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Betula pendula
CautionHänge-Birke · (Betula pendula)
Birch family (Betulaceae)
Description
The white, papery peeling bark and slender drooping branches make the silver birch one of Central Europe's most recognisable trees. Its young leaves, gathered in early summer, are the part put to use: rich in flavonoids, tannins and saponins, they carry an EMA traditional-use registration as a flushing therapy for mild urinary complaints and a positive Commission E assessment as a supportive tea for rheumatism, gout and skin conditions. The bark yields betulin and betulinic acid, compounds under active research, applied externally for psoriasis and seborrhoeic dermatitis. In folk tradition, birch sap tapped from the trunk in spring is valued as a mineral-rich tonic. Note: leaf-tea flushing therapy needs adequate fluid intake and is unsuitable for oedema linked to heart or kidney impairment, and those with birch pollen allergy should be cautious of possible cross-reactions.
Traditional use as an aquaretic (irrigation therapy) for supportive treatment of mild urinary complaints — EMA HMPC monograph (traditional use).
Preparation & dosage
INFUSION (aquaretic): 2–3 g (approx. 1–1.5 tsp) dried, coarsely cut birch leaves in 200 ml boiling water, covered, steep 10–15 min, strain. 3× daily fresh, between meals. Daily dose 6–9 g. Ensure adequate fluid intake (at least 1.5–2 L/day) as the effect depends on urinary irrigation. Duration per EMA HMPC up to 2–4 weeks; fever, blood in urine or persisting complaints require prompt medical attention. CONTRAINDICATED in oedema due to cardiac or renal insufficiency — irrigation therapy must not be used in these cases.
- Dry amount
- 2–3 g
- Doses per day
- 3×
- Max duration
- 4 weeks
⚠ Age restriction: ≥ 18 years — Per EMA HMPC traditional use monograph: adults only — insufficient data for children/adolescents under 18.
Traditional birch leaf tincture as aquaretic; folk use also for joint complaints — adjunctive, no clinical proof for joint indication.
Preparation & dosage
TINCTURE (DER 1:5 in 25–40 % ethanol): 1–2 ml (~20–40 drops) 3× daily diluted in water. Ensure adequate fluid intake (min. 1.5 L/day) — irrigation remains the key principle. Onset of action after ~1–2 weeks. No longer than 4 weeks without medical supervision. Contraindicated in oedema from heart or kidney insufficiency. Folk use also for joint complaints (gout, rheumatoid arthritis) as an adjunct — no clinical evidence for this indication.
- Liquid amount
- 1–2 ml
- Doses per day
- 3×
- Max duration
- 4 weeks
⚠ Age restriction: ≥ 18 years — Adults only. Due to ethanol content, not for alcohol dependence, liver disease, or epilepsy.
Fresh spring leaves as wild salad green and historical folk-medicine practice ('blood-cleansing') — folk custom without modern evidence.
Preparation & dosage
FRESH LEAVES (spring): Very young, pale-green birch leaves (April–May flush) may be eaten fresh as a wild salad green — mildly herbaceous, slightly resinous flavour. Folk tradition used freshly pressed birch juice (leaves + birch sap) as a spring 'blood-cleansing' drink. Pharmacological evidence is lacking; the educational value lies in the historical folk practice.
Birch sap — traditional spring drink tapped from drilled trunks, rich in minerals and sugars, folk use as a tonic and aquaretic.
Preparation & dosage
BIRCH SAP ('birch water'): In early spring (Feb–Mar, before leaf burst) the trunk is drilled or a thin branch cut, and the clear flowing sap is collected (max 1–2 L/day per tree; seal the hole immediately to protect the tree). Fresh birch sap contains sugars (mainly fructose), amino acids, vitamins (C, B-group), minerals (potassium, calcium, magnesium) and small amounts of betuloids and saponins. Folk medicine use for urinary complaints, spring fatigue and skin conditions. Fresh sap lasts only 2–3 days refrigerated — consume quickly or ferment.
Folk birch-leaf full bath for skin conditions and joint complaints — mildly astringent, traditional use without clinical study evidence.
Preparation & dosage
FULL BATH / PARTIAL BATH: 50–100 g dried birch leaves in 2 L boiling water, steep 20 min, strain and add to bath water (36–38 °C, 15–20 min). Traditionally used for skin conditions (psoriasis, eczema, acne), dry or scaly skin, and joint / muscle complaints. The tannin-rich decoction has mild astringent and anti-inflammatory effects on skin. Evidence based on folk tradition and in-vitro data; controlled clinical trials are lacking. Use with caution in known birch pollen allergy — possible cross-reaction.
- Dry amount
- 50–100 g
Betulin-containing birch bark topical for psoriasis and seborrhoeic dermatitis — betulin and betulinic acid are clinically investigated lead compounds of the bark.
Preparation & dosage
BIRCH BARK EXTRACT / BETULIN PREPARATION (topical): Extracts from birch outer bark (rich in betulin, betulinic acid, lupeol) are used externally for psoriasis, seborrhoeic dermatitis and wound care. Betulin is the key constituent of commercial creams (e.g. Birken-CORS®). Apply thinly 2× daily to affected skin areas. Caution in concurrent birch pollen allergy. Do not apply to open, infected wounds. Clinical data on betulin exist for specific formulations (e.g. Eucerin® with Betulae cortex extract in psoriasis patients).
- Liquid amount
- 5–10 ml
- Doses per day
- 2×
Kommission E positive: birch leaf tea as adjunct for rheumatism, gout and skin conditions — diuretic, anti-inflammatory, saluretic.
Preparation & dosage
SUPPORTIVE USE for joint diseases (gout, rheumatoid arthritis) and skin conditions: 2–3 g birch leaves in 200 ml boiling water, steep 10–15 min, strain. 3× daily. Kommission E rated birch leaves positively for supportive treatment of rheumatic conditions and gout as an adjunct (not monotherapy). The diuretic, anti-inflammatory and saluretic effect is primary. Drink plenty of fluids. CONTRAINDICATED in renal or cardiac oedema. Not a substitute for specific antirheumatic therapy.
- Dry amount
- 2–3 g
- Doses per day
- 3×
- Max duration
- 4 weeks
Historical birch tar ointment from bark distillate for psoriasis and eczema — folk and historical-dermatological; modern equivalent is PAH-free betulin cream.
Preparation & dosage
BIRCH TAR OINTMENT / BIRCH TAR (Pix betulina): Dark oil produced by dry distillation of birch bark (birch tar, Oleum Betulinae empyreumaticum). Historically used in folk and dermatological medicine for chronic psoriasis, eczema and seborrhoeic dermatitis as an ointment (5–10 % in petrolatum or lanolin). Birch tar contains polycyclic aromatic hydrocarbons (PAHs) — prolonged use on large areas not recommended (carcinogenic PAH potential). Modern equivalent: betulin extract creams (PAH-free). Now only historical and very limited niche medical use.
IMPORTANT: Irrigation therapy (birch leaf tea, tincture) only with adequate fluid intake (min. 1.5–2 L/day). NOT in oedema (fluid retention) due to impaired cardiac or renal function — increased fluid intake may worsen such oedema. Fever, blood in urine, severe flank pain or urinary complaints persisting beyond 2 weeks require immediate medical attention (possible infection, stone or structural disease). Birch pollen allergy sufferers should avoid birch leaf preparations or consult a physician first — cross-reactions possible. Birch bark extracts (betulin) topical: do not apply to open or infected wounds.
⏱ Max continuous use: 4 weeks
Per EMA HMPC not recommended in pregnancy due to insufficient data. Avoid therapeutic doses (tea, tincture). Birch sap in small amounts as a food beverage is traditionally considered safe, but controlled studies are lacking.
Per EMA HMPC not recommended during lactation due to lack of data. Culinary use of birch sap in usual amounts is considered safe.
Per EMA HMPC not recommended for children/adolescents under 18 — insufficient safety and efficacy data. Birch sap in small amounts as food is traditionally safe. Urinary complaints in children always require medical assessment.
Drug interactions
Diuretika (Furosemid, Hydrochlorothiazid, Spironolacton)
Birch leaves act as an aquaretic (increase excretion of water and electrolytes). Additive effect with chemical diuretics possible — risk of electrolyte loss (hypokalaemia, hyponatraemia), dehydration and hypotension. Regular electrolyte and blood pressure monitoring recommended.
Antihypertensiva (ACE-Hemmer, Angiotensin-II-Antagonisten, Betablocker)
The aquaretic effect of birch leaves may enhance the blood-pressure-lowering action of antihypertensives — risk of hypotension and dizziness. Monitor blood pressure regularly.
Lithium
Aquaretic plant extracts may theoretically influence renal lithium excretion (sodium loss → compensatory lithium retention). Not clinically documented for birch leaves specifically; caution and lithium level monitoring advised.
Contraindications
- Oedema (fluid retention) due to impaired cardiac or renal function — irrigation therapy with increased fluid intake is contraindicated in these cases.
- Hypersensitivity to birch leaves or birch pollen (possible cross-reaction between birch pollen allergy and birch leaf preparations).
- Pregnancy and lactation at therapeutic doses — avoid due to lack of data.
- Acute nephritis or acute urinary tract disease with fever — immediate medical treatment; no self-medication.
Harvested part: young leaves
- Time of day:
- Dry, sunny morning (9–12), once morning dew has fully evaporated. Harvest only during the fresh spring flush (pale-green, still slightly sticky leaves) — flavonoid content is highest at this stage. Fully mature summer leaves are pharmacologically weaker.
- Drying:
- Strip individual leaves from twigs (discard old, damaged or mould-affected leaves). Dry in a single layer on cloth or screens in shade, well-ventilated, max 40 °C (dehydrator or shade air-drying). Approximately 3–5 days until crumbly dry — in humid climates use a dehydrator only (mould risk). Finished drug: greenish, aromatic, slightly astringent taste. Store in airtight dark containers, cool and dry, use within 1–2 years.
- Storage:
- 18 months — Airtight, dark, dry, cool (below 20 °C). Use within 18 months — flavonoid content declines significantly thereafter. Discard if yellowing or musty smell.
- Time of day:
- Bark from felled or heavily pruned branches (NEVER strip from living trunks — causes severe damage and may kill the tree). Ideal: use freshly felled birch trees. Spring (Mar–Apr, before leaf burst) or autumn (Oct–Nov, after leaf fall) — at these times the outer bark separates more easily.
- Drying:
- Use only the white outer bark (cork-suberin layer, betulin-containing part) — keep the inner brown bast layer separate. Spread fresh outer bark flat and dry at 40–50 °C in a dehydrator or fan oven (door slightly ajar) for 12–24 h until brittle. Crush or grind dry bark (mortar, food processor) for extract preparation. For betulin-rich extracts, solvent extraction (96 % ethanol, hexane) is recommended — commercial process, not for home use.
- Storage:
- 24 months — Dry, cool, protected from light in closed containers. Dry bark is very long-lasting (up to 2 years) — betulin is chemically stable.
- Flavonoide (Hyperoside, Rutin, Myricetin-3-glucuronid, Quercitrin, Quercetin)FlavonoidContent: 1-3 %Leaf
Lead compound group of birch leaves; hyperoside (quercetin-3-galactoside) and rutin dominant. Diuretic, antioxidant and capillary-protective; basis of the aquaretic effect. EMA monograph uses total flavonoid content (calculated as rutin) as quality marker.
- Betulin (Lup-20(29)-en-3β,28-diol)OtherContent: 10-30 %Bark
Pentacyclic lupane-type triterpene alcohol; primary constituent (up to 30 %) of birch outer bark (cork layer). Responsible for the characteristic white bark colour. In vitro anti-inflammatory, antiviral and weakly antiproliferative (tumour cell lines). Basis of cosmetic and dermatological birch bark extract preparations (psoriasis, wound healing).
- Betulinsäure (Betulinic acid, 3β-Hydroxy-lup-20(29)-en-28-oic acid)OtherContent: 0.1-0.5 %Bark
Oxidation product of betulin; intensively studied for selective apoptosis induction in melanotic tumour cell lines (in-vitro and animal model data). Clinical studies in humans still limited. No therapeutic claim for OTC use; scientifically relevant lead compound.
- Ätherisches Öl (Methylsalicylat, Betulenol, Betulinol — Spuren)Essential oilContent: 0.04-0.1 %Leaf
Very small quantity of volatile constituents in leaves; main components methyl salicylate (analgesic, antirheumatic at higher concentrations), betulenol. Contributes to the characteristic aromatic scent of birch leaf tea; pharmacologically only marginally relevant at usual dosage.
- Gerbstoffe (Procyanidine, Catechingerbstoffe)TanninContent: 2-5 %Leaf
Condensed tannins (small fraction of hydrolysable tannins) give the leaf its astringent properties. In folk baths they act mildly skin-protective and anti-inflammatory. High tannin content of bark (>10 %) played a historical role in the leather tanning industry.
- Saponine (Birken-Saponine, Betulosid-Typ)SaponinContent: 0.5-1 %Leaf
Triterpene saponins (aglycone mostly betulin or oleanolic acid derivatives) contribute to the diuretic effect of the leaf. Lower concentrations in birch sap. No acute toxicity at doses used in teas.
- Ascorbinsäure (Vitamin C) und weitere Vitamine (B-Gruppe)VitaminContent: 0.1-0.3 %Leaf
Fresh birch leaves and birch sap contain notable amounts of vitamin C and B vitamins (especially thiamine, riboflavin). Contributes to the folk reputation as a 'spring tonic'. Significant vitamin C loss occurs during drying — negligible in dried leaf tea.
- Mineralstoffe (Kalium, Calcium, Magnesium, Kieselsäure)MineralContent: 2-5 % AscheLeaf
Birch sap contains comparatively high potassium (~100 mg/L) as well as calcium, magnesium and silicic acid (silicon dioxide). Lower concentrations in tea. Silicic acid was traditionally credited with beneficial effects on skin and hair (folk medicine); clinical evidence lacking.
- [1]MonographEMA/HMPC/573241/2014 — European Union herbal monograph on Betula pendula Roth and/or Betula pubescens Ehrh., folium (Final, 2016)(accessed: 2026-05-21)
- [2]MonographESCOP Monographs — Betulae folium (Birch Leaf), 2nd edition (incl. supplement 2009)(accessed: 2026-05-21)
- [3]MonographKommission E — Betulae folium (Birkenblätter), Monographie positiv, BAnz Nr. 101, 1. Juni 1990(accessed: 2026-05-21)
- [6]MonographPlants For A Future (PFAF) — Betula pendula database entry(accessed: 2026-05-21)
- [4]BookWichtl, Max (Hrsg.) — Teedrogen und Phytopharmaka: Ein Handbuch für die Praxis, 5. Aufl. Wissenschaftliche Verlagsgesellschaft, Stuttgart 2009. Betulae folium, S. 89–92.(accessed: 2026-05-21)
- [5]BookMadaus, Gerhard — Lehrbuch der biologischen Heilmittel, Band I: Betula (Birke), 1938 (Public Domain)(accessed: 2026-05-21)
- [7]WikipediaHänge-Birke (Wikipedia DE)(accessed: 2026-05-21)
- [8]WikipediaBetula pendula — Silver Birch (Wikipedia EN)(accessed: 2026-05-21)