The Elder is not the most beautiful of trees either in sight or smell, but is beyond value for its numerous medicinal properties. Evelyn, the great British historian of trees, sings its praises most highly saying: "If the medicinal properties of the leaves, bark, berries and flowers were thoroughly known, I cannot tell what our countrymen could ail, for which they might not find a remedy from every hedge, either for sickness or wound. The inner bark of the Elder applied to any burning takes out the fire immediately, that or, in season, the buds boiled in water-grewel for a breakfast, has effected wonders in a fever; and the decoction is admirable to assuage inflammation. But an extract may be composed of the berries, which is not only greatly efficacious to assist longevity, but is a kind of catholicon [universal preventative] against all infirmities whatsoever: and of the same berries is made an incomparable spirit, which drunk by itself, or mingled with wine, is not only an excellent drink, but admirable in the dropsy. The ointment made with the young buds and leaves in May with butter is most sovereign for aches and shrunk sinews."

Of all the trees of the Celtic Forest, the Elder without doubt provides the best stocked pharmacy for followers of herbal medicine. One could write a whole book devoted solely to its rich and diverse medicinal uses with leaves, buds, blossoms, berries, pith, wood and bark all having healing value. The buds and leaves are gathered as soon as they appear and added to baths and washes for bruises, wounds, chilblains and inflammations. The flowers, at their opening, can be harvested and made into an infusion for both external and internal treatment of wounds, inflammations and fevers. The mature flowers, when placed in a bowl of water for an hour in the sun, provide a cooling face wash and reduce inflammations of the eyes and when taken internally eases childhood colic and reduces fevers. The berries, when ripe, can be made into a most effective syrup for colds and fevers and infused to treat rheumatism. The bark of the younger, sappier branches pared off close to the wood makes a salve for relieving scolds and the pith when infused treats fevers, wounds and ulcers. Its flowers and berries are both used in the treatment of hayfever, sinusitis and other respiratory illness.

The Elder is a fast growing tree while young and produces stout shoots which when a year old are as large as those of most other trees at two or three years of age. These shoots contain an unusually high proportion of pith which is easily removed for the fashioning of flutes and pipes. Its leaves, when infused, create a wash for plants that acts as an insect repellent and dissuades most species of caterpillar. In olden times carters would place bunches of leaves on a horse's head to deter flies. In late spring, white flowers grow at the extremities of the shoots and are followed later in the season by small, black berries that have a slightly sickly taste. This flavour is removed when they are boiled. The wood of the older branches is yellow and very hard and has been used in the past for making meat skewers and shoemakers' pegs. The bark is used to produce a dye.

The Elder prefers a damp environment, but will grow anywhere and even tolerate exposure to sea-breezes. It is very hardy, growing on most soils and easily propagated from seeds or cuttings. In Cornwall it was most revered and has found its name included in the names of both places and families. The old Cornish words for the Elder are "scau" and "scauan" and appear in the names of Boscauan-ros and Boscauancen in the parish of St. Berian, Penscauan in St. Enoder and Lescauan in Sheviock and as the family name Boscawen of the Lord Viscount Falmouth. There was also a mineral water from St. Ives called Fentonscauan.

Magically Elder wine has been drunk to aid clairvoyance and its wood used to fashion protective amulets against enchantment, negativity and lightning. It is a fairy tree and Elder whistles when played in the woods aid fairy contact. In Ireland the witches' broom shaft was made of elder rather than the more traditional ash. In the Celtic Tree Calendar the Elder marks the darkest time of the year (25th November - 22nd December) and so is also associated with death and the Crone aspect of the Triple Goddess. Even before Celtic times this tree had associations with death and megalithic funerary flints have been found in long barrows in the shape of elder leaves while other sites have elder leaf shaped portals carved out between two slabs of stone at the entrance to the barrow.