Mistletoe Monograph

Viscum album

1. Nomenclature:

Common Name: Mistletoe

Irish Name: Drualas

Synonyms: Mistiltan (in Old English) Birdlime Mistletoe, Herbe de la Croix, Mystyldene, Lignum Crucis, European mistletoe, European white-berry mistletoe, common mistletoe, all-heal, masslin, Golden bough, Devil's Fuge

Parts Used: Leaves/young twigs/berries.

Family: Loranthaceae

2. Description:

Habitat: Not an Irish native but naturalised in some parts. Considered rare. It is universally accepted that European mistletoe, Viscum album L., is not a native Irish species, but a relatively recent importation; there is no entry for Viscum album in either An Irish Flora (Webb, Parnell and Doogue, 1996) or Census catalogue of the flora of Ireland (Scannell and Synnott, 1987). The New atlas of the flora of Britain and Ireland (Preston, Pearman and Dines, 2002) has what might be regarded as an up-to-date map of the occurrence of mistletoe in Ireland; six 10-km squares are indicated, five in Northern Ireland

and a single one for the Dublin area. Referring to the on-line Flora of Northern Ireland (http://www.habitas.org.uk/flora/species.asp?item=3624, accessed 10 October 2006) there are two additional records (squares) in the Province, and consulting other publications, especially Sylvia Reynolds’ A Catalogue of Alien Plants in Ireland (2002), there are at least another half dozen published records for the rest of Ireland. Mistletoe is a partially parasitic, growing on several woody hosts (trees and shrubs) in a variety of wooded habitats, extending from the tropics (typical V. album is recorded from the Chin Hills in Burma) into temperate regions. Across its geographical range, it can be found growing on gymnosperms as well as broadleaved trees. In the UK, poplar, lime, apple and hawthorn are common hosts. Mistletoes on native European oaks are rare.  Other hosts include Acer platanoides (Norway Maple) and Acer pseudoplatanus (Sycamore); Aesculus carnea (Red Horse-chestnut); Betula sp. (Birch); Cotoneaster horizontalis (Wall Cotoneaster); Crataegus spp. and cultivars (Hawthorns); Malus cultivars including ‘Bramley Seedling’ and ‘Lord Lamborne’ (Apples); Malus sylvestris (Crab Apple); Populus × canadensis; P. nigra (Black-poplar); Salix spp. (Willow); Sorbus aucuparia (Rowan); Tilia

spp. or cultivars (Lime).

Description: Viscum album is a small woody shrub, frequently globular in shape and can reach over 1 m in diameter. It grows on the branches of other trees, to which it is attached by a swelling called a haustorium. In common with all mistletoes, it is hemiparasitic which means that although it depends on its host for water and mineral nutrients, it is able to photosynthesise (create its own carbohydrates using sunlight) because it has green leaves and stems.

The stems of the mistletoe appear characteristically forked, (pseudo-dichotomously branched) and it is possible to estimate the age of a mistletoe bush simply by counting the number of times that the branches fork and adding two years (since often one fork is produced in each year from the third year after germination). V. album is dioecious, which means that male and female flowers are produced on separate plants. The small, easily overlooked flowers are produced in a short inflorescence of three to five flowers in the forks of the branches. Although small, the flowers are reported to be insect-pollinated and they are said to be sweetly scented and to produce nectar. The white berries appear from about October until May. Inside they contain a single green seed which lacks a seed coat but is surrounded by a sticky pulp.

Image courtesy: http://www.geograph.org.uk/photo/196611

Conservation Status: Rated by IUCN (International Union for Conservation of Nature) as of Least Concern (LC). However a Guardian article from 2010 suggests The National Trust fears that the decline of traditional apple orchards, where mistletoe thrives, may lead to the parasitic plant disappearing – or becoming much harder to obtain in the next 20 years. There are only about a dozen or so Mistletoe sites in all of Ireland, near Waterford for example. Local but common in the UK. Viscum album is locally common in the UK. The most recent survey (1993-6) showed that, in its stronghold in the former apple orchard areas of the Welsh borders, the populations had fallen in numbers as a direct consequence of the decline of the orchards. In spite of this, the plant was still much more common in the counties of Gloucestershire, Herefordshire and Worcestershire, when compared with what are probably more natural frequencies found elsewhere.

Infestations of mistletoe are detrimental to the host tree, and large infestations can eventually lead to the host's death, particularly during prolonged periods of dry weather. As mistletoe reduces the productivity of commercial fruit trees it is often pruned out to try and stop its spread.

3. Cultivation:

Mistletoe is propagated primarily by birds who deposit the berries during flight. These berries quickly root in their new home and in some places, trees are green in winter from the Mistletoe they host. Germination of Mistletoe seeds has a mythology of its own and patent methods abound in old gardening literature. The earliest account seems to be in John Morton's Natural History of Northamptonshire (1712) where he describes successful planting on Black Poplar during March.

Germination can be divided into non-parasitic and parasitic phases. In the first the seed extends a green hypocotyl which bends towards the host surface. Once this is contacted it flattens to a sucker-shaped holdfast adhering to the host surface.  Once the holdfast is established the parasitic phase begins as the seedling begins to penetrate the host tissue stimulating the growth of a connecting organ or haustorium. The haustorium grows with the host, often causing strange twistings and swellings in the branch.

(Note that these instructions are written for European Mistletoe - and may not be appropriate for other mistletoe species)

Mistletoe seeds need intact healthy host bark, and light, to grow. There is no need to cut open the bark. You'll need a lot of berries to be sure of success however. Timing is important and February and March are the best times. Although Mistletoe grows VERY slowly in the first 4 years, it grows very profusely once established. Mistletoe cut at winter solstice is not ideal, but berries can be kept fresh by detaching them and leaving them in a shed until mid-February. Far better to harvest your berries fresh on February 2nd – if you have a local source try netting them at Christmas to ensure some are left. In February, if the berries have been stored, rehydrate them for a few hours in a little water.

Whether fresh or stored, the seed needs to be squeezed out of the berry, along with a quantity of the sticky viscin.

Collect several sticky seeds on your fingers. You'll find they stick on just fine!

Then choose your host, bearing in mind European Mistletoe's preferences – apple first, then poplars, limes, false acacia, hawthorn etc. Most shrubs of the Rosaceae are suitable. Remember that mistletoe is a parasite and will affect the growth of the branch it is on and, on apple, will reduce fruit yield.

Choose young branches, from 2 to 6 cm diameter. Avoid older branches and the trunk (ignore old gardening texts that suggest planting in older fissured bark).

Stick those half-dozen seeds you stuck on your hand onto the branch. LABEL THEM - with a plant label tied to the branch (it's very easy to forget which branch you used). Try to plant as many as possible, at least 20 berries at once, divided between 4 or so branches. Germination is easy - but many will later die, or be eaten by birds and invertebrates. And remember mistletoe is 'dioecious' - so each plant will be either male or female. This means you’ll need male and female plants to produce berries.

By March/April your seeds should be germinating. A few will already be missing, eaten by birds or grazed off by invertebrates - but survivors should begin to look like this:

This is as big as they get in Year One - so be sure your label is tied securely to the branch or you'll lose track of them by next year.

Year three gets proper leaves, after which it will grow quite rapidly.

Harvest: Harvest young leafy twigs on a dry day in Spring just before the formation of berries. A ladder will be required.

Ecology:

Although a parasite mistletoe does have its own separate ecology and plays host to 6 specific mistletoe insect species including the mistletoe weevil, picture below:

4. Mythology:

First described by the Greek naturalist Theophrastus in the Third Century BC.

Allen and Hatfield mention:

"Viscum was one of the 3 herbs mentioned by Pliny the Elder in his Natural History as held in high esteem by the contemporary Gauls - and, as it was a plant well known to the Romans, there can hardly be doubt as to its identity. Pliny says the Druids believed it an antidote for all poisons and called it 'All-Heal'. In Ireland the plant has enjoyed a reputation in Cavan and Meath for soothing the nerves in general, and in Limerick and Cork for palliating epilepsy and hysteria specifically.

Maud Grieve tells us:

" Mistletoe was held in great reverence by the Druids. They went forth clad in white robes to search for the sacred plant, and when it was discovered, one of the Druids ascended the tree and gathered it with great ceremony, separating it from the Oak with a golden knife. The Mistletoe was always cut at a particular age of the moon, at the beginning of the year, and it was only sought for when the Druids declared they had visions directing them to seek it. When a great length of time elapsed without this happening, or if the Mistletoe chanced to fall to the ground, it was considered as an omen that some misfortune would befall the nation. The Druids held that the Mistletoe protected its possessor from all evil, and that the oaks on which it was seen growing were to be respected because of the wonderful cures which the priests were able to effect with it. They sent round their attendant youth with branches of the Mistletoe to announce the entrance of the new year. It is probable that the custom of including it in the decoration of our homes at Christmas, giving it a special place of honour, is a survival of this old custom.

The curious basket of garland with which 'Jack-in-the-Green' is even now occasionally invested on May-day is said to be a relic of a similar garb assumed by the Druids for the ceremony of the Mistletoe. When they had found it they danced round the oak to the tune of 'Hey derry down, down, down derry!' which literally signified, 'In a circle move we round the oak. ' Some oak woods in Herefordshire are still called 'the derry'; and the following line from Ovid refers to the Druids' songs beneath the oak:

'---Ad viscum Druidce cantare solebant---.'

Shakespeare calls it 'the baleful Mistletoe,' an allusion to the Scandinavian legend 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.

In Norse mythology it was the God of peace Balder, that inspired Mistletoe to become the kissing plant. When struck by an arrow, his life was restored so his parents gave Mistletoe to the Norse Goddess of love and she dedicated it to its widely used modern purpose."

The Norse goddess of love was Frigga. Frigga had two sons, one of which was blind. The evil figure of Loki made an arrow out of mistletoe wood and shot Frigga's blind son with the mistletoe arrow. The blind son died, and the goddess' tears became the mistletoe's white berries. When Frigga's blind son came back to life later, the Nordic goddess decided to turn mistletoes in Scandinavia into a symbol of love and fertility, requiring a kiss between humans meeting beneath mistletoes in Scandinavia.

Hippocrates and 17th century herbalist Culpepper prescribed it for disorders of the spleen. However it was traditionally used for convulsions (epilepsy). Native Americans used it to induce abortion and stimulate contractions during childbirth. American 19th century eclectic physicians forerunners of today's naturopaths, recommended it for epilepsy, typhoid fever, menstrual cramps, and postpartum hemorrhage.

"Here we must mention the reverence felt for this plant by the Gauls. The Druids -- for thusly are their priests named - hold nothing more sacred than the mistletoe and the tree that bears it, as long as that tree be an oak.... Mistletoe is very rarely encountered; but when they do find some, they gather it, in a solemn ritual....  After preparing for a sacrifice and a feast under the oak, they hail the mistletoe as a cure-all and bring two white bulls there, whose horns have never been bound before. A priest dressed in a white robe climbs the oak and with a golden sickle cuts the mistletoe, which is caught in a white cloak. Then they sacrifice the victims, begging the god, who gave them the mistletoe as a gift, to make it propitious for them. They believe that a potion prepared from mistletoe will make sterile animals fertile, and that the plant is an antidote for any poison. Such is the supernatural power with which peoples often invest even the most trifling things"  Pliny the Elder (23-79 AD)

It is interesting that, due to Ireland's own Druidic history that there isn't more mention of Mistletoe, Because of its pagan past Mistletoe is banned from churches however.

5. Energetics:

Culpeper tells us Mistletoe is under the dominion of the Sun, the herb is therefore heating and drying.

The fresh bark and leaves have a peculiar, disagreeable odor, and a nauseous, sweetish, slightly acrid and bitterish taste.

6. Medicinal Uses:

Classification: Nervine (Hypotensive)

Actions: Nervine; narcotic, antispasmodic, diaphoretic, tonic, tranquilizer, vasodilator, hypotensive, cardiac depressant, vagus nerve stimulant, diuretic, immunostimulant, anti-inflammatory, antineoplastic.

Uses: Hypertension, insomnia, temporal arthritis, nervous excitability, anxiety, hyperactivity, limb-twitching, epilepsy (petit mal), chorea, exhaustion, vertigo, tinnitus, rabies, arteriosclerosis, headache, migraine, whopping cough (Dr Christopher), dizziness, fatigue, benzodiazepine addiction, cancer.

Specific indications: Determination of blood to brain, flushed face, and oft-recurring headache; tearing, rending rheumatic or neuralgic pains, coming on in paroxysms; weak, irregular heart-action, with dyspnoea, cardiac hypertrophy, and valvular insufficiency.

Since druidic times the herb has been used applied to external cancers. Both Pliny and Hippocrates report its use for cancers and epilepsy. Used as an adjunct to therapy and surgery. Combines well with Skullcap and Valerian in nervous conditions, with Motherwort and Hawthorn for myocarditis and with Blue Cohosh for menstrual irregularity (Bartram). It should never be combined with Gotu Kola according to Dr John Heinerman.

Rudolf Steiner introduced the use of mistletoe extracts for the treatment of cancer in 1916.The berries are used specifically. The berries are toxic  in large does but recent research suggest the leaves are not.

This plant possesses toxic properties. Vomiting, catharsis, with tenesmus and sometimes bloody stools, papillary contraction, muscular spasm, prostration, coma, convulsions, and death have been reported from eating the leaves and berries. Viscum has been beneficially employed in epilepsy, hysteria, insanity, paralysis, and other nervous diseases. In using this agent, it is always necessary to regulate the condition of the stomach and bowels, and the menstrual discharge, and other faulty secretions, and remove worms, if any are present, previous to its exhibition. It is asserted of some value as an oxytocic, and to restrain postpartum and other uterine hemorrhages. It produces intermittent contractions, and by some physicians, especially Dr. Ellingwood, is declared to be safer, in many respects, than ergot. It is useful in amenorrhea and dysmenorrhea. It is also reputed a heart tonic. According to Dr. Tascher, it is a remedy for cardiac hypertrophy and dropsy, associated with enlarged heart. Cardiac hypertrophy, valvular insufficiency, feeble pulse, oedema, dyspnoea, and inability to lie down, were the symptoms of the cases favorably influenced by 20 to 30-drop doses of the fluid extract. Dr. Ellingwood advises it with strychnine to support the weak, irregular, and rapid heart-action, with tendency to collapse, in typhoid fever. It may be given in doses of from 30 to 60 grains, and gradually increased to 3 or 4 drachms, 3 or 4 times a day, and if it produces sleep or other narcotic effects, the doses must be diminished; fluid extract, 10 to 40 drops; specific mistletoe, 1 to 15 minims. Preparations of the fresh plant should be used, as the drug loses its properties when old. The powder is best given in an infusion of valerian.

Mistletoe was at one time supposed to have properties resembling digitalis, and has been used in the treatment of cardiac and other dropsies; also in albuminuria and arteriosclerosis. In reality it has a depressant action on the heart, certainly it has no effect in any way resembling that of digitalis. It is said to lower arterial tension, but the clinical evidence in support of this is unconvincing. The berries are purgative and emetic, and are said to have emmenagogue and ecbolic properties when given in large doses. Its principal action is to depress the nervous system, especially the medulla. The extract is administered in pill form with or without tannin. An infusion or decoction, made by boiling 2 ounces of the bruised plant with 10 fluid ounces of water, may be given in tablespoonful doses several times daily. A liquid extract for hypodermic or intravenous injection is prepared in the same way as the extract, except that evaporation is stopped when the mixed liquids measure 50; sodium chloride, 0.35, is then added and the liquid filtered, after which the preparation is sterilised by heating to 120° in an autoclave for twenty minutes.

Physiological Action—Several cases of severe poisoning from eating the leaves and berries are on record. It produces vomiting, prostration, coma, contraction of the pupil, with muscular spasm. In other cases it produces tenesmus, bloody stools, convulsions, emesis, catharsis and death.

In its influence both upon the cerebral circulation and upon the womb and reproductive functions it acts similarly to ergot.

Combinations: Combines well with Tilia and Crataegus in benign hypertension

Preparations:

Dried leaves: 2-6g or by infusion

Liquid Extract: 1:1 in 25% alcohol, 1-3ml

Tincture: 1:5 in 45% alcohol, 0.5ml

Infusion: 1:20 in cold water

7. Other Uses:

Homeopathy:

Boericke's Homoeopathic Materia Medica.
VISCUM ALBUM (Mistletoe) Lowered blood pressure. Dilated blood vessels but does not act on the centers in the medulla. Pulse is slow due to central irritation of the vagus. The symptoms point especially to rheumatic and gouty complaints; neuralgia, especially sciatica. Epilepsy, chorea, and metrorrhagia. Rheumatic deafness. Asthma. Spinal pains, due to uterine causes. Rheumatism with tearing pains. Hypertensive albuminuria. Valvular disease, with disturbances in sexual sphere. Symptoms like epileptic aura and petit mal.

Head. - Feeling as if whole vault of skull were lifted up. Blue rings around eyes. Double vision. Buzzing and stopped-up feeling in ear. Deafness from cold. Facial muscles in constant agitation. Persistent vertigo.

Respiratory. - Dyspnoea; feeling of suffocation when lying on left side. Spasmodic cough. Asthma, it connected with gout or rheumatism. Stertorous breathing.

Female. - Hemorrhage, with pain; blood partly clots and bright red. Climacteric complaints. [Loch.; Sulph.] Pain from sacrum into pelvis, with tearing, shooting pains from above downwards. Retained placenta. [Secale.] Chronic endometriosis. Metrorrhagia. Ovaralgia, especially left.

Heart. - Hypertrophy with valvular insufficiency; pulse small and weak; unable to rest in a reclining position. Palpitation during coitus. Low tension. Failing compensation, dyspnoea worse lying on left side. Weight and oppression of heart; as if a hand were squeezing it; tickling sensation about heart.

Extremities. - Pains alternate in the knee and ankle with shoulder and elbow. Sciatica. Tearing, shooting pains in both thighs and upper extremities. A glow rises from the feet to the head; seems to be on fire. Periodic pains from sacrum into pelvis, worse in bed, with pains into thighs and upper extremities. General tremor, as if all muscles were in state of fibrillary contraction. Dropsy of extremities. Sensation of a spider crawling over back of hand and foot. Itching all over. Compressing pain in feet.

Sleep. - Hard and un refreshing; dreams of flying. Sleeplessness in neurasthenics.

Relationship. - Compare: Gnaph.; Cimicif.; Staph.; Mezer.; Piscidia—White dogwood—(a nerve sedative. Insomnia due to worry, nervous excitement, spasmodic coughs; pains of irregular menstruation; regulates the flow. Neuralgic and spasmodic affections. Use tincture in rather material doses.)
Dose. - First to sixth potency.

Aromatherapy:

Not used. Artificial mistletoe fragrances are used in various perfumes and other cosmetics

Iscador:

Iscador is a preparation made from mistletoe for the treatment of cancer. It was first used in Switzerland 90 years ago. It mode of action is stimulation of the immune response to fight cancer cells. Iscador is often applied intravenously and can only be prescribed by a medical doctor usually in conjunction with other orthodox treatments. Iscador is well accepted in Germany , Switzerland and Northern Europe as an approved cancer treatment. Today, mistletoe extracts are the most frequently prescribed unconventional cancer therapies in Germany and in some other European countries. In Europe , approximately 60 to 70 percent of cancer patients use mistletoe. According to Pengelly, the anti-tumour activity is associated with PKC (Protein Kinase C) inhibition by phenylpropanoids (Panossian et al 1998)

Bird Lime:

The sticky juice of mistletoe berries was used as adhesive to trap small animals or birds. In South Africa it is called "Bird lime" in English and voelent in Afrikaans. A handful of ripe fruits are chewed until sticky, and the mass is then rubbed between the palms of the hands to form long extremely sticky strands which are then coiled around small thin tree branches where birds perch. When a bird lands on this it gets stuck to the branch and is then easy to catch by hand.

Grown commercially in Worcestershire, Herefordshire and Gloucestershire for the Christmas market (kissing mistletoe) but seeds from such plants are often immature.

8. Phytochemistry:

European mistletoe contains glycoprotein's, polypeptides (viscotoxins), flavonoids, caffeic and other acids, lignans, acetylcholine, and, in the berries: polysaccharides. Viscotoxins inhibit tumors and stimulate immune resistance (Viscotoxin is a cardio-active polypeptide), viscotoxins and mistletoe lectins, protein toxins, and polysaccharides.

·         Glycoproteins: mistletoe lectins I (galactoside-specific lectin), II, and III

·         Proteins: Viscotoxin (Viscotoxin is a cardio-active polypeptide),

·         Polysaccharides: galacturonan, arabinogalactan

·         Alkaloids:

Mistletoe’s lectins are cytotoxic glycoproteins of approximately 10,000 molecular weight; they cause cells to agglutinate and inhibit protein synthesis on the ribosomal level. The lectins, also known as viscumin or agglutinin, are dual chain molecules. Chain A inhibits protein synthesis and chain B activates macrophages and releases lymphokines from lymphocytes. Both the A and B chains of mistletoe lectin I also inhibit allergen-induced histamine release from leukocytes and collagen-induced serotonin release from platelets. Lectins are structurally similar to two highly biologically active toxic proteins, ricin and abrin. The amounts and biological activity of V. album lectins are dependent on the host tree,

manufacturing process, and time of harvest. Viscotoxin is a 46-amino acid peptide that damages cell membranes. Viscotoxin is found only in V. album. Various polysaccharides are thought to be involved in mistletoe’s antineoplastic effects.  

Crude viscin may be obtained by kneading the finely bruised mistletoe bark with water, as long as anything is dissolved, and removing the ligneous impurities mechanically. A purer product may be obtained by boiling the crude product in strong alcohol, macerating the residue with ether, evaporating the ethereal extracts, purifying these extracts by kneading first with alcohol and then with water. The formula C₂₀H48O8 (C₂₀H32 + 8H₂O) has been given to it by Reinsch. Pawlevsky (Bull. Soc. Chim. (2), 34, 348) obtained from mistletoe a crystallizable acid, slightly soluble in water, insoluble in alcohol and ether, fusing at from 101° to 103° G. (213.8°-217.4° F.), to which he gave the formula CH₃O₃.OH. The berries, which are white, and about the size of a pea, abound in the peculiar viscid principle, and are sometimes used in the preparation of birdlime, of which this principle is the basis. Mistletoe is said to be productive of vomiting and purging when largely taken. The berries caused in a child three years old vomiting and prostration, coma, a fixed and somewhat contracted pupil, and convulsive movements. [Ann. Ther., 1859, 36.) A fatal case is recorded. (M. T. G., 1867, 26.) The plant was formerly looked upon as a, powerful nervine, but it is now out of use. The leaves and wood were given in the dose of a drachm (3.9 G-m.) in substance. Viscum has been recommended by Gaultier (S. M., 1907) for the reduction of high blood pressure in arteriosclerosis and other conditions of excessive arterial tension. But Dossin (A. I. P. T; 1911, xxi, p. 432) finds that the lowering of blood pressure is of but short duration and is preceded by a rise and concludes, therefore, that the drug is not clinically useful for this purpose. Gaultier employed a watery extract in doses of 3 grains (0.2 Gm.) daily. According to P. Riehl (D, M. W., xxvi, 1900), viscin affords an excellent basis for the making of applications to the skin, a benzene viscin solution mixed with starch affording an excellent plaster mass. (Remmington and Wood US dispensatory 1918)

According to Henry, the berries contain viscin, green wax, gum, bassorin, brown extractive, salts, etc. P. Reinsch (Neues Jahrbuch f. d. Pharm., Vol. XIV, 1860, pp. 129-153) obtained crude viscin from the berries and the bark. The former yield a purer product, but are difficult to obtain in quantity, as they invariably grow on high trees. The scrapings from the bark are first kneaded with gradually increased quantities of water, which removes gum, albumen, sugar, chlorophyll, tannin, and salts; the residual mass is treated with alcohol, which removes yellow wax; the residual crude viscin is then dissolved by ether, which, upon evaporation, leaves a residue which, when washed with alcohol and water, and heated for some time to 120° C. (248° F.), constitutes pure viscin, a clear, tasteless, and odorless mass of the consistency of honey, and capable of being drawn out into threads. In the above treatment, ether leaves undissolved a mixture of plant fibers and a yellowish-brown, exceedingly sticky mass, which is soluble in oil of turpentine.

9. Dosage:

The doses given here are for noncancerous conditions.
Cold infusion: 2.5 g finely chopped leaf (fresh is considered more active than dried) covered in cold water, steeped at room temperature for 10 - 12 hours; 1 - 2 cups daily.
Warm infusion: 2 - 6 g dried leaf, 3 times daily.
Tincture (1:4 in 40% to 50% alcohol): 10 - 60 drops, 3 times daily; 0.5 ml, twice daily.
Fluidextract (1:1 in 25% to 50% alcohol): 25 - 60 drops, 3 times daily; 1 - 3 ml, 3 times daily.
Powder: 10 - 60 grains, 3 or 4 times daily.
Dried herb: 9 - 16 g daily.

Mistletoe, in coarse powder	100.00	|	20 ounces
Distilled Water, boiling, a sufficient quantity.

Macerate the drug with 120 fluid ounces of boiling water for twelve hours, strain, press and twice repeat the maceration, using 300 (60 fluid ounces) of the menstruum; mix the liquids, filter, and evaporate to the consistence of a thick extract.
Dose.—10 to 15 decigrams (15 to 24 grains). BPC

10. Contraindications:

Avoid during pregnancy and lactation. The berries are highly poisonous . Monitoring of patients with undergoing cardiac and blood pressure treatment, immune-suppressing or coagulation therapy is advised. Do not take if using MAO inhibitor medication, such as some anti-depressants.

11. Research:

1. Büssing A, Raak C, Ostermann T.

Quality of life and related dimensions in cancer patients treated with mistletoe extract (Iscador): a meta-analysis.

Abstract

Objectives. The aim of this meta-analysis was to determine the effectiveness of the fermented plant extract Iscador, produced from the white-berry European mistletoe, in the treatment of patients with cancer with respect to quality-of-life- (QoL-) associated measures. Methods. We searched databases such as PubMed/Medline, Excerpta Medica Database (EMBASE), CAMbase, and other for controlled clinical studies on parameters associated with QoL. Outcome data were extracted and converted into standardized mean differences and their standard errors. Results. Thirteen prospective and controlled studies which met the inclusion/exclusion criteria reported positive effects in favor of the Iscador application. A random-effect meta-analysis estimated the overall treatment effect at standardized mean difference = 0.56 (CI: 0.41 to 0.71, P < .0001). However, the methodological quality of the studies was poor. Conclusions. The analyzed studies give some evidence that Iscador treatment might have beneficial short-time effects on QoL-associated dimensions and psychosomatic self-regulation.

2. Brandenberger M, Simões-Wüst AP, Rostock M, Rist L, Saller R.

An Exploratory Study on the Quality of Life and Individual Coping of Cancer Patients During Mistletoe Therapy.

Abstract

Background. Although several clinical studies have shown that mistletoe therapy (MT, Viscum album) may improve cancer patients' quality-of-life (QoL), qualitative information on the improvement's nature is still lacking. Design. This exploratory, prospective, cohort-study comprised 25 patients with different types of cancer. The patients filled in the EORTC QLQ-C30 Version 3.0 questionnaire at the beginning of MT (n = 25) and three months later (n = 21). If patients agreed, they were interviewed on both occasions (n = 17); the interviews were transcribed verbatim and submitted to a qualitative content analysis (n = 12). RESULTS: Analysis of the questionnaires showed significant improvements in several subscales during MT. The interviews analysis revealed that most patients adopted the MT with a supportive goal, with all patients undergoing conventional therapies. After three months of MT, most interviewed patients revealed higher vitality and autonomy. MT was often seen as a chance to make an own personal contribution to the therapy, which was particularly appreciated in cases in which no conventional therapy was (anymore) advised. Concrete personal achievements such as changes in the private and/or in the professional environment were spontaneously mentioned by the patients, illustrating and corroborating their improvements in QoL. CONCLUSION: Our results show that the patients experienced an improvement of QoL during MT. This therapy seemed to offer a platform for an integrative coping with the disease, which might be important in reconciling the perceived shock of an existential illness with a good QoL.

Revolution Health offers an excellent summary of research on Mistletoe followed by copious references for further research:

Mistletoe, a semiparasitic plant, holds interest as a potential anticancer agent because extracts derived from it have been shown to kill cancer cells in vitro^{1,2,3,4,5,6,7,8,9,10,11,12,13,14,15} Reviewed in ^16,17 and to stimulate immune system cells both in vitro and in vivo. ^{18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48} Reviewed in ^{17,49,50,51,52,53,54,55,56,57,58,59,60} Two components of mistletoe, namely viscotoxins and lectins, may be responsible for these effects.^{1,4,7,9,10,11,13,24,26,27,28,30,31,32,33,35,36,38,39,40,41,42,46,47,48,61,62,63} Reviewed in ^{16,17,43,49,50,51,52,54,55,56,57,58,59,64,65,66,67} Viscotoxins are small proteins that exhibit cell-killing activity and possible immune-system-stimulating activity.^7,13,47,48 Reviewed in ^50,64 Lectins are complex molecules made of both protein and carbohydrates that are capable of binding to the outside of cells (e.g., immune system cells) and inducing biochemical changes in them. Reviewed in ^{17,51,56,68,69,70,71} In view of mistletoe’s ability to stimulate the immune system, it has been classified as a type of biological response modifier. Reviewed in ⁵¹ Biological response modifiers constitute a diverse group of biological molecules that have been used individually, or in combination with other agents, to treat cancer or to lessen the side effects of anticancer drugs.

Preparations from mistletoe extracts are most frequently used in the treatment of cancer patients in German-speaking countries.⁷² Commercially available extracts are marketed under a variety of brand names, including Iscador, Eurixor, Helixor, Isorel, Iscucin, Plenosol, and ABNOBAviscum. Some extracts are marketed under more than one name. Iscador, Isorel, and Plenosol are also sold as Iscar, Vysorel, and Lektinol, respectively. All of these products are prepared from Viscum album Loranthaceae (Viscum album L. or European mistletoe). They are not available commercially in the United States. (See below for more information concerning United States availability of these extracts.)

In addition to European mistletoe, extracts from a type of Korean mistletoe (Viscum album coloratum Kom.) have demonstrated in vitro and in vivo cytoxocity in laboratory studies.^{73,74,75,76,77}

Mistletoe grows on several types of trees, and the chemical composition of extracts derived from it depends on the species of the host tree (e.g., apple, elm, oak, pine, poplar, and spruce), the time of year harvested, how the extracts are prepared, and the commercial producer.^4,78 Reviewed in ^{15,49,51,52,54,55,56}

Mistletoe extracts are prepared as aqueous solutions or solutions of water and alcohol, and they can be fermented or unfermented.^4,13 Reviewed in ^{8,11,20,37,52,53,78,79,80} Some extracts are prepared according to homeopathic principles, and others are not. Reviewed in ^17,81 In addition, the commercial products can be subdivided according to the species of host tree. Iscador, a fermented aqueous extract of Viscum album L. that is prepared as a homeopathic drug, is marketed as IscadorM (from apple trees), IscadorP (from pine trees), IscadorQ (from oak trees), and IscadorU (from elm trees). Helixor, an unfermented aqueous extract of Viscum album L. that is standardized by its biological effect on human leukemia cells in vitro, is marketed as HelixorA (from spruce trees), HelixorM (from apple trees), and HelixorP (from pine trees). Reviewed in ⁵² Eurixor, an unfermented aqueous extract of Viscum album L. harvested from poplar trees, is reportedly standardized to contain a specific amount of one of mistletoe’s lectins (i.e., the lectin ML-1; refer to the History section of this summary for more information). Reviewed in ⁵² Some proponents contend the choice of extract should depend on the type of tumor and the gender of the patient.⁸² Reviewed in ^52,55,83

A recombinant ML-1 from E. coli bacteria known as rViscumin or aviscumine has been studied in the laboratory and in phase I clinical trials. Since this is not an extract of mistletoe, it is out of the purview of this summary.⁸⁴

Mistletoe extracts are usually given by subcutaneous injection, although administration by other routes (i.e., oral, intrapleural, and intravenous) has been described.^{27,36,42,45,46,51,57,58,59,65,66,82,83,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101} Reviewed in ^{52,53,55,56,60,81} In most reported studies, subcutaneous injections were given 2 to 3 times a week, but the overall duration of treatment varied considerably.

Viscum album is listed in the Homeopathic Pharmacopoeia of the United States, which is the officially recognized compendium for homeopathic drugs in this country.¹⁰² Although the U.S. Food and Drug Administration (FDA) has regulatory authority over homeopathic drugs, this authority is usually not exercised unless the drugs are formulated for injection or there is evidence of severe toxicity. At present, the FDA does not allow the importation or distribution of injectable preparations of mistletoe, including homeopathic formulations, except for the purpose of clinical research. The extracts are not available commercially in the United States and are not approved as a cancer treatment.

Before researchers can conduct clinical drug research in the United States, they must file an Investigational New Drug (IND) application with the FDA. IND approval is also required for clinical investigation of homeopathic drugs. The FDA does not disclose information about IND applications or approvals; this information can be released only by the applicants. At present, at least two U.S. investigators have IND approval to study mistletoe as a treatment for cancer.^103,104

In this summary, the mistletoe extract or product used in each study will be specified wherever possible.

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103.            Mansky PJ, National Center for Complementary and Alternative Medicine: Phase I Study of Gemcitabine and Mistletoe in Patients With Advanced Solid Tumors, NCCAM-02-AT-260, Clinical trial, Closed.

104.            Rosenzweig S, Kimmel Cancer Center at Thomas Jefferson University - Philadelphia: Phase II Study of Supplemental Treatment With Mistletoe in Patients With Stage IIIB or IV Non-Small Cell Lung Cancer Receiving Palliative Chemotherapy, TJUH-01F.45, Clinical trial, Closed.

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Irish Botanical News #17, March 2007

Hatfield and Allen, Medicinal Plants in Folk Tradition, 2004

Kew Gardens Research Department

Maude Grieve, A Modern herbal, 1931

The Guardian, Tuesday 7 December 2010

http://www.longwoodherbal.org/mistletoe/mistletoe.pdf

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Revolution Health: http://www.revolutionhealth.com/articles/mistletoe-extracts-complementary-and-alternative-medicine---health-professional-information-nci-pdq-/ncicdr0000269596

William Boericke, Homoeopathic Materia Medica.

Compiled by Belfast Herbalist 2011