Plant Comparison
Bistort vs Perforate St John’s-wort
A side-by-side comparison of two medicinal plants — every documented constituent, action, use, safety note and cited source, assembled automatically from the Omnia Sana database.
At a glance
Bistort and Perforate St John’s-wort: they share 6 indicated uses (arthritis / joint pain, bruising, infection (general), …); 2 pharmacological actions in common.
Evidence face-off — shared uses
| Condition | Bistort | Perforate St John’s-wort | Verdict |
|---|---|---|---|
| Arthritis / joint pain | 1/10 | 1/10 | Comparable evidence |
| Bruising | 1/10 | 1/10 | Comparable evidence |
| Infection (general) | 1/10 | 1/10 | Comparable evidence |
| Inflammation (general) | 1/10 | 1/10 | Comparable evidence |
| Skin irritation | 1/10 | 1/10 | Comparable evidence |
| Wounds | 1/10 | 1/10 | Comparable evidence |
Evidence scores (1–10) are computed from the tier of each cited source. “Comparable” means the two scores are within one point. Follow a score to its detailed sources.
Key Constituents
Very high tannin content is the basis of the strong astringency.
Contribute to antioxidant and antibacterial activity.
Red pigments historically used to standardise extracts; contribute to antiviral activity and are the compounds responsible for photosensitivity risk.
Considered the principal compound behind the antidepressant activity and the main driver of the herb's potent CYP3A4/P-glycoprotein induction and drug-interaction profile.
Antioxidant flavonoids contributing to overall activity.
Pharmacological Actions
Anti-inflammatory gargle / mouthwash for inflammation of the mouth and throat (sore throat)
Bistorta officinalis (Polygonum bistorta) rhizome extract, rich in gallotannins and phenolic acids, shows cytotoxic and pro-apoptotic activity against hepatocellular and other cancer cells (preclinical).
Astringent for mild diarrhoea (tannins tighten the gut lining and reduce excess secretion)
Antibacterial (topical) - GC-MS-characterised extracts showed antibacterial activity
Astringent for mild diarrhoea (tannins tighten the gut lining and reduce excess secretion)
Traditional & Indicated Uses
inferred from anti-inflammatory action
Polygonum bistorta (Bistorta officinalis) methanol-water and aqueous extracts inhibit hepatocellular carcinoma cells via ROS-induced ER stress and apoptosis (delaying xenograft tumour growth), with phenolic constituents driving the cytotoxicity (preclinical).
Astringent for mild diarrhoea (tannins tighten the gut lining and reduce excess secretion)
inferred from styptic action
inferred from antimicrobial action
Anti-inflammatory gargle / mouthwash for inflammation of the mouth and throat (sore throat)
inferred from astringent action
Anti-inflammatory gargle / mouthwash for inflammation of the mouth and throat (sore throat)
inferred from anti-inflammatory action
inferred from antiviral action
inferred from anti-inflammatory action
inferred from sedative action
inferred from anti-inflammatory action
Safety, Cautions & Contraindications
Very tannin-rich: high or prolonged intake may cause stomach upset or constipation and can reduce the absorption of iron and some medicines taken at the same time.
Traditional use only; diarrhoea persisting beyond a few days, or mouth/throat inflammation that does not settle, needs medical assessment.
Safety in pregnancy and breastfeeding is not established; avoid medicinal doses.
Significant drug interactions: strongly induces CYP3A4 and P-glycoprotein, reducing plasma levels of many drugs including oral contraceptives, antiretrovirals, cyclosporine, warfarin, and digoxin. May cause photosensitivity (fair-skinned individuals). Do not combine with SSRIs, SNRIs, or MAOIs (serotonin syndrome risk). Avoid in bipolar disorder.
Duke (2002) rates St. John's wort as ++ (raised from earlier editions) and notes antidepressant, antiviral, antibacterial, and wound-healing activities at experimental and clinical levels. Hypericin and hyperforin are identified as key active constituents. Clinical evidence (score 2) confirms antidepressant efficacy in mild-to-moderate depression, and WHO/Commission E provide approval for this indication. Dose: 300 mg standardized extract (0.3% hypericin, 3–5% hyperforin) three times daily. Duke emphasizes the critical drug interaction: St. John's wort is a potent CYP3A4 inducer and can significantly reduce blood levels of many medications including oral contraceptives, cyclosporine, antiretrovirals, and warfarin. Avoid combined use with SSRIs (serotonin syndrome risk) and pharmaceutical antidepressants (Duke, 2002).
External Ids
Botanical Description
Perennial herb rising from a thick, twisted, S- or snake-shaped rhizome (giving the names 'bistort' and 'snakeroot'), blackish outside and pink inside. The basal leaves are broadly oval to lance-shaped on long stalks; stem leaves are smaller and stalkless. A single dense, cylindrical spike of small, pale pink flowers is borne atop each unbranched flowering stem.[14]
Erect, branching perennial herb with paired, oval leaves dotted with tiny translucent oil glands that look like pinpricks when held to the light (giving the species name 'perforatum'). Bright yellow, five-petalled flowers with numerous stamens and black dots along the petal edges are borne in flat-topped clusters, and release a reddish pigment when crushed.[4]
Habitat
Grows in damp meadows, pastures, streamsides and mountain grassland on moist, often calcareous soils; native to Europe and temperate Asia, favouring cooler upland regions.[14]
Grows in grassland, roadsides, woodland clearings and waste ground on well-drained soils; native to Europe, Western Asia and North Africa and widely naturalised elsewhere, including North America and Australia.[4]
Harvesting
The rhizome is dug in autumn or early spring, when tannin content is highest, cleaned and dried; aerial parts are gathered in summer while flowering.[14]
The flowering tops (flower and upper leaf) are cut in summer as the flowers open, around the traditional St John's Day period, and dried quickly in a warm, shaded, airy place to preserve the hypericin and hyperforin content.[4]
Traditional Uses
Bistort rhizome, one of the most tannin-rich temperate herbs, has a long European folk history as a powerful astringent for mild diarrhoea, as a gargle for sore throat and mouth inflammation, and topically as a vulnerary and styptic for minor wounds and bleeding; young leaves have also traditionally been eaten as a spring pot-herb ('Easter-ledge pudding').[13, 14]
St John's wort has a centuries-long European folk reputation as a wound-healing and nerve tonic herb, traditionally used for mild wounds, burns and nerve pain and to lift low mood; this traditional mood-supporting use is now one of the most extensively clinically studied applications of any herbal medicine, with standardised extracts shown comparable to conventional antidepressants for mild-to-moderate depression.[1, 4]
Preparations
Flowering-top extract standardised to hypericin and/or hyperforin content, taken as tablets or capsules; the best-studied clinical form for mood support.
References
Lookalikes Review
Dosage
Not documented
Clinical trials for mild-to-moderate depression commonly use around 300 mg of standardised extract three times daily (900 mg/day total); given extensive drug interactions, use should be discussed with a healthcare provider, especially alongside other medicines. Educational reference only, not a prescription.
Drug Class Interactions
Not documented
Pairings
Not documented
St John's wort raises serotonin activity and can cause serotonin syndrome when combined with other serotonin-boosting agents; pairing it with another mood-active, serotonergic herb such as saffron may add to this risk.[30]
St John's wort is a strong enzyme inducer and increases serotonin activity; combining it with another antidepressant-type herb such as rhodiola may add to serotonergic effects and unpredictably change how each is handled by the body.[30]
St John's wort speeds up the breakdown of many substances and also raises serotonin activity; pairing it with a sedative herb such as valerian may add to drowsiness and can unpredictably change how each is handled by the body.[30, 31]
St John's wort is a strong enzyme inducer and kava is a liver-metabolised sedative; combining them may add to central-nervous-system effects and alter how kava is processed, so combined use warrants caution.[30, 31]
References & Sources
- Pawłowska, K.A., Hałasa, R., Dudek, M.K., Majdan, M. et al (2020) 'Antibacterial and anti-inflammatory activity of bistort (Bistorta officinalis) aqueous extract and its major components: justification of the usage of the medicinal plant material as a traditional topical agent', Journal of Ethnopharmacology, 260, pp. 113077. doi:10.1016/j.jep.2020.113077 Preclinical
https://doi.org/10.1016/j.jep.2020.113077 - Jovanović, M., Morić, I., Nikolić, B., Pavić, A. et al (2020) 'Anti-Virulence Potential and In Vivo Toxicity of Persicaria maculosa and Bistorta officinalis Extracts', Molecules, 25(8), pp. 1811. doi:10.3390/molecules25081811 Preclinical
https://doi.org/10.3390/molecules25081811 - Duwiejua, M., Zeitlin, I.J., Waterman, P.G. and Gray, A.I (1994) 'Anti-inflammatory activity of Polygonum bistorta, Guaiacum officinale and Hamamelis virginiana in rats', Journal of Pharmacy and Pharmacology, 46(4), pp. 286-290. doi:10.1111/j.2042-7158.1994.tb03795.x Preclinical
https://doi.org/10.1111/j.2042-7158.1994.tb03795.x - Esmaealzadeh, N., Abdolghaffari, A., Baeeri, M., Hasanpour, M., Iranshahi, M., Santarcangelo, C., Gholami, M. and Bahramsoltani, R (2024) 'Protective effect of freeze-dried extract of Persicaria bistorta Samp. on acetic acid-induced colitis model in rats: involvement of nitric oxide and opioid system', Inflammopharmacology, 32(6), pp. 3845-3861. doi:10.1007/s10787-024-01518-8 Preclinical
https://doi.org/10.1007/s10787-024-01518-8 - Klimczak, U., Wozniak, M., Tomczyk, M. and Granica, S (2017) 'Chemical composition of edible aerial parts of meadow bistort (Persicaria bistorta (L.) Samp.)', Food Chemistry, 230, pp. 281-290. doi:10.1016/j.foodchem.2017.02.128 Preclinical
https://doi.org/10.1016/j.foodchem.2017.02.128 - Manoharan, K.P., Benny, T.K.H. and Yang, D (2005) 'Cycloartane type triterpenoids from the rhizomes of Polygonum bistorta', Phytochemistry, 66(19), pp. 2304-2308. doi:10.1016/j.phytochem.2005.07.008 Preclinical
https://doi.org/10.1016/j.phytochem.2005.07.008 - Liu, X., Hua, H., Liu, J., Chen, F. and Wu, L (2006) 'A new tannin-related compound from the rhizome of Polygonum bistorta L', Journal of Asian Natural Products Research, 8(4), pp. 299-302. doi:10.1080/10286020500034956 Preclinical
https://doi.org/10.1080/10286020500034956 - Yang, W., Qian, Z., Wu, M., Gao, J., Huang, Q., Zou, Y. and Tang, D (2023) 'Online microextraction coupled with HPLC-ABTS for rapid analysis of antioxidants from the root of Polygonum bistorta', Evidence-Based Complementary and Alternative Medicine, 2023, pp. 7496848. doi:10.1155/2023/7496848 Preclinical
https://doi.org/10.1155/2023/7496848 - Bauer, I., Rimbach, G., Nevermann, S., Neuhauser, C., Schwarzinger, B., Schwarzinger, C., Weghuber, J. and Luersen, K (2023) 'In-vitro antidiabetic activity of a Bistorta officinalis Delarbre root extract can not be confirmed in the in-vivo models hen's egg test and Drosophila melanogaster', Journal of Physiology and Pharmacology, 74(1). doi:10.26402/jpp.2023.1.04 Preclinical
https://doi.org/10.26402/jpp.2023.1.04 - Intisar, A., Zhang, L., Luo, H., Kiazolu, J.B., Zhang, R. and Zhang, W (2012) 'Anticancer constituents and cytotoxic activity of methanol-water extract of Polygonum bistorta L', African Journal of Traditional, Complementary and Alternative Medicines, 10(1), pp. 53-59. doi:10.4314/ajtcam.v10i1.9 Preclinical
https://doi.org/10.4314/ajtcam.v10i1.9 - Liu, Y., Weng, Y., Lin, H., Tang, S., Chen, C., Liang, C., Ku, C. and Lin, J (2017) 'Aqueous extract of Polygonum bistorta modulates proteostasis by ROS-induced ER stress in human hepatoma cells', Scientific Reports, 7, pp. 41437. doi:10.1038/srep41437 Preclinical
https://doi.org/10.1038/srep41437 - Khan, S., Arshad, S., Masood, I., Arif, A., Abbas, S., Qureshi, A.W., Parveen, A. and Seemab Ameen, Z (2023) 'GC-MS Analysis of Persicaria bistorta: Uncovering the Molecular Basis of Its Traditional Medicinal Use', Applied Biochemistry and Biotechnology, 196(4), pp. 2270--2288. doi:10.1007/s12010-023-04580-0 Traditional / reference
https://doi.org/10.1007/s12010-023-04580-0 - WebMD (n.d.) 'Bistort: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews'. Available at: https://www.webmd.com/vitamins/ai/ingredientmono-75/bistort Traditional / reference
https://www.webmd.com/vitamins/ai/ingredientmono-75/bistort - (2020) 'Antibacterial and anti-inflammatory activity of bistort (Bistorta officinalis) aqueous extract and its major components - justification of the usage of the medicinal plant material as a traditional topical agent', Journal of Ethnopharmacology. doi:10.1016/j.jep.2020.113077 Traditional / reference
https://doi.org/10.1016/j.jep.2020.113077
- Ng, Q.X., Venkatanarayanan, N. and Ho, C.Y.X (2017) 'Clinical use of Hypericum perforatum (St John's wort) in depression: A meta-analysis', Journal of Affective Disorders, 210, pp. 211-221. doi:10.1016/j.jad.2016.12.048 Meta-analysis / review
https://doi.org/10.1016/j.jad.2016.12.048 - Kholghi, G., Arjmandi-Rad, S., Zarrindast, M.R. and Vaseghi, S (2022) 'St. John's wort (Hypericum perforatum) and depression: what happens to the neurotransmitter systems?', Naunyn-Schmiedeberg's Archives of Pharmacology, 395(6), pp. 629-642. doi:10.1007/s00210-022-02229-z Traditional / reference
https://doi.org/10.1007/s00210-022-02229-z - Fugh-Berman, A (2000) 'Herb-drug interactions', Lancet, 355(9198), pp. 134-138. doi:10.1016/S0140-6736(99)06457-0 Traditional / reference
https://doi.org/10.1016/S0140-6736(99)06457-0 - Nobakht, S.Z., Akaberi, M., Mohammadpour, A.H., Tafazoli Moghadam, A. and Emami, S.A (2022) 'Hypericum perforatum: Traditional uses, clinical trials, and drug interactions', Iranian Journal of Basic Medical Sciences, 25(9), pp. 1045-1058. doi:10.22038/IJBMS.2022.65112.14338 Meta-analysis / review
https://doi.org/10.22038/IJBMS.2022.65112.14338 - Jiang, Z., Wang, F., Zhao, Y., Lu, L., Jiang, X., Huang, T., Lin, Y., Guo, L., Weng, Z. and Liu, E (2024) 'Hypericum perforatum L. attenuates depression by regulating Akkermansia muciniphila, tryptophan metabolism and NFkB-NLRP2-Caspase1-IL1beta pathway', Phytomedicine, 132, pp. 155847. doi:10.1016/j.phymed.2024.155847 Preclinical
https://doi.org/10.1016/j.phymed.2024.155847 - Oliveira, A.I., Pinho, C., Sarmento, B. and Dias, A.C.P (2016) 'Neuroprotective Activity of Hypericum perforatum and Its Major Components', Frontiers in Plant Science, 7, pp. 1004. doi:10.3389/fpls.2016.01004 Meta-analysis / review
https://doi.org/10.3389/fpls.2016.01004 - Russo, E., Scicchitano, F., Whalley, B.J., Mazzitello, C., Ciriaco, M., Esposito, S., Patane, M., Upton, R., Pugliese, M., Chimirri, S., Mammi, M., Palleria, C. and De Sarro, G (2013) 'Hypericum perforatum: pharmacokinetic, mechanism of action, tolerability, and clinical drug-drug interactions', Phytotherapy Research, 28(5), pp. 643-655. doi:10.1002/ptr.5050 Meta-analysis / review
https://doi.org/10.1002/ptr.5050 - Saddiqe, Z., Naeem, I. and Maimoona, A (2010) 'A review of the antibacterial activity of Hypericum perforatum L', Journal of Ethnopharmacology, 131(3), pp. 511-521. doi:10.1016/j.jep.2010.07.034 Meta-analysis / review
https://doi.org/10.1016/j.jep.2010.07.034 - Mennini, T. and Gobbi, M (2004) 'The antidepressant mechanism of Hypericum perforatum', Life Sciences, 75(9), pp. 1021-1027. doi:10.1016/j.lfs.2004.04.005 Meta-analysis / review
https://doi.org/10.1016/j.lfs.2004.04.005 - Liu, Y., Jiang, Y., Huang, R., Yang, J., Xiao, B. and Dong, J (2013) 'Hypericum perforatum L. preparations for menopause: a meta-analysis of efficacy and safety', Climacteric, 17(4), pp. 325-335. doi:10.3109/13697137.2013.861814 Meta-analysis / review
https://doi.org/10.3109/13697137.2013.861814 - Wurglics, M. and Schubert-Zsilavecz, M (2006) 'Hypericum perforatum: a 'modern' herbal antidepressant: pharmacokinetics of active ingredients', Clinical Pharmacokinetics, 45(5), pp. 449-468. doi:10.2165/00003088-200645050-00002 Meta-analysis / review
https://doi.org/10.2165/00003088-200645050-00002 - Kasper, S (2001) 'Hypericum perforatum - a review of clinical studies', Pharmacopsychiatry, 34(Suppl 1), pp. S51-S55. doi:10.1055/s-2001-15467 Meta-analysis / review
https://doi.org/10.1055/s-2001-15467 - Nathan, P (1999) 'The experimental and clinical pharmacology of St John's Wort (Hypericum perforatum L.)', Molecular Psychiatry, 4(4), pp. 333-338. doi:10.1038/sj.mp.4000557 Meta-analysis / review
https://doi.org/10.1038/sj.mp.4000557 - Verotta, L (2003) 'Hypericum perforatum, a source of neuroactive lead structures', Current Topics in Medicinal Chemistry, 3(2), pp. 187-201. doi:10.2174/1568026033392589 Meta-analysis / review
https://doi.org/10.2174/1568026033392589 - Linde, K. et al (2008) 'St John'. Traditional / reference
https://scholar.google.com/scholar?q=St%20John - Natural Standard (2013) 'Hypericum perforatum (St'. Traditional / reference
https://scholar.google.com/scholar?q=Hypericum%20perforatum%20%28St - Duke, J.A (2002) 'Handbook of Medicinal Herbs, Second Edition'. Traditional / reference
https://scholar.google.com/scholar?q=Handbook%20of%20Medicinal%20Herbs%2C%20Second%20Edition - Zhou, S., Chan, E., Pan, S.Q., Huang, M. and Lee, E.J.D (2004) 'Pharmacokinetic interactions of drugs with St John's wort', Journal of Psychopharmacology, 18(2), pp. 262-276. doi:10.1177/0269881104042632 Meta-analysis / review
https://doi.org/10.1177/0269881104042632 - Izzo, A.A. and Ernst, E (2009) 'Interactions between herbal medicines and prescribed drugs: an updated systematic review', Drugs, 69(13), pp. 1777-1798. doi:10.2165/11317010-000000000-00000 Meta-analysis / review
https://doi.org/10.2165/11317010-000000000-00000 - Borrelli, F. and Izzo, A.A (2009) 'Herb-drug interactions with St John's wort (Hypericum perforatum): an update on clinical observations', The AAPS Journal, 11(4), pp. 710-727. doi:10.1208/s12248-009-9146-8 Meta-analysis / review
https://doi.org/10.1208/s12248-009-9146-8 - Nicolussi, S., Drewe, J., Butterweck, V. and Meyer zu Schwabedissen, H.E (2020) 'Clinical relevance of St. John's wort drug interactions revisited', British Journal of Pharmacology, 177(6), pp. 1212-1226. doi:10.1111/bph.14936 Meta-analysis / review
https://doi.org/10.1111/bph.14936 - Piscitelli, S.C., Burstein, A.H., Chaitt, D., Alfaro, R.M. and Falloon, J (2000) 'Indinavir concentrations and St John's wort', Lancet, 355(9203), pp. 547-548. doi:10.1016/S0140-6736(99)05712-8 Clinical study
https://doi.org/10.1016/S0140-6736(99)05712-8 - Barone, G.W., Gurley, B.J., Ketel, B.L., Lightfoot, M.L. and Abul-Ezz, S.R (2000) 'Drug interaction between St. John's wort and cyclosporine', Annals of Pharmacotherapy, 34(9), pp. 1013-1016. doi:10.1345/aph.10088 Clinical study
https://doi.org/10.1345/aph.10088 - Murphy, P.A., Kern, S.E., Stanczyk, F.Z. and Westhoff, C.L (2005) 'Interaction of St. John's Wort with oral contraceptives: effects on the pharmacokinetics of norethindrone and ethinyl estradiol, ovarian activity and breakthrough bleeding', Contraception, 71(6), pp. 402-408. doi:10.1016/j.contraception.2004.11.004 Clinical study
https://doi.org/10.1016/j.contraception.2004.11.004 - Murphy, P.A., Kern, S.E., Stanczyk, F.Z. and Westhoff, C.L (2005) 'Interaction of St. John's Wort with oral contraceptives: effects on the pharmacokinetics of norethindrone and ethinyl estradiol, ovarian activity and breakthrough bleeding', Contraception, 71(6), pp. 402-408. doi:10.1016/j.contraception.2004.11.004 Clinical study
https://doi.org/10.1016/j.contraception.2004.11.004 - Pfrunder, A., Schiesser, M., Gerber, S., Haschke, M., Bitzer, J. and Drewe, J (2003) 'Interaction of St John's wort with low-dose oral contraceptive therapy: a randomized controlled trial', British Journal of Clinical Pharmacology, 56(6), pp. 683-690. doi:10.1046/j.1365-2125.2003.02005.x Randomized trial
https://doi.org/10.1046/j.1365-2125.2003.02005.x - Johne, A., Brockmoller, J., Bauer, S., Maurer, A., Langheinrich, M. and Roots, I (1999) 'Pharmacokinetic interaction of digoxin with an herbal extract from St John's wort (Hypericum perforatum)', Clinical Pharmacology and Therapeutics, 66(4), pp. 338-345. doi:10.1053/cp.1999.v66.a101944 Clinical study
https://doi.org/10.1053/cp.1999.v66.a101944 - Mathijssen, R.H.J., Verweij, J., de Bruijn, P., Loos, W.J. and Sparreboom, A (2002) 'Effects of St. John's wort on irinotecan metabolism', Journal of the National Cancer Institute, 94(16), pp. 1247-1249. doi:10.1093/jnci/94.16.1247 Randomized trial
https://doi.org/10.1093/jnci/94.16.1247 - Smith, P., Bullock, J.M., Booker, B.M., Haas, C.E., Berenson, C.S. and Jusko, W.J (2004) 'The influence of St. John's wort on the pharmacokinetics and protein binding of imatinib mesylate', Pharmacotherapy, 24(11), pp. 1508-1514. doi:10.1592/phco.24.16.1508.50958 Clinical study
https://doi.org/10.1592/phco.24.16.1508.50958 - Izzo, A.A (2004) 'Drug interactions with St. John's Wort (Hypericum perforatum): a review of the clinical evidence', International Journal of Clinical Pharmacology and Therapeutics, 42(3), pp. 139-148. doi:10.5414/cpp42139 Meta-analysis / review
https://doi.org/10.5414/cpp42139 - Caus, M.N., Lupoae, M. and Chitescu, C.L (2026) 'Efficacy and Safety of Herbal Supplements with Anxiolytic, Antidepressant, and Sedative Action: A Review of Clinical Data and Toxicological Risks', Pharmaceuticals, 19(3), pp. 399. doi:10.3390/ph19030399 Meta-analysis / review
https://doi.org/10.3390/ph19030399
Generated automatically from the Omnia Sana plant database and its cited sources. For educational purposes only — not medical advice. Always consult a qualified practitioner before using medicinal plants.