Botanical Name: Viscum album, Loranthaceae

Common names: Mistletoe, Viscum

Plant description: Mistletoe is an evergreen parasitic plant that grows on the branches of certain deciduous trees, forming pendent bushes, 50-150 cm in diameter, the leaves thick and leathery, oval to round, 2.5-5 cm long. The small, spring flowers leave behind yellowish-white, sticky, autumn berries, smooth and semitransparent, that remain throughout the winter

Habitat, ecology and distribution: Mistletoe (Viscum album) is native to temperate Europe, found on deciduous trees such as apple, oak, birch and poplar.  Other genera in the Loranthaceae occur in North America, such as Phoradendron (with Quercus) and Arceuthobium (with conifers, e.g. Abies, Larix, Juniperus, Pinus, Tsuga), but it is not known to what extent these species can be used interchangeably with Viscum.

Part used: whole plant.

History: Mistletoe has long been one of the most magical and sacred plants in European folklore, held in great reverence by the Celtic Druids, who searched for the plant in the tops of the 'sacred oak' tree on the sixth night of the moon. They believed that the mistletoe protected its possessors from all evil, and used it as an aphrodisiac, a protection against poison, and to bestow long life and fertility.  Mistletoe was also hung from beams and ceilings to ward off evil spirits. Kissing under the mistletoe is first found associated with the Greek festival of Saturnalia. Scandinavian mythology states that Balder, the god of Peace, was slain with an arrow made of Mistletoe. He was restored to life at the request of the other gods and goddesses, and Mistletoe was afterwards given into the keeping of the goddess of Love, and it was ordained that everyone who passed under it should receive a kiss, to show that the branch had become an emblem of love, and not of hate. Christian folklore believes mistletoe was once a tree, of whose wood the cross on which Christ died was made. The tree then shriveled up with shame, changing into a plant that pours down good fortune on all who pass under it.  The name 'Mistletoe' is derived from the Anglo-Saxon word 'dung' (mistle) 'twig' (tan). Culpepper states that Mistletoe is under the dominion of the Sun, those specimens found growing on Oaks also ruled by the influence of Jupiter, an influence native to this tree.

Constituents: Mistletoe contains a number of important constituents, some of which such as the alkaloids can vary depending upon the host species. Generally represented compounds include the flavonoids (quercitin, chalcone and flavone derivatives), terpenoids (e.g. beta-amyrin, betulinic acid, oleanic acid, beta-sitosterol, stigmasterol, ursolic acid, lupeol and ester combinations), amines (e.g. acetylcholine, choline, histamine, GABA and tyramine), and the viscotoxins A2, A3 and B.  Mistletoe also contains an assortment of phenolic compounds including caffeic and myristic acid, lectins, fatty acids, sugars, tannins and mucilage (Newall et al 1996, 193).

Medical Research: The vast majority of research conducted on Mistletoe has involved the subcutaneous injection of an aqueous extract of Mistletoe called Iscador, manufactured by Weleda AG of Switzerland.  Other brands used in research include Eurixor, Helixor, Isorel, Vysorel, and ABNOBAviscum. Iscador products are subdivided according to the species of host tree. Thus IscadorM is obtained from apple trees (Malus spp.), IscadorP comes from pine trees (Pinus spp.), IscadorQ comes from oak trees (Quercus spp.), and IscadorU comes from elm trees (Ulmus spp.). The basis of its usage is rooted in the anthroposophical movement of Rudolf Steiner, who is said to have stated that Mistletoe would eventually replace the use of a surgeon's scalpel.  In 1920 Rudolf Steiner founded the Society for Cancer Research to promote mistletoe extracts and anthroposophical medicine.  Today, Mistletoe is the most commonly used oncological drug in Germany.  Unfortunately most this research, of which only recent highlights are presented, cannot be applied to oral dosages of the herbal extract used by herbalists.
Immunostimulant: Ninety-two children 5 to 14 years of age living in areas exposed to the radioactive fallout from Chernobyl with recurrent respiratory infections (RRIs) were treated after randomization with either Viscum album praeparatum mali or pini (Iscador M or P). The dosage was two subcutaneous injections a week for 5 weeks with individual doses of 0.001 mg to 1.0 mg. Both Viscum album preparations were effective in significantly reducing clinical symptoms. One year after a single treatment course, the frequency of RRI relapses decreased by 78% and 73%, respectively. Immunomodulatory effects were assessed by investigation of lymphocyte subsets, natural killer (NK) cell activity, phagocytic and oxidative activity of polymorphonuclear leukocytes, and antiviral activity of serum before and 1 week after treatment. Viscum album therapy resulted in normalization of initial immune indices either below or above the normal ranges. High levels of antiviral activity before treatment were significantly decreased by Viscum album mali (Chernyshov et al 2000).
Cancer:Interleukin-6 (IL-6) has been shown to be involved in several diseases including lymphoid malignancies, binding to soluble IL-6 receptor (sIL-6R) circulating in blood, leading to signal transduction via gp130. Soluble IL-6R shows agonistic activity for IL-6, and the soluble form of gp130 (sgp130) an antagonistic effect against the complex IL-6/sIL-6R.  Researchers investigated the effect of Viscum album extract (Iscador) on the serum levels of IL-6, sIL-6R and sgp130 in B-cell lymphoma patients (n = 27), in comparison to healthy controls (n = 28). Twenty-one of 27 patients had been treated previously with chemo-radiotherapy. The patients were divided into two groups; those with short-term (investigated before and during treatment) or those with long-term Viscum album (VA) therapy (investigated during therapy). Clinical results indicated that half of the patients (6/12) with long-term treatment had a continuous complete remission, whereas only 2/15 patients with short-term treatment had a complete remission (Kovacs and Kuehn 2002). Researchers examined whether or not Iscador treatment prolongs survival time of patients with carcinoma of the colon, rectum, or stomach; breast carcinoma with or without axillary or remote metastases; or small cell or non-small-cell bronchogenic carcinoma; and to explore synergies between Iscador treatment and psychosomatic self-regulation. The research design was a prospective nonrandomized and randomized matched-pair study nested within a long-term epidemiological cohort study involving 10,226 cancer patients.  These included 1668 patients treated with Iscador and 8475 who had taken neither Iscador nor any other mistletoe product.  In the nonrandomized matched-pair study, survival time of patients treated with Iscador was longer for all types of cancer studied. In the pool of 396 matched pairs, mean survival time in the Iscador groups (4.23 years) was roughly 40% longer than in the control groups (3.05 years; P < .001). Synergies between Iscador treatment and self-regulation manifested in a longer survival advantage for Iscador patients with good self-regulation (56% relative to control group; P = .03) than for patients with poor self-regulation (Grossarth-Maticek et al 2001). Interleukin-6 (IL-6) has been shown to be involved in several diseases including lymphoid malignancies, binding to soluble IL-6 receptor (sIL-6R) circulating in blood, leading to signal transduction via gp130. Soluble IL-6R shows agonistic activity for IL-6, and the soluble form of gp130 (sgp130) an antagonistic effect against the complex IL-6/sIL-6R.  Researchers investigated the effect of Viscum album extract (Iscador) on the serum levels of IL-6, sIL-6R and sgp130 in B-cell lymphoma patients (n = 27), in comparison to healthy controls (n = 28). Twenty-one of 27 patients had been treated previously with chemo-radiotherapy. The patients were divided into two groups; those with short-term (investigated before and during treatment) or those with long-term Viscum album (VA) therapy (investigated during therapy). Clinical results indicated that half of the patients (6/12) with long-term treatment had a continuous complete remission, whereas only 2/15 patients with short-term treatment had a complete remission (Kovacs and Kuehn 2002).  Researchers examined whether or not Iscador treatment prolongs survival time of patients with carcinoma of the colon, rectum, or stomach; breast carcinoma with or without axillary or remote metastases; or small cell or non-small-cell bronchogenic carcinoma; and to explore synergies between Iscador treatment and psychosomatic self-regulation. The research design was a prospective nonrandomized and randomized matched-pair study nested within a long-term epidemiological cohort study involving 10,226 cancer patients.  These included 1668 patients treated with Iscador and 8475 who had taken neither Iscador nor any other mistletoe product.  In the nonrandomized matched-pair study, survival time of patients treated with Iscador was longer for all types of cancer studied. In the pool of 396 matched pairs, mean survival time in the Iscador groups (4.23 years) was roughly 40% longer than in the control groups (3.05 years; P < .001). Synergies between Iscador treatment and self-regulation manifested in a longer survival advantage for Iscador patients with good self-regulation (56% relative to control group; P = .03) than for patients with poor self-regulation (Grossarth-Maticek et al 2001).  The effect of an intrapleural administration of mistletoe extract (Helixor) was examined in 20 cancer patients with malignant pleural effusions were treated intrapleurally with the mistletoe extract. The overall response rate for pleurodesis was 72%, with only 1.2% displaying side effects of the World Health Organization classification I. The decline of tumour cells in the effusion liquid correlated negatively with the number of instillations. However, the elimination of tumour cells was associated with a transient increase in macrophages and eosinophils, and a constant increase in CD8+T cells. Compared to the responder group, the non-responders exhibited high proportions of macrophages, CD8+T cells and T cells with human leukocyte antigens with DR specificity (HLA-DR) in the effusion liquid, compatible with a disturbance of macrophage/T cell co-operation and thus failure to eliminate the malignant cells. The preliminary results suggest that mistletoe-mediated pleurodesis is due to a stimulation of antitumour immunity rather than mechanical sclerosis (Stumpf and Bussing 1997).
•Hypotensive: Newal et al report a hypotensive effect for Mistletoe, by a variety of plant constituents including acetylcholine, histamine, GABA, tyramine and flavonoids (1996, 194).

Toxicity: Mistletoe is generally stated to be toxic and ingestion is often treated aggressively by medical practitioners. In 1997 researchers analyzed the outcomes of 1,754 exposures to Mistletoe, the data extracted from the American Association of Poison Control Centers for the period of 1985 to 1992. Pediatric exposures accounted for 92.1% of the cases.  Of all cases, 99.2% had an outcome associated with no morbidity, and there were no fatalities. Gastrointestinal decontamination techniques had no bearing on outcomes (Krenzelok et al 1997).  The parenteral administration of European mistletoe may promote adverse events such as flu-like symptoms and transient exacerbations of gingivitis, fever, and eosinophilia (Gorter etal 1999). 

Herbal action: mild hypotensive, cardiac sedative, anticonvulsant, analgesic

Indications: headaches, dizziness, fatigue, irritability, feeble pulse, edema, dyspnea, ventricular hypertrophy, valvular insufficiency, arrhythmia, hypertension, peripheral arterial disease, rheumatic or neuralgic pain, epilepsy, depression, anxiety

Contraindications and cautions: May have an oxytocic activity and therefore best avoided in pregnancy (Newall et al 1996, 195; Felter and Lloyd 1893).  Avoid combining with Centella asiatica (Bartram 1995, 296).'

Medicinal uses: Mistletoe has largely been used as a mild cardiac sedative with hypotensive properties, used particularly in the aged in the treatment symptoms of cardiovascular disease, including headaches, dizziness, fatigue, and irritability. Felter and Lloyd state that the indications for Mistletoe include a flushed face, chronic headaches, with weak cardiac function, dyspnea and a feeble pulse.  Some practitioners may think Mistletoe helpful in reducing blood pressure, but it is unlikely that it directs much of a clinical effect in this area, improving the symptomology but not objective assessments of cardiovascular disease.  This is not so much the deficit of Mistletoe as it is of the idea that reducing blood pressure has any significant outcome in cardiovascular disease: elevated blood pressure is only a symptom, not the cause of heart disease. Another important traditional use for Mistletoe mentioned by Culpepper is in "falling sickness" taken internally as well as hung around the neck.  The efficacy of Mistletoe in epilepsy is also noted by King's American Dispensatory, as well as its utility in paralysis and psychological disturbance such as "hysteria" or "insanity" (1893).  Felter and Lloyd state that Mistletoe (Phoradendron flavescens) is a reliable oxytocic, useful to"…restrain postpartum and other uterine hemorrhages…declared to be safer, in many respects, than ergot." (1893). Culpepper states that "…both the leaves and berries of Misselto do heat and dry, and are of subtle parts; the birdlime doth molify hard knots, tumours, and imposthumes; ripens and discusses them, and draws forth thick as well as thin humours from the remote parts of the body, digesting and separating them."

Pharmacy and dosage:
Fresh Plant Tincture: fresh green plant, 1:2, 95% alcohol, 3-20 gtt
Dry Plant Tincture: recent dried plant, 1:5, 50% alcohol, 3-30 gtt.
Hot Infusion: recent dried plant, 1:20, 30-60 mL
Powder: recent dried plant, finely sieved, 500-1500 mg

REFERENCES

Bartram, Thomas. 1995. Encyclopedia of Herbal Medicine. Dorset: Grace Publishers.
Chernyshov VP, Heusser P, Omelchenko LI, Chernyshova LI, Vodyanik MA, Vykhovanets EV, Galazyuk LV, Pochinok TV, Gaiday NV, Gumenyuk ME, Zelinsky GM, Schaefermeyer H, Schaefermeyer G. 2000. Immunomodulatory and clinical effects of Viscum album (Iscador M and Iscador P) in children with recurrent respiratory infections as a result of the Chernobyl nuclear accident. Am J Ther May;7(3):195-203
Felter, HW and JU Lloyd. 1893. King's American Dispensatory. Digitized version available from http://www.ibiblio.org/herbmed/eclectic/kings/main.html.
Gorter RW, van Wely M, Reif M, Stoss M. 1999. Tolerability of an extract of European mistletoe among immunocompromised and healthy individuals. Altern Ther Health Med Nov;5(6):37-44, 47-8
Grieve, Maude. 1971. A Modern Herbal. New York: Dover Publications.
Grossarth-Maticek R, Kiene H, Baumgartner SM, Ziegler R. 2001. Use of Iscador, an extract of European mistletoe (Viscum album), in cancer treatment: prospective nonrandomized and randomized matched-pair studies nested within a cohort study. Altern Ther Health Med. May-Jun;7(3):57-66, 68-72, 74-6
Kovacs E, Kuehn JJ. 2002. Measurements of IL-6, soluble IL-6 receptor and soluble gp130 in sera of B-cell lymphoma patients. Does viscum album treatment affect these parameters? Biomed Pharmacother May;56(3):152-8
Krenzelok EP, Jacobsen TD, Aronis J. 1997. American mistletoe exposures. Am J Emerg Med Sep;15(5):516-20
Moore, Michael.  1979. Medicinal Plants of the Mountain West. Santa Fe: Museum of New Mexico Press
Newall, Carol A., Linda A. Anderson and J.D. Phillipson. 1996. Herbal Medicines: A Guide for Health-Care Professionals. London: The Pharmaceutical Press.
Stumpf C, Bussing A. 1997. Stimulation of antitumour immunity by intrapleural instillation of a Viscum album L. extract. Anticancer Drugs Apr;8 Suppl 1:S23-6
Weiss, Rudolf. 1988. Herbal Medicine. Translated by A.R. Meuss. Beaconsfield, England: Beaconsfield Publishers
van Wely M, Stoss M, Gorter RW. 1999. Toxicity of a standardized mistletoe extract in immunocompromised and healthy individuals. Am J Ther Jan;6(1):37-43