A Gynecological Remedy

So what do our classical writers say about the uses of artemisia in gynaecology and do those attributed to mugwort differ? Dioscorides recommends a decoction of the herb in a bath to draw down the menstrual blood and to bring out the foetus and the afterbirth. This is achieved by a warming and thinning effect, which could also procure an abortion. A pessary made from the juice of artemisia mixed with myrrh Commiphora molmol, or three drachms (12 g, increasing to 15 g in Ibn Sina’s entry) of the leaves given in drink will similarly draw out the menstrual blood or contents of the womb. The herb liberally plastered onto the lower abdomen will bring on a period and the decoction added to the bath water will treat uterine closure and inflammation. Pliny mentions only the pessary as cleansing for the uterus, with oil of iris or figs as a substitute for myrrh. Galen records that both artemisias have a heating effect in the second degree or above and are moderately drying in the first or second degree. They are of thin parts and can be used for fomentations of the uterus. Apuleius mentions no gynaecological uses and may be writing of Mattioli’s Artemisia tenuifolia instead.

Having cited the classical texts, Bauhin moves to describe the gynaecological uses commonly known in his time for Artemisia rubra or ‘ruddy’ mugwort, seemingly one of the kinds of mugwort described by Dodoens, Gerard and Parkinson above. He regards the qualities of mugwort to be extremely hot and dry, in the fourth degree, and cites the Salernitan Platearius on this matter. Also like the Salernitans, he recommends the leaves above the root and the fresh herb over the dried, but the Salernitan text suggests finding mugwort in sandy places, mountains and gardens rather than only by the sea. Bauhin cites Brunfels concerning a decoction of the plant with mace Myristica fragrans, an elaboration on Dioscorides, taken two or three times daily for heating the female organs, stimulating suppressed menses and expelling the afterbirth ‘and whatever bad things adhere to these parts’. This may include the tumours which Macer mentions. The distilled water taken as regularly will effect the same, and a wine made from mugwort approaches the strength of pennyroyal Mentha pulegium in treating these conditions. Bauhin also draws on the Salernitan herbal for a use of mugwort against sterility due to dampness, and warns that if the problem is due to dryness then giving mugwort will worsen the condition. We can understand this by recalling that one of Galen’s causes of dryness in the body is the use of heating foods and medicines and mugwort is a heating herb. The Salernitan text explains that it is possible to decide whether to give ‘arthemisia’ (mugwort) or not from the woman’s complexion: if she is fat, then an excess of moisture in the womb is supposed the cause of her sterility, whereas a lean body suggests that an imbalance of dryness is at the root of her problem. The Salernitan text called Trotula on the treatment of women makes a preliminary statement that women may be divided into two groups: those requiring heating medicines and those requiring cooling ones. The two types are to be discerned by use of a piece of lint the size of a little finger, moistened with oil of pennyroyal or laurel or another hot oil, tied round the thighs with string and inserted into the vagina at night. If it is drawn further inside, then it indicates a cold womb; if it is expelled overnight, then it testifies to the heat of the womb. Suitable treatments for a womb that is too hot and dry include marshmallow Althaea officinalis, violets Viola odorata and roses in water. Heating medicines should be contraindicated for women with a reduced fecundity due to dryness. For sterility due to moisture Bauhin wants an electuary or thick syrup to be made, whose recipe lies in the Salernitan herbal: equal parts of powdered mugwort leaves, astringent bistort root Polygonum bistorta and heating nutmeg Myristica fragrans are cooked with honey to the right consistency, then added to a decoction of mugwort. The Dioscoridean hot compress of mugwort leaves over the womb, or of an oil made from them, or a decoction in a bath with the addition of bay leaves are also listed in the Salernitan text, with a comment that these are to be preferred to the electuary.

According to the Salernitan herbal, if a woman drinks ‘arthemisia’ decocted in wine, she will not give birth prematurely. This may imply that she is pregnant when she takes the drink. Macer’s herbal warns that arthemisia causes abortion, as does the 17th century translation of Dioscorides by lohn Goodyer (1934) while the original Greek text is more open to interpretation. However, it is not unreasonable to conclude that if a herb can cause the menses to flow, it can bring on a miscarriage of a foetus, for ‘an emmenogogue is an agent that stimulates the menstrual function: thus, if there is a pregnancy, an emmenogogue will also cause an abortion‘. It may be that the Salernitan writer means such a drink to be taken only by those women whose wombs were sufficiently moist and slippery as to risk miscarriage, in which case ‘arthemisia’ will dry up the superfluous moisture or, as we might understand it, bring a lax uterus into tone and strengthen its retention of the foetus. Given to a woman without such superfluous moisture or laxity, ‘arthemisia’ may cause overcontraction of the womb and expulsion of the foetus.

The compress or fomentation of Dioscorides has slight elaborations in other texts: Dalechamps suggests that mugwort can be mixed with barley flour and applied to the belly; in Macer it is mixed with red wine or simply tied onto the belly overnight; Parkinson recommends that it is mixed with other herbs and decocted and that the woman then sits over a bowl of the steaming liquid to promote menstruation, facilitate labour or expel the afterbirth. A remedy for difficult parturition in the Red Book of the physicians of Myddfai states that fresh mugwort must be bound to the left thigh of a woman unable to give birth to her child, but it must be removed as soon as she has delivered, lest it cause haemorrhage.

To sum up the gynaecological uses of mugwort, our authors up to the end of the 17th century do not stray from the indications given by Dioscorides: to provoke suppressed menstruation, to facilitate labour and the expulsion of the afterbirth and to cleanse the womb in the treatment of uterine diseases and perhaps, for women of a certain temperament, as a preparation for conception and as protection against miscarriage. The principal use of mugwort is for female complaints, writes Quincy, so that it is held in the highest esteem by midwives and nurses, while later in the 18th century both Miller and Hill only mention its use for promoting menstruation, and for distempers of the female sex such as hysteric fits or the vapours. The leaves are used in infusion or the official syrup of Artemisia is given. Wren reaffirms its employment as an emmenogogue for obstruction of menstruation, usually in combination with pennyroyal Mentha pulegium and southernwood Artemisia abrotanum, both emmenogogues, in an infusion of 1 oz of herbs to 1 pint of boiling water, taken in wineglassful doses, variously measured as iy2 to 2 fl oz or three to four tablespoons, approximately 45-60 mL. Hool advises mugwort for an adolescent girl whose periods are delayed, although experience tells us that menarche occurs at different ages and the judgment that menstruation is delayed is better not made too quickly. The National Botanic Pharmacopoeia includes painful menstruation as an indication, as does the British Herbal Pharmacopoeia, which also specifies delayed or irregular menstruation and functional amenorrhoea, at a dose of 0.5-2 g of the dried herb three times daily, with large doses to be avoided.

John Stevens, an associate of Coffin and active in political work advancing the cause of herbal medicine in mid-19th century England, notes that cold is very frequently the cause of period pain and that heat will generally remove it (Stevens 1847). He therefore advocates the regular Thomsonian treatment, including a vapour bath, and this he asserts will in most cases be effective when these distressing affections occur. He also recommends that the woman sits over the steam of a strong decoction of mugwort, and foments her abdomen with hot bitter herbs, such as wormwood, tansy and hops. Injections into the vagina of warm mugwort and yarrow tea can also be beneficial. This approach echoes the methods of Diosco-rides, Trotula and Parkinson already discussed, but the tea to be drunk in wineglassful doses during the distressing symptoms is formulated along Thomsonian lines: equal amounts of mugwort, pennyroyal Mentha pulegium and thyme Thymus species in infusion, to which is added guaiacum Guaiacum officinale ΒΌ oz and the same amount of a specific formula (‘no.6 rheumatic’, composed of 16 oz myrrh Commiphora molmol dissolved in one gallon of brandy in a water bath with 1 oz cayenne pepper Capsicum minimum added).

A current view recommends emmenogogues such as mugwort not only to stimulate menstrual flow and function but ‘in a wider sense to indicate a remedy that normalizes and tones the reproductive system’ (Hoffmann).

Artemisia is not limited in use to acting as an emmenogogue. Dioscorides states that it breaks urinary stones and remedies retention of urine. Pliny affirms the same, for which the herb should be given in sweet wine, and adds that it protects him who carries it on his person from witchcraft and sorcery, poison and venomous beasts, particularly toads, and will prevent a traveller from feeling fatigue on his journey. Taken in wine, it will counteract an excessive dose of opium. Of these indications Galen mentions only kidney stones. Apuleius gives the use of Artemisia for travellers and as a protection against all evil, but states its benefits for digestive pains when taken in water and honey, while pounded in fat and rubbed onto the feet, it takes away their pains.

The four uses cited in Apuleius are repeated in the Old English Herbarium. Hildegard picks up the use for the digestion: mugwort, she says, is very hot and its juice is of great value, healing ailing intestines and warming a cold stomach. It is particularly useful when a person has eaten rotten food or drink and has abdominal pains. In this case he should eat the pureed plant, or take it with meat or lard, and it will draw to itself and purge the offending substance. Likewise, the expressed juice of mugwort made up with honey can be laid on to discharging wounds, covered with egg white and tied with cloth, and repeated until the corruption is resolved. Macer says that mugwort comforts the stomach. The Salernitan herbal suggests powdered mugwort in mead for abdominal pains due to cold, or else pine resin vapour should be introduced into the lower regions of the body, followed by sitting over a tile on which mugwort is heated.

This use of mugwort for the digestion, passing down through the Middle Ages from the herbal of Apuleius, is mentioned very little among Renaissance writers. Mattioli writes separately of Artemisia tenuifolia, crushed into almond oil and rubbed onto the stomach to ease pains there. This application is repeated by Dodoens, who gives his mugwort the same Latin name, and by Gerard, who does not, suggesting that Gerard may simply have copied Dodoens. Thereafter, no mention is made of mugwort for digestive problems in our authors for nearly 400 years (save for Hool who suggests an infusion drunk and a fomentation applied to the belly in cases of abdominal pain, and Grieve who cites a passage from Culpeper unknown to us). The British Herbal Pharmacopoeia gives poor appetite, nervous indigestion and intestinal worms as indications. Pelikan adds heartburn, hyperacidity and colic. Weiss, however, suggests that mugwort is superfluous for such purposes despite its volatile oils and bitter terpenoids when its close relative wormwood is available.

The indications of artemisia in Dioscorides for urinary problems are picked up by Renaissance and early modern writers but are rarely given much attention after Culpeper. The Old English Herbarium attributes relief of urinary retention to another mugwort, that is tansy. In the 19th century Fox says the infusion of mugwort promotes perspiration, urine and menstruation, and is good for hysteric fits. Diaphoretic and nervine tonic actions are listed in the National Botanic Pharmacopoeia, while Grieve emphasizes the herb’s effect on the nervous system above diuretic and diaphoretic actions. An infusion of 1 oz of mugwort to 1 pint of water, she says, taken warm in half-teaspoonful doses for fevers and the common cold, which Hool says will be dealt with speedily when taken in half-teacup doses, becomes a tonic for them both when taken cold three times daily, owing to its bitterness and aromatic character. In support of its use for palsy and epilepsy, Grieve cites Gerard: ‘it cureth the shaking of the joints inclining to the palsie’, but the full quotation in Gerard continues ‘and helpeth the contraction or drawing together of the nerves and sinewes’. In fact Grieve is only copying Fernie’s (1897) partial quotation of Gerard; at least she does not go as far as he in suggesting that mugwort is scentless because it contains no volatile oils.

Gerard’s misquoted assertion may be simply a re-interpretation of Dioscorides’ use of mugwort for joint problems: he recommends that for blood hardening around joints, the stems of the plant should be boiled with oil of roses and the sick man rubbed all over with this liquid before sleep. In Dodoens this same preparation cures the ache, shaking and drawing together of the sinews. Parkinson repeats Bauhin’s proposal of a warm decoction of mugwort, chamomile Matricaria recutita and agrimony Agrimonia eupatoria to bathe the joints and remove pain in the sinews and cramp, while Apuleius recommends an ointment of mugwort for pains in the feet. Hool also recommends mugwort for rheumatism and gout: to subdue inflammatory swelling, bathe the part for 1 hour in a hot infusion, then apply a poultice of chickweed Stellaria media or slippery elm Ulmus fulva. Bruises, poisoned hands or wounds, whitlows, abscesses, carbuncles, even tumours are amenable to this topical treatment if, he says, it is persevered with.