Chamomile (Matricaria chamomilla L. / Chamaemelum nobile)
1. Identity: Botanical Classification, Common Names, and Preparations
Botanical Classification and Species
Chamomile is a plant belonging to the family Asteraceae. There are two principal species used medicinally: German chamomile (Chamomilla recutita, also classified as Matricaria chamomilla L.) and Roman chamomile (Chamaemelum nobile). German chamomile (Matricaria chamomilla L.), belonging to the family Asteraceae (formerly Compositae), is an essential medicinal herb indigenous to Europe and Asia. Chamaemelum nobile (L.) All. (Asteraceae), widely known as Roman chamomile, is a perennial herb native to South-Western Europe, but it is cultivated as a medicinal plant all over Europe and in Africa as well.
The word "chamomile" comes from two Greek words, Chemos and Melos, meaning "ground apple" for its apple-like smell. There are many varieties of chamomile, known by an array of names, such as Babuna camomile, German chamomile, Roman chamomile, English chamomile, Hungarian chamomile, Single chamomile, Camomilla, Flos chamomile, pinheads, sweet false chamomile, and scented mayweed.
At present, 26 countries around the world have included Matricaria chamomilla L. in their pharmacopoeia. Dried flowers of the cultivated, double-flowered variety of Roman chamomile are official in the European Pharmacopoeia. Incorporating the plant in traditional herbal medicinal products has been acknowledged by the European Medicines Agency.
Morphology and Source Material
Chamomile is a native of the Old World and is a member of the daisy family (Asteraceae or Compositae). The hollow, bright gold cones of the flowers are packed with disc or tubular florets and are ringed with about fifteen white ray or ligulate florets, widely represented by two known varieties. German chamomile is composed of white daisy-like petals and yellow composite disc florets. Found in populated areas and temperate climates, it can stand up to 24 inches high in full sun. It often grows near roads, in disturbed areas, and in cultivated fields as a weed, because the seeds require open soil to survive.
Common Forms and Preparations
Many different preparations of chamomile have been developed, the most popular of which is in the form of herbal tea consumed more than one million cups per day. Essential oils of chamomile are used extensively in cosmetics and aromatherapy. In a systematic review examining 83 studies of chamomile mono-preparation — comprising 72 clinical trials and 11 case reports — the frequency of topical and oral usage was nearly identical; however, capsules were the most commonly used form, with a dosage ranging from 300 to 1500 mg daily.
Extraction techniques — from aqueous infusions to hydroalcoholic, supercritical fluid and nanoemulsion-based methods — profoundly influence phytochemical yield and composition. Other documented preparations include tinctures, standardized dry extracts in capsule or tablet form, topical creams and ointments containing chamomile extract, mouth rinses, and steam inhalation of the essential oil.
The European Pharmacopoeia stipulates that chamomile flowers should contain at least 0.25% of apigenin-7-glucoside to be used as a therapeutic agent. Similarly, the US Pharmacopoeia states that dried chamomile flowers should contain no less than 0.3% apigenin-7-glucoside and no less than 0.15% in bisabolan derivatives.
2. Traditional and Historical Use
Ancient Civilizations
Chamomile is one of the oldest, most widely used and well-documented medicinal plants in the world and has been recommended for a variety of healing applications. Chamomile has been used for thousands of years in Greece, Rome, and ancient Egypt.
Chamomile held a sacred place in ancient Egypt, where it was associated with the sun god Ra. Egyptians used chamomile as a remedy for fevers, digestive ailments, and skin conditions, and also in embalming practices due to its preservative and antimicrobial properties. Chamomile was valued not only as an herb that could heal any ailments, but Egyptian nobility also used it in their beauty regimens.
The Romans sipped chamomile as a healing beverage and used it as incense. Ancient Greek physicians, like Dioscorides, made frequent mention of prescribing the herb chamomile for a variety of ailments.
Medieval and European Use
English brewers used chamomile flowers throughout the Middle Ages as a bittering agent in beer making. The bitter hops flowers we associate with beer making today eventually replaced chamomile as a key beer flavoring ingredient. Monks during the Middle Ages cultivated the plant not only for beer but also for use in traditional herbal remedies.
In the Middle Ages, people scattered chamomile on floors to help repel vermin and pests and to serve as a natural deodorizer. Chamomile was listed as one of the nine sacred herbs of the Lacnunga, an ancient Anglo-Saxon herb guide.
Traditional Use in Asian Medicine Systems
In China, the detailed use of chamomile was first recorded in Uyghur medicine. Veteran practitioners of TCM believe that preparations containing chamomile have a calming effect. The plant is also used in homeopathic and Unani preparations. In the Zhu Medical Canon, a Uyghur medical work written in the 10th century, chamomile is called "Bamu Nai." Its taste and fragrance is described as slightly bitter. The plant was said to nourish the nerves and the stomach, improve appetite, relieve painful swellings and sweating, and was frequently used for chronic headaches, constipation, poor sweating, joint swelling, and urinary system disorders.
Several uses of chamomile are reported in the TCM literature, and it is one of the most commonly used herbal medicines to treat stomach problems, cramps, dermatitis, and minor infections.
Traditional Preparations and Indications Across Cultures
Chamomile preparations have been traditionally used for many human ailments such as hay fever, inflammation, muscle spasms, menstrual disorders, insomnia, ulcers, wounds, gastrointestinal disorders, rheumatic pain, and hemorrhoids.
3. Key Constituents and Active Compounds
Overview of Phytochemistry
The phytochemical composition of essential oils and extracts of M. chamomilla has been widely analyzed, showing that the plant contains over 120 constituents. The lipophilic fraction includes individual components of the essential oil, coumarins, methoxylated flavone aglyca, phytosterols, and "lipidic and waxy substances." The hydrophilic fraction consists of flavonoids, mucilage, phenyl carboxylic acids, amino acids, and choline.
Chamomile flowers contain essential oils and other terpenes, phenolic compounds (flavonoids, coumarins, and phenolic acids), organic acids, polysaccharides, sterols and mineral compounds. Apart from these, the following compound classes have been detected: mucins, coumarins, phenol carboxylic acids, amino acids, phytosterols, choline, and mineral substances.
Essential Oil Constituents (Terpenoids)
The flowers of chamomile contain 1–2% volatile oils including alpha-bisabolol, alpha-bisabolol oxides A & B, and matricin, usually converted to chamazulene, which possess anti-inflammatory and antiphlogistic properties. The two key constituents, (−)-alpha-bisabolol and chamazulene, account for 50–65 percent of total volatile oil content. Other components of the oil include (−)-alpha-bisabolol oxide A and B, (−)-alpha-bisabolone oxide A, spiroethers, sesquiterpenes, cadinene, farnesene, furfural, spathulenol, and proazulene (matricarin and matricin). Chamazulene is formed from matricin during steam distillation of the oil.
Chamazulene is implicated as a potent anti-inflammatory agent. It is also an antioxidant and free radical scavenger, and can suppress leukotriene B4 synthesis. The antioxidant and anti-inflammatory properties of chamazulene have been proposed as mechanisms for treating osteoarthritis, as evidenced by animal studies.
Flavonoids
Chamomile contains up to 8% flavone glycosides (apigenin 7-glycoside and its 6′-acetylated derivative) and flavonols (luteolin glucosides, quercetin glycosides and isorhamnetin); up to 10% mucilage polysaccharides; up to 0.3% choline; and approximately 0.1% coumarins (umbelliferone and its methyl ether, herniarin).
Apigenin is a naturally occurring compound of the flavone family, sometimes referred to by its chemical name 4′,5,7-trihydroxyflavone. It is an aglycone derivative of many naturally occurring glycosides with the generic molecular formula C₁₅H₁₀O₅ and molecular weight 270.24. Numerous biological effects including antioxidant, anticancer, anti-inflammatory, anti-allergic, anti-genotoxic, cardioprotective, neuroprotective, and antibacterial have been demonstrated for apigenin and its synthetic flavone derivatives.
It has been demonstrated that methanolic chamomile extract has a high concentration of apigenin-7-O-glucoside along with several polyphenolic constituents including caffeic acid, luteolin, and luteolin-7-O-glucoside.
The individual active constituents including geraniol, caffeic acid, chlorogenic acid, umbelliferone, and rutin have also been found to elicit significant beneficial properties in various disorders.
4. Established Mechanisms of Action
Anti-Inflammatory Mechanisms
One of chamomile's key anti-inflammatory activities involves the inhibition of LPS-induced prostaglandin E₂ release and attenuation of cyclooxygenase (COX-2) enzyme activity without affecting the constitutive form, COX-1. Apigenin is recognized as the most pharmacologically active constituent targeting inflammation. It suppresses iNOS and COX-2 expression via inhibiting NF-κB and MAPK signaling to reduce inflammatory mediator generation. Other flavonoids similarly downregulate cytokines TNF-α, IL-1β, IL-6 and IL-8 production through modulating transcriptional factors including NF-κB and AP-1.
Network pharmacology research found that German chamomile volatile oil regulated T-cell lymphatic subpopulations to inhibit the Th17 cell differentiation signaling pathway. This resulted in a reduction of interleukin-17 (IL-17), thereby inhibiting the activation of the NF-κB and MAPK pathways, decreasing the secretion of pro-inflammatory factors TNF-α and IL-6.
A study in human volunteers demonstrated that chamomile flavonoids and essential oils penetrate below the skin surface into the deeper skin layers. This is important for their use as topical anti-inflammatory agents.
Anxiolytic/Sedative Mechanisms (GABA-A / Benzodiazepine Receptor Activity)
Reported antispasmodic and sedative activity of chamomile extracts may derive from the action of apigenin, which binds to central benzodiazepine receptors. Apigenin, a flavone component of chamomile, interacts with GABA(A)-benzodiazepine receptors in vitro and inhibits locomotor behavior in rats. This interaction at the benzodiazepine binding site of the GABA-A receptor complex provides a plausible molecular basis for the herb's traditional calming effects.
Antispasmodic / Smooth Muscle Relaxation
Apigenin, luteolin, and (−)-α-bisabolol produce slow, concentration-dependent relaxations in both coronary and splenic arteries. Removal of extracellular calcium inhibited the relaxations to all three compounds, and these compounds also inhibited calcium re-addition-evoked contractions, indicating that the relaxation response may be mediated through inhibition of calcium influx. In vivo studies show that Matricaria chamomilla has antidiarrheal and antispasmodic effects, presumably mediated by ion modulation of K⁺ and Ca²⁺ ions.
Relaxant effects have also been detected on human jejunum preparations, providing scientific reassurance for the traditional use of Roman chamomile in spasmodic gastrointestinal disorders.
Antioxidant Mechanisms
The main terpenoid found in chamomile, chamazulene, scavenges free radicals and inhibits propagation of radical chains and lipid peroxidation. Terpenoids like bisabolol and chamazulene aid apigenin's effects on reducing lipid peroxidation and scavenging reactive oxygen/nitrogen species linked to chronic inflammation.
Glycemic Modulation Mechanisms
Isolated polyphenols from chamomile, notably apigenin and apigenin-7-O-glucoside, inhibit key digestive enzymes (α-amylase, maltase) and impede glucose and sucrose transport in intestinal cell models. Molecular docking and competitive binding studies revealed distinct interactions with enzyme active sites and glucose transporters, including GLUT2. These mechanistic insights position chamomile constituents as promising modulators of post-prandial hyperglycaemia.
5. Scientific Evidence by Area of Use
5.1 Anxiety and Generalized Anxiety Disorder (GAD)
Some preliminary studies suggest that a chamomile dietary supplement might be helpful for generalized anxiety disorder and associated depression.
The most substantial body of human clinical evidence for chamomile in any single indication comes from a series of studies conducted at the University of Pennsylvania. In the only existing randomized controlled trial at the time, that research group found a significantly greater reduction in mean general anxiety symptom scores for chamomile as compared with placebo after 8 weeks of therapy (Amsterdam et al., 2009). In a subsequent open-label phase, subjects with moderate to severe GAD received open-label treatment with pharmaceutical-grade chamomile extract 1500 mg/day for up to 8 weeks.
Recognizing that GAD is a recurrent disorder that often requires long-term therapy, the investigators sought to extend preliminary results by conducting a randomized, double-blind, placebo-substitution, long-term safety and efficacy study of chamomile therapy in GAD, with the primary aim of examining if long-term chamomile therapy prolonged the time to relapse of anxiety symptoms following recovery from GAD. Participants were treated with 1500 mg (3 capsules daily) of open-label chamomile extract for up to 12 weeks. Individuals who had successfully attained a clinical response were then randomized to either continuation chamomile or placebo for an additional 26 weeks.
The efficacy and tolerability of chamomile extract (Matricaria recutita), administered for 8–12 weeks, was studied in outpatients with GAD in two randomized trials (Amsterdam et al., 2009; Mao et al., 2016) and one open-label study. It was found that chamomile was safe and efficacious in reducing anxiety symptoms in moderate GAD cases, but did not affect the rate of relapse.
A 2019 systematic review and meta-analysis examined the broader evidence base: this review aimed to study the efficacy and safety of chamomile for the treatment of state anxiety, GAD, sleep quality, and insomnia in humans, searching 11 databases including PubMed, Cochrane Central, and Scopus, with 12 RCTs included. The meta-analysis of three RCTs did not show any difference in case of state anxiety (standardized mean difference = −0.15, 95% CI [−0.46, 0.16], P = 0.4214). The evidence for GAD specifically, as opposed to state anxiety, was more positive in the individual trials described above.
Evidence strength: Moderate but limited. Two RCTs and one open-label trial, primarily from one research group, support efficacy in moderate-to-severe GAD at 1500 mg/day of pharmaceutical-grade extract. Chamomile did not prevent relapse in the long-term trial. Evidence for general state anxiety is not statistically significant in pooled meta-analysis.
5.2 Sleep and Insomnia
Chamomile extract has been investigated for treatment of stress and GAD. Two small studies have evaluated the effect of chamomile essential oil on the autonomic nervous system. One study found that chamomile oil increased comfortable feelings and decreased alpha 1 (8–10 Hz) EEG recordings at the parietal and temporal brain regions.
Only one RCT evaluated the effect of chamomile on insomnia and it found no significant change in insomnia severity index (P > 0.05).
Evidence strength: Weak for clinically diagnosed insomnia. A single RCT showed no significant improvement on the Insomnia Severity Index. Mechanistic plausibility (via GABA-A receptor binding by apigenin) exists, but clinical trial evidence is insufficient to support chamomile as a primary treatment for insomnia.
5.3 Gastrointestinal Conditions
Some research has found that products containing certain combinations of herbs that include chamomile may be of benefit for diarrhea in children and for infants with colic. However, chamomile alone has not been shown to be helpful for these conditions.
Traditional use has included chamomile preparations for muscle spasms, ulcers, and gastrointestinal disorders. In vitro evidence supports the antispasmodic rationale, with relaxant effects detected on human jejunum preparations, supporting the traditional use of chamomile in spasmodic gastrointestinal disorders.
Evidence strength: Preclinical (in vitro and in vivo animal) evidence is supportive, and traditional use is extensive, but human clinical trial evidence for chamomile as a mono-preparation for specific GI conditions (IBS, colic, diarrhea) remains limited and largely drawn from multi-herb products.
5.4 Glycemic Control and Type 2 Diabetes
A single-blind randomized controlled clinical trial was conducted on 64 subjects with type 2 diabetes mellitus (males and females) aged 30–60 years. The intervention group (n = 32) consumed chamomile tea (3 g/150 mL hot water) 3 times per day immediately after meals for 8 weeks. Chamomile tea significantly decreased concentration of HbA1C (p = 0.03), serum insulin levels (p < 0.001), and homeostatic model assessment for insulin resistance (p < 0.001).
A systematic review and meta-analysis found that 4 clinical trials on humans met inclusion criteria. With regard to RCTs, a favorable effect of chamomile consumption was observed on serum fasting blood glucose (SMD: −0.65, 95% CI: −1.00, −0.29, P < 0.001; I² = 0%) and hemoglobin A1C levels (SMD: −0.90, 95% CI: −1.39, −0.40, P < 0.001; I² = 45.4%).
A separate systematic review found that administration of several preparations of chamomile samples (tea, ethanolic, and aqueous extracts) could improve glycemic control and may be beneficial in the management of diabetes. However, included trials were carried out in smaller populations with limited follow-up. The effects of chamomile on animal models were more pronounced than in humans.
Evidence strength: Preliminary but promising. A small number of RCTs (n = 4 in meta-analysis) and their pooled analysis indicate statistically significant improvements in HbA1c and fasting glucose, but trials are generally small, of short duration, and limited in their clinical characterization.
5.5 Topical Anti-Inflammatory and Wound Healing
Evidence from preclinical and clinical studies indicates that chamomile exerts photoprotective effects by reducing UV-induced ROS generation and preserving dermal collagen. Both chamomile extracts promote wound healing through fibroblast stimulation, collagen deposition, and antimicrobial activity.
Oil of German chamomile, extracted through steam distillation, is used to treat skin allergies, eczema, psoriasis and other flaky skin conditions; the high α-bisabolol content promotes granulation (healing) and tissue regeneration.
Chamomile's flavonoid apigenin has been shown to reduce ROS generation, attenuate DNA photoproduct formation, and restore autophagy in keratinocytes following UVB exposure. However, translation into human trials remains incomplete, and the absence of large-scale controlled trials limits firm conclusions about the role of chamomile in preventing actinic damage in vivo.
Evidence strength: Biologically plausible and supported by preclinical data and limited clinical observations. A small number of clinical studies (including a published double-blind study on wound healing) show promise, but large-scale RCTs are lacking.
5.6 Oral Mucositis (Chemotherapy/Radiation)
Small studies suggest that mouthwashes containing chamomile might prevent or treat swelling or irritation in the mouth resulting from radiation therapy, chemotherapy, or stem cell transplantation.
Evidence strength: Preliminary. Evidence is limited to small studies; no large controlled trials have confirmed efficacy for oral mucositis.
5.7 Anticancer Activity
Most evaluations of tumor growth inhibition by chamomile involve studies with apigenin, which is one of the bioactive constituents of chamomile. Chamomile has shown anti-proliferative and tumor-suppressing properties. In vitro and animal studies indicate that chamomile extracts have anti-inflammatory, anti-hyperglycemic, antigenotoxic, and anticancer properties. Apigenin, a flavone present in chamomile, has chemopreventive effects.
Evidence strength: Preclinical only. Anticancer activity has been demonstrated in cell culture and animal models, primarily attributable to apigenin-mediated pathways, but no human clinical trials have investigated chamomile for cancer prevention or treatment.
5.8 Cardiovascular Activity
Animal and in vitro studies suggest hypocholesterolemic and anti-platelet activities for chamomile which support its cardioprotective potential. Hydroxylated compounds (apigenin, luteolin and (−)-α-bisabolol) found in chamomile all cause a slow relaxation of isolated blood vessels through an effect on calcium influx.
Evidence strength: Preclinical only. No human trials have specifically evaluated chamomile for cardiovascular endpoints.
6. Body Systems Associated with Chamomile
- Central Nervous System: Anxiolytic and mild sedative effects via apigenin's interaction with GABA-A/benzodiazepine receptors; investigated in GAD.
- Gastrointestinal System: Antispasmodic effects on smooth muscle; traditional use for colic, IBS, gastritis, and ulcers; in vitro and in vivo animal data support antidiarrheal effects.
- Metabolic / Endocrine System: Preliminary human RCT data support improvements in fasting glucose, HbA1c, and insulin resistance in type 2 diabetes.
- Integumentary System (Skin): Anti-inflammatory, wound-healing, and antioxidant effects; extensive topical use in dermatology and cosmetics.
- Immune System: Anti-inflammatory activity via NF-κB, MAPK, and COX-2 pathways; in vitro antifungal and antibacterial properties.
- Cardiovascular System: Preclinical vasodilatory, anti-platelet, and hypocholesterolemic activity; no human trial data.
- Oral/Mucosal: Mouthwash preparations investigated for mucositis in oncology settings.
7. Dosage Forms and Dosages Reported in Studies
In a systematic review of 83 chamomile mono-preparation studies, capsules were the most commonly used form, with a dosage ranging from 300 to 1500 mg daily.
- Oral extract (capsules) — Anxiety (GAD):
During Phase 1 of the long-term GAD trial, participants received 12 weeks of open-label therapy with pharmaceutical-grade chamomile extract 1500 mg (500 mg capsule 3 times daily).
- Oral — Type 2 Diabetes:
In the T2DM RCT, the intervention group consumed chamomile tea (3 g/150 mL hot water) 3 times per day immediately after meals for 8 weeks.
- Pharmacopeial quality standard:
According to the European Pharmacopoeia, chamomile should contain no less than 4 mL essential oil per kg of dried flowers.
Studies of the effectiveness of chamomile for a variety of specific conditions have not produced sufficient reliable evidence to rate clinical usefulness. Also, some studies examine products made of chamomile plus other herbs, so it is difficult to isolate chamomile's exact contribution from those studies.
8. Safety, Adverse Events, and Drug Interactions
General Safety Profile
Data extracted from clinical trials and published case reports suggest that chamomile is generally safe when used in controlled dosages, with self-limiting minor adverse events. The NCCIH states chamomile is "likely safe when used in amounts commonly found in teas." It is also safe to take orally for medicinal purposes "over the short term."
Common Adverse Events
The most common adverse events in clinical trials were gastrointestinal complications and drowsiness, both of which were self-limiting and non-serious.
Allergic Reactions
No allergic adverse events were reported in the clinical trials themselves; however, among eleven case reports reviewed, six reported adverse events associated with allergic reactions to chamomile, ranging from anaphylactic reactions (in three patients) to short-lasting acute rhinitis. Individuals allergic to ragweed or members of the Compositae family, such as chrysanthemums, should avoid chamomile. Additionally, individuals with mugwort pollen allergies should also avoid chamomile, as there have been multiple cases of cross-reactions.
Drug Interactions
Interactions between chamomile and some drugs metabolized by the liver and warfarin (a blood thinner) have been reported, and there are theoretical reasons to suspect that chamomile might interact with other drugs as well, such as sedatives. An assessment of case report studies revealed that the use of chamomile requires careful consideration of potential issues, including allergic reactions and drug interactions, particularly with cyclosporine and anticoagulants such as warfarin.
NCCIH notes that interactions between chamomile and cyclosporine, a drug used to prevent transplant organ rejection, have been reported. Chamomile might interact with other drugs as well.
Pregnancy and Lactation
There is a lack of sufficient data regarding the safety of chamomile use during pregnancy and lactation. Some small studies have shown that women who used chamomile every day throughout pregnancy had a slightly higher risk for early delivery as well as lower birth weight compared to mothers who did not use chamomile.
Long-Term Use
Data from included studies suggest that chamomile is generally safe when used in controlled dosages, although there is evidence of a wide range of safety, with one study reporting consumption of up to 60 g. Some minor and self-limiting adverse events may occur.
Topical Use
The long-term safety of using chamomile on the skin for medicinal purposes is unknown.
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