Elderberry — Sambucus nigra

Common & Latin Names

Common names: Elderberry, Black elder, European elder, Elder flower Latin name: Sambucus nigra L. (European elder); S. canadensis (American elder — sometimes treated as a subspecies) German: Holunder TCM name: Jie Gu Mu (接骨木)

Plant Family & Parts Used

Family: Adoxaceae (formerly Caprifoliaceae/honeysuckle family) Parts used: Berries (ripe, cooked or processed — raw berries contain cyanogenic glycosides) and flowers. Berries are used for antiviral/immune preparations. Flowers are used as a diaphoretic (fever management) and for allergy/sinus support. Bark and leaves are NOT used medicinally (toxic — contain sambunigrin, a cyanogenic glycoside). Habitat: Native to Europe, western Asia, and North Africa. Naturalized in North America. Grows as a large shrub or small tree (3-10m) in hedgerows, woodland edges, and disturbed sites. Extremely common throughout temperate Europe.

Traditional Uses

European Folk Medicine (Ancient)

Elder has been called “the medicine chest of the common people” in European folk tradition. Hippocrates referred to it as his “medicine chest.” Every part of the tree was used medicinally in folk practice, though we now know bark and leaves carry toxicity risks.

Traditional uses include:

• Berries: Cold and flu treatment (syrups, wines, cordials), immune tonic, laxative
• Flowers: Diaphoretic (inducing sweating to break fevers), hay fever and allergy relief, cosmetic skin preparations (Elder Flower Water), eyewash for conjunctivitis
• European folk belief: Elder was considered a protective, sacred tree with strong associations to the Mother Goddess (Holda/Hulda in Germanic tradition). Cutting an elder tree without permission was considered bad luck.

Native American Traditions (S. canadensis)

Native American peoples used American elder similarly to European use — berries for food and medicine (fever, infections, rheumatic pain), flowers for fever management, and bark decoctions (with appropriate caution) for various conditions.

Active Compounds & Pharmacology

Primary Phytochemicals

Anthocyanins (cyanidin-3-glucoside, cyanidin-3-sambubioside): The deep purple-black pigments of elderberries. Potent antioxidants (ORAC value among the highest of any fruit). Anti-inflammatory. Contribute to antiviral activity.

Flavonoids: Quercetin, isorhamnetin, kaempferol, rutin — anti-inflammatory, antiviral, mast cell-stabilizing (anti-allergic).

Lectins (Sambucus nigra agglutinins/SNAs): These carbohydrate-binding proteins have immunostimulatory properties — they enhance cytokine production and activate immune cells.

Polysaccharides: Immunostimulatory — activate macrophages and enhance cytokine production.

Phenolic acids: Chlorogenic acid, caffeic acid — antioxidant, antiviral.

Cyanogenic glycosides (sambunigrin): Present in raw berries, bark, leaves, and seeds. Hydrolyzed to hydrogen cyanide (HCN) in the gut. Cooking, drying, or processing destroys cyanogenic glycosides — properly prepared elderberry products are safe.

Mechanisms of Action

1. Antiviral (Direct): Elderberry flavonoids (particularly quercetin and cyanidin derivatives) bind to and inhibit viral neuraminidase (the “N” in H1N1, H5N1) and hemagglutinin — the same targets as pharmaceutical antivirals oseltamivir (Tamiflu). This blocks viral entry into host cells and inhibits viral replication and release. In vitro studies demonstrate activity against influenza A and B, HIV, and herpes simplex virus.

2. Cytokine Enhancement: Elderberry stimulates production of inflammatory cytokines (IL-1beta, TNF-alpha, IL-6, IL-8) from monocytes. This is beneficial in acute infection (enhances immune response) but has raised theoretical concerns about cytokine storm — discussed under Safety.

3. Antioxidant: Anthocyanins provide among the highest antioxidant capacity of any food or herb — direct free radical scavenging plus induction of endogenous antioxidant enzymes.

4. Anti-inflammatory: Despite cytokine-stimulating effects in infection, elderberry also demonstrates anti-inflammatory effects through NF-kB inhibition and COX-2 inhibition, particularly relevant for allergic and chronic inflammatory conditions.

5. Diaphoretic (flowers): Elder flowers promote sweating through vasodilation and increased perspiration — this traditional fever management technique helps the body dissipate heat and is particularly effective in the early stages of febrile illness.

Clinical Evidence

Key Clinical Trials

Tiralongo, E., Wee, S.S., & Lea, R.A. (2016). “Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial.” Nutrients, 8(4), 182.

• 312 economy-class passengers traveling from Australia to an overseas destination, standardized elderberry extract (capsules, 600-900mg/day) vs placebo from 10 days before travel to 4-5 days after arrival
• Results: No significant difference in cold incidence between groups. However, those in the elderberry group who DID get colds had significantly shorter duration (4.75 vs 6.88 days, p=0.02) and significantly reduced cold severity scores (p=0.04).
• Important context: air travel represents a significant immune challenge (confined space, recycled air, stress, disrupted circadian rhythm).

Hawkins, J., Baker, C., Cherry, L., & Dunne, E. (2019). “Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials.” Complementary Therapies in Medicine, 42, 361-365.

• Meta-analysis of 4 RCTs (total 180 participants)
• Results: Elderberry supplementation significantly reduced upper respiratory symptoms (standardized mean difference -1.75, p<0.001). Effects were particularly robust for influenza symptoms.
• Concluded that elderberry is an effective, safe, and cost-efficient treatment for upper respiratory symptoms.

Zakay-Rones, Z., Thom, E., Wollan, T., & Wadstein, J. (2004). “Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections.” Journal of International Medical Research, 32(2), 132-140.

• 60 influenza patients (confirmed by rapid antigen test), standardized elderberry extract (Sambucol) 15mL 4 times daily vs placebo for 5 days
• Results: Elderberry group recovered an average of 4 days earlier than placebo (3.1 vs 7.1 days, p<0.001). Elderberry group used significantly less rescue medication.

Zakay-Rones, Z., Varsano, N., Zlotnik, M., et al. (1995). “Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucol) during an outbreak.” Journal of Alternative and Complementary Medicine, 1(4), 361-369.

• The original Sambucol study during an influenza B outbreak in an Israeli kibbutz
• Results: 93.3% of elderberry group showed significant improvement within 2 days, versus 91.7% of placebo group showing improvement at day 6.

Therapeutic Applications

Conditions

• Influenza (treatment — the strongest evidence base, 4 days faster recovery)
• Common cold (symptom reduction, duration reduction)
• Seasonal immune prevention (travel, cold season)
• Allergic rhinitis and sinusitis (flowers — diaphoretic and anti-allergic)
• Antioxidant support (one of the highest ORAC-value foods)
• Fever management (flowers)

Dosage Ranges

• Standardized extract syrup (Sambucol or equivalent): 15mL (1 tablespoon), 4 times daily for acute illness; 15mL daily for prevention
• Standardized extract capsules: 300-600mg, 2-3 times daily
• Dried berries (tea/decoction): 3-5g simmered in 250mL water for 15 minutes, 2-3 cups daily
• Elder flower tea: 2-4g dried flowers steeped in hot water for 10 minutes, 2-3 cups daily (for fever management and allergies)
• Elderberry syrup (homemade): Simmered berries with honey — the classic folk preparation. Dose: 1 tablespoon for adults, 1 teaspoon for children, 3-4 times daily during illness.
• Elderberry tincture (1:5 in 25% alcohol): 5mL, 3 times daily

Critical Preparation Note

Raw elderberries contain cyanogenic glycosides (sambunigrin) that can cause nausea, vomiting, and diarrhea. Always COOK elderberries before consumption. Heat processing (simmering, making syrup, commercial extraction) destroys cyanogenic glycosides. All commercial elderberry products are processed and safe.

Safety & Contraindications

Generally Safe When Properly Prepared

Properly processed elderberry products have an excellent safety record. Side effects in clinical trials are comparable to placebo.

The Cytokine Storm Concern

During the COVID-19 pandemic, concern circulated that elderberry might contribute to cytokine storm (the hyperinflammatory response that drives severe COVID-19 pneumonia). This concern was based on in vitro studies showing elderberry enhances pro-inflammatory cytokines. However:

• The cytokine enhancement occurs in healthy immune cells responding to infection — this is a NORMAL immune response, not a cytokine storm
• Cytokine storm is driven by dysregulated immune responses, not by enhanced normal responses
• No clinical evidence exists linking elderberry use to cytokine storm in any respiratory illness
• Elderberry simultaneously has anti-inflammatory effects (NF-kB inhibition) that may counterbalance excessive inflammation
• Nonetheless, patients with severe active infections (hospitalized, high fever, pneumonia) should exercise caution and consult healthcare providers.

Contraindications

• Raw consumption: Do not eat raw elderberries, bark, or leaves (cyanogenic glycosides).
• Autoimmune conditions: Theoretical concern regarding immune stimulation. As with echinacea, clinical relevance is debated.
• Immunosuppressant therapy: May counteract immunosuppressive drugs.
• Pregnancy: Generally considered safe in food doses (cooked berries, commercial syrups). Insufficient data for high-dose concentrated extracts.

Drug Interactions

• Immunosuppressants: May reduce efficacy.
• Diabetes medications: Elderberry may lower blood sugar — monitor.
• Diuretics: Elderberry has mild diuretic properties — additive effect.
• Theophylline: Elderberry may affect CYP1A2 metabolism.

Energetics

Western Herbal Energetics

• Temperature: Cool (berries) / Warm (flowers — diaphoretic)
• Moisture: Moistening (berries — mucilaginous), Drying (flowers)
• Taste: Sweet-sour (berries), Sweet-aromatic (flowers)
• Organ Affinity: Immune system, respiratory system, skin (flowers)

TCM Classification (Modern Integration)

• Temperature: Cool (berries), Slightly warm (flowers)
• Flavor: Sweet, slightly sour
• Meridian entry: Lung, Bladder
• Actions: Releases exterior, clears Heat-Toxin, promotes sweating (flowers), dispels Wind
• Pattern correspondence: Wind-Heat invasion (early-stage cold/flu with sore throat, mild fever)

Ayurvedic Classification (Modern Integration)

• Rasa: Madhura (sweet), Amla (sour)
• Virya: Shita (cooling)
• Vipaka: Madhura (sweet)
• Dosha effects: Reduces Pitta. Balances Vata (moistening). May increase Kapha in excess (sweet, heavy).

Functional Medicine Integration

Acute Immune Protocol

Elderberry is the first-line antiviral botanical in FM acute respiratory illness protocols. The clinical evidence for shortening influenza by up to 4 days is strong (Zakay-Rones 2004). Protocol: High-dose elderberry syrup (15mL 4x daily) at first sign of illness, combined with zinc (75mg/day lozenges), vitamin C (1-3g divided doses), and vitamin D (10,000 IU daily for 3 days then maintenance).

Seasonal Immune Prevention

Daily elderberry during cold and flu season provides antioxidant protection, mild immune enhancement, and antiviral readiness. Lower dose than treatment dose (15mL once daily or 300mg extract daily).

Allergy Protocol (Elder Flowers)

Elder flower is a traditional allergy remedy — the flavonoids (particularly quercetin and rutin) stabilize mast cells and reduce histamine release. Combined with nettle leaf, quercetin, and vitamin C for comprehensive allergy support.

Antioxidant Protocol

Elderberry’s anthocyanin content makes it one of the most potent food-based antioxidants — relevant in protocols for oxidative stress, cardiovascular disease prevention, and skin health.

Four Directions Connection

Primary Direction: Serpent (South — Physical Body)

Elderberry is the Serpent’s shield — the instinctual immune defense that recognizes and repels viral invaders at the gates. The Serpent is the body’s first responder, the ancient immune intelligence that existed long before consciousness. Elderberry works at this level — it does not require understanding or intention. It simply enhances the body’s innate capacity to fight. The purple-black color of elderberries is the color of concentrated life force, the dense pigments that protect the berry from oxidative damage serving the same protective function in the human body.

Secondary Direction: Hummingbird (North — Soul Journey)

The elder tree’s sacred status in European folk tradition — associated with the Mother Goddess, requiring permission before cutting — connects elderberry to the Hummingbird’s domain of sacred narrative and relationship with the living world.

Tertiary: Eagle (East — Wisdom)

The antioxidant protection of brain tissue and cognitive function serves the Eagle’s domain of mental clarity.

References

1. Tiralongo, E., Wee, S.S., & Lea, R.A. (2016). Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers. Nutrients, 8(4), 182.

2. Hawkins, J., Baker, C., Cherry, L., & Dunne, E. (2019). Black elderberry supplementation effectively treats upper respiratory symptoms: A meta-analysis. Complementary Therapies in Medicine, 42, 361-365.

3. Zakay-Rones, Z., et al. (2004). Randomized study of oral elderberry extract in influenza A and B. Journal of International Medical Research, 32(2), 132-140.

4. Zakay-Rones, Z., et al. (1995). Inhibition of several strains of influenza virus and reduction of symptoms by Sambucol. Journal of Alternative and Complementary Medicine, 1(4), 361-369.

5. Ulbricht, C., Basch, E., Cheung, L., et al. (2014). An Evidence-Based Systematic Review of Elderberry and Elderflower by the Natural Standard Research Collaboration. Journal of Dietary Supplements, 11(1), 80-120.

6. Porter, R.S., & Bode, R.F. (2017). A Review of the Antiviral Properties of Black Elder (Sambucus nigra L.) Products. Phytotherapy Research, 31(4), 533-554.

7. Sidor, A., & Gramza-Michalowska, A. (2015). Advanced research on the antioxidant and health benefit of elderberry (Sambucus nigra) in food. Journal of Functional Foods, 18, 941-958.