Plant Comparison
Witch Hazel 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
Witch Hazel and Perforate St John’s-wort: they share 5 indicated uses (arthritis / joint pain, bruising, inflammation (general), …); 3 pharmacological actions in common.
Evidence face-off — shared uses
| Condition | Witch Hazel | Perforate St John’s-wort | Verdict |
|---|---|---|---|
| Arthritis / joint pain | 5/10 | 1/10 | Stronger for Witch Hazel |
| Bruising | 1/10 | 1/10 | Comparable evidence |
| Inflammation (general) | 5/10 | 1/10 | Stronger for Witch Hazel |
| Skin irritation | 5/10 | 1/10 | Stronger for Witch Hazel |
| 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
The principal astringent and anti-inflammatory constituents.
Antioxidant and anti-inflammatory constituents of the bark and leaf.
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 and antioxidant (supports irritated/atopic skin); Relief of haemorrhoid symptoms (astringent and anti-inflammatory)
Astringent for skin irritation and minor inflammation of the skin and oral mucosa (tannins), applied topically; Relief of haemorrhoid symptoms (astringent and anti-inflammatory)
Traditional & Indicated Uses
inferred from anti-inflammatory action
Vulnerary for minor wounds, bruises and insect bites
inferred from anticancer action
Relief of haemorrhoid symptoms (astringent and anti-inflammatory)
Astringent for skin irritation and minor inflammation of the skin and oral mucosa (tannins), applied topically
Astringent for skin irritation and minor inflammation of the skin and oral mucosa (tannins), applied topically
Astringent for skin irritation and minor inflammation of the skin and oral mucosa (tannins), applied topically
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
For topical use. Do not apply to deep wounds, serious burns or severe rectal bleeding - these need medical care.
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
Large, multi-stemmed deciduous shrub or small tree with broad, oval, wavy-toothed leaves, asymmetrical at the base. Unusually, it flowers in late autumn to winter after the leaves have fallen, bearing clusters of small, spidery, bright yellow flowers with narrow, crinkled, ribbon-like petals. The woody seed capsule matures the following autumn and explosively ejects its seeds ('snapping hazelnut').[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
Native to woodland understorey and forest margins of eastern North America; widely cultivated as an ornamental and medicinal shrub.[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
Bark is stripped from branches (not the main trunk, to avoid harming the plant) and leaves are picked in summer; both are dried for use, or steam-distilled together with twigs to produce distilled witch-hazel water, the most common commercial form.[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
Witch hazel has a long Native American and, after adoption by European settlers, worldwide reputation as a topical astringent and anti-inflammatory remedy for skin irritation, minor wounds, bruises, insect bites and haemorrhoids, and as a soothing wash for irritated skin and mucous membranes.[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.
Dosage
The EU herbal monograph on Hamamelis virginiana L., cortex gives, for cutaneous use, tincture at a strength corresponding to 5-10% in semi-solid preparations several times daily, or a dry extract (5-7.7:1, ethanol 30% m/m) at a strength corresponding to 1.3% as an ointment several times daily; for anorectal use, a decoction of 5-10 g per 250 mL up to 3 times daily as impregnated dressings. For topical use only. Educational reference only, not a prescription.
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.
References
Lookalikes Review
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
- Skowrońska, W., Pawłowska, K.A., Obrębski, M., Piwowarski, J.P. et al (2025) 'Chemical composition, skin microbiota metabolism, antimicrobial potential and anti-inflammatory properties of witch hazel bark (Hamamelis virginiana L.)', Journal of Ethnopharmacology, 353(Pt B), pp. 120433. doi:10.1016/j.jep.2025.120433 Preclinical
https://doi.org/10.1016/j.jep.2025.120433 - Piazza, S., Martinelli, G., Vrhovsek, U., Masuero, D. et al (2022) 'Anti-Inflammatory and Anti-Acne Effects of Hamamelis virginiana Bark in Human Keratinocytes', Antioxidants (Basel), 11(6), pp. 1119. doi:10.3390/antiox11061119 Preclinical
https://doi.org/10.3390/antiox11061119 - Janarthanam, V.A., Rajan, P.S.S., Panda, S.P., Panigrahy, U.P. et al (2025) 'Hamamelitannin from Hamamelis virginiana Attenuates Ethanol-Induced Oxidative and Inflammatory Responses in Danio rerio Larvae', Molecular Biotechnology, 68(5), pp. 2369-2385. doi:10.1007/s12033-025-01502-9 Preclinical
https://doi.org/10.1007/s12033-025-01502-9 - Piazza, S., Martinelli, G., Magnavacca, A., Fumagalli, M., Pozzoli, C., Terno, M., Canilli, L., Angarano, M., Maranta, N., Dell'Agli, M. and Sangiovanni, E (2022) 'Unveiling the Ability of Witch Hazel (Hamamelis virginiana L.) Bark Extract to Impair Keratinocyte Inflammatory Cascade Typical of Atopic Eczema', International Journal of Molecular Sciences, 23(16), pp. 9279. doi:10.3390/ijms23169279 Preclinical
https://doi.org/10.3390/ijms23169279 - Amendola, I., Viegas, D.J., Freitas, E.T., Oliveira, J.R., Santos, J.G., Oliveira, F.E., Lagareiro Netto, A.A., Marcucci, M.C., Oliveira, L.D. and Back-Brito, G.N (2024) 'Hamamelis virginiana L. extract presents antimicrobial and antibiofilm effects, absence of cytotoxicity, anti-inflammatory action, and potential to fight infections through the nitric oxide production by macrophages', Anais da Academia Brasileira de Ciencias, 96(1), pp. e20200031. doi:10.1590/0001-3765202320200031 Preclinical
https://doi.org/10.1590/0001-3765202320200031 - Habtemariam, S (2002) 'Hamamelitannin from Hamamelis virginiana inhibits the tumour necrosis factor-alpha (TNF)-induced endothelial cell death in vitro', Toxicon, 40(1), pp. 83-88. doi:10.1016/s0041-0101(01)00195-7 Preclinical
https://doi.org/10.1016/s0041-0101(01)00195-7 - Natella, F., Guantario, B., Ambra, R., Ranaldi, G., Intorre, F., Burki, C. and Canali, R (2021) 'Human Metabolites of Hamamelis virginiana (Extract) Modulate Fibroblast Extracellular Matrix Components in Response to UV-A Irradiation', Frontiers in Pharmacology, 12, pp. 747638. doi:10.3389/fphar.2021.747638 Randomized trial
https://doi.org/10.3389/fphar.2021.747638 - Dauer, A., Rimpler, H. and Hensel, A (2003) 'Polymeric proanthocyanidins from the bark of Hamamelis virginiana', Planta Medica, 69(1), pp. 89-91. doi:10.1055/s-2003-37022 Preclinical
https://doi.org/10.1055/s-2003-37022 - Vennat, B., Pourrat, H., Pouget, M.P., Gross, D. and Pourrat, A (1988) 'Tannins from Hamamelis virginiana: identification of proanthocyanidins and hamamelitannin quantification in leaf, bark, and stem extracts', Planta Medica, 54(5), pp. 454-457. doi:10.1055/s-2006-962499 Preclinical
https://doi.org/10.1055/s-2006-962499 - Duckstein, S.M., Lorenz, P. and Stintzing, F.C (2012) 'Conversion of phenolic constituents in aqueous Hamamelis virginiana leaf extracts during fermentation', Phytochemical Analysis, 23(6), pp. 588-597. doi:10.1002/pca.2359 Preclinical
https://doi.org/10.1002/pca.2359 - Sanchez-Tena, S., Fernandez-Cachon, M.L., Carreras, A., Mateos-Martin, M.L., Costoya, N., Moyer, M.P., Nunez, M.J., Torres, J.L. and Cascante, M (2012) 'Hamamelitannin from witch hazel (Hamamelis virginiana) displays specific cytotoxic activity against colon cancer cells', Journal of Natural Products, 75(1), pp. 26-33. doi:10.1021/np200426k Preclinical
https://doi.org/10.1021/np200426k - Theisen, L.L., Erdelmeier, C.A.J., Spoden, G.A., Boukhallouk, F., Sausy, A., Florin, L. and Muller, C.P (2014) 'Tannins from Hamamelis virginiana bark extract: characterization and improvement of the antiviral efficacy against influenza A virus and human papillomavirus', PLoS One, 9(1), pp. e88062. doi:10.1371/journal.pone.0088062 Preclinical
https://doi.org/10.1371/journal.pone.0088062 - Cheesman, M.J., Alcorn, S.R., White, A. and Cock, I.E (2023) 'Hamamelis virginiana L. Leaf Extracts Inhibit the Growth of Antibiotic-Resistant Gram-Positive and Gram-Negative Bacteria', Antibiotics, 12(7), pp. 1195. doi:10.3390/antibiotics12071195 Preclinical
https://doi.org/10.3390/antibiotics12071195 - European Medicines Agency (HMPC) (n.d.) 'European Union herbal monograph on Hamamelis virginiana L., cortex/folium/aqua (Hamamelidis cortex)'. Available at: https://www.ema.europa.eu/en/medicines/herbal/hamamelidis-cortex Traditional / reference
https://www.ema.europa.eu/en/medicines/herbal/hamamelidis-cortex - (2025) 'Hamamelis virginiana L. in Skin Care: A Review of Its Pharmacological Properties and Cosmetological Applications', Molecules. doi:10.3390/molecules30132744 Randomized trial
https://doi.org/10.3390/molecules30132744 - Herbal Reality (n.d.) 'Witch Hazel (Hamamelis virginiana): Benefits, Safety, Uses'. Available at: https://www.herbalreality.com/herb/witch-hazel/ Traditional / reference
https://www.herbalreality.com/herb/witch-hazel/
- 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.