic pain, renal colic, neurogenic bladder due to upper motor neuron lesions (particularly spina bifida), and unresponsive BPH. Unlike its cousins Atropa belladonna (belladonna) and Datura stramonium (thornapple), this herb has a great affinity for the urinary system. But it will work on smooth muscle spasms anywhere in the body. Monitor patients carefully for urinary retention.
The dose should be titrated up slowly, one drop at a time, until the patient either has relief or develops the warning signs you are approaching a toxic dose, which are a dry mouth and dry eyes. The dose should not be increased once reaching these signs. If there is still no relief of symptoms, then simply discontinue the tincture.
Signs of overdose would include pupillary dilation, blurry vision (not the same as dry eyes!), hallucinations, confusion, or constipation. Confusion or hallucinations are extremely dangerous signs. Discontinue use of the henbane and call your local poison control center or send a patient to the emergency room if these signs develop.
Henbane is contraindicated in pregnancy and lactation.
The major indications are bladder spasms, pelvic pain, renal colic, neurogenic bladder due to upper motor neuron lesions (particularly spina bifida), and unresponsive BPH. Unlike its cousins Atropa belladonna (belladonna) and Datura stramonium (thornapple), this herb has a great affinity for the urinary system. But it will work on smooth muscle spasms anywhere in the body. Monitor patients carefully for urinary retention.
References
Bahmanzadegan A, Sefidkon F, Sonboli A (2009) "Determination of hyoscyamine and scopolamine in four Hyoscyamus species from Iran" Iranian J Pharm Res 8(1):65–70.
Burke RE (1986) "The relative selectivity of anticholinergic drugs for the M1 and M2 muscarinic receptor subtypes" Mov Disord 1(2):135–144.
Burke RE (1986) "The relative selectivity of anticholinergic drugs for the M1 and M2 muscarinic receptor subtypes" Mov Disord 1(2):135–144.