In the midst of the current pandemic, I’m surprised how little mention there is of boneset, once considered the number one remedy for influenza and deemed a ‘miracle life-saving herb’ during the 1918-19 Spanish influenza responsible for the deaths of 675,000 Americans and ranging from 21 million to 100 million worldwide.
Other than the general disdain for herbal medicine still prevalent in most of the Western world, I can think of but two reasons that boneset has fallen unjustly into neglect: first, it has in recent years been found to contain a varyingly small number of toxic pyrrolizidine alkaloids (Pas) and second, it is nauseatingly bitter.
No one has proven that boneset is, indeed, toxic. It was used for centuries by Indigenous people and European settlers, included as a treatment for fever in the U.S. Pharmacopoeia from 1820 through 1916, and in the National Formulary, the pharmacists’ manual, from 1926 through 1950. Last but not least, it was successfully used by Eclectic medical doctors, during the Spanish flu outbreak – all with no recorded deaths but only some minor symptoms of nausea, vomiting or diarrhea from taking too much.
As well, there is no comparison with the risk of taking boneset herb compared to other common OTC drugs with well-known liver toxicity such as acetaminophen (Tylenol), which causes 2600 hospitalizations and 500 deaths each year.
Further, regarding the PA toxicity of boneset herbalist-biochemist, Lisa Ganora, founder of the Colorado School of Clinical Herbalism, recently wrote,
There are something like 660 different kinds of PAs, some absolutely harmless, only a few that are toxic / hepatocarcinogenic. It is not sufficient to simply ban an herb that contains PAs without knowing which PA subtypes a plant contains. Some are indeed very toxic to both animals and humans but others have either low toxic potential or no toxicity whatsoever.
Boneset belongs to the PA group known as retronecine monoesters, lycosamine and intermedine, their N-oxides and acetylated derivatives, of all the potentially toxic kinds, these are the least. No case reports of HSOS (the new name for VOD (veno-occlusive disease), which is what an excess of a toxic PA can cause) from use of boneset. Given its awesome bitterness (which is part of its power as a profound relaxant), it would be hard if not impossible to reach toxic levels with traditional use, IMO.
As to boneset’s bitterness: this is easily mitigated by dispensing it in capsules rather than teas or in teas or tinctures combined with other herbs such as mint. However, I would still recommend taking boneset by itself both for prevention as well as treatment. Furthermore, unlike many herbs, dosage for boneset tea is in tablespoonsful while the tincture it is measured in drops. This further mitigates issues of toxicity as well as any side effects of vomiting or diarrhea that might occur from overdose.
Prevention and Treatment of Flu with Boneset
Clinical herbalist Larkin Morgan states her experience regarding the bitterness of boneset: She gives it as “a simple… no added flavors or sweeteners, 1/2 – 1 cup for an adult dose. It tastes horrible when not running a fever. When you need it, I find boneset tea tastes pleasantly refreshing, no cloying aftertaste and it even settles the stomach. I’ve had even picky young children gulp it down. I have rarely needed to administer more than 4 doses across the span of an illness.”
Some claim a prophylactic benefit from taking boneset preventing catching the flu by taking boneset as a small dose of one or two “00” sized capsules daily with warm water. Of boneset tea, take as a standard decoction of one ounce infused in a pint of boiling water, allow to cool and take one or two tablespoons once a day. Of 1:5 tincture of boneset, take 10 drops of the 5:1 extract at 75% alcohol, 25% water once or twice a day.
For flu treatment with boneset, take the same dose of the tea but more often throughout the day. I recommend brewing the tea with 3 or 4 slices of raw ginger root. Felter, the famous Eclectic medical doctor, recommends 1 to 60 drops of the tincture. Certainly, take as much as your body can tolerate but 10 to 20 drops every one or two waking hours works for most. Stop taking it or take a lower dose, if nausea or diarrhea develops, which is unlikely at these low dosages. It is best to take tincture or capsules with a little warm water.
Besides ginger, to mitigate some of its bitterness, one can add a drop or two of food grade peppermint oil, or take it with peppermint and elder flower tea, an old standby for colds and influenza.
Boneset naturally occurs in wetlands over a widespread area covering nearly have of the Eastern half of North America. It was therefore readily available when needed as an old-time farmer’s remedy for all of the following:
- to induce sweating in fevers, colds and flu
- to stimulate immune system
- muscle pains
For fevers and colds, they used 1-2 teaspoons dried boneset, aerial parts (or 1 tablespoon fresh to one cup of water. Steep covered for 15 minutes. Strain and sweeten. Drink 1/2 cup every hour, as hot as you can stand it, until symptoms improve.
Boneset is has a well-established reputation as an effective remedy arthritis and rheumatism and to clear excess uremic acid from the body treatment for gout.
My interest in boneset for the flu was piqued after reading an engrossing book, American Eden by Victoria Johnson. It is based on the life of the botanist-physician, David Hosack. The book, peopled with all of the famous founders of the early republic who all shared a widespread interest in plants and botany, offers a glimpse of herbal healing during its early days. The achievements of David Hosack both as the leading botanist of the time and one of the leading physicians founded the first botanical garden in the United Sates which was situated on the present site of Rockefeller center in downtown New York. He was also the physician who attended Hamilton in the famous duel with then vice president Aaron Burr and that led to Hamilton’s death. Rich in history, the book provides many references to the uses of medicinal plants especially Hosack’s favorite herbal medicine, boneset, with which he successfully treated all types of fevers, including malaria and other plagues of the day. By doing so, he found that boneset was safer and more effective than the then prevailing practice of bloodletting and the use of mercury.
Boneset is a member of the Asteraceae family of which there are numerous subspecies with a propensity to hybridize. It was a valuable medicine for Indigenous people and one of the first native North American herbs adopted by European settlers. Its popular name, boneset, refers to its use for the treatment of dengue fever. In fact, however, Indigenous people first introduced it to the early settlers for all fever-producing illnesses: influenza, cholera, dengue, malaria, and typhoid. This gave rise to other more useful popular names for the plant more broadly descriptive of its uses – ague weed, feverwort, sweat plant.
So, if boneset was so effective for fevers, muscular pain and influenza, why was it replaced? Many herbs in the U.S. Pharmacopoeia were replaced with the so-called “wonder” drugs antibiotics and aspirin. That time and up until mid 19th century, most people, including doctors, had no idea regarding the side effects of most of these. So, some of our most important herbs fell out of favor and were deemed too old-fashioned for use except by a dwindling number of die-hard older people who, remembering things how once were, kept seeking them out. By the mid- 1960s an herbal renaissance began with a handful of younger people of the time, including myself, who were eager to return to nature and became drawn to medicinal herbs as a safer alternative to drugs.
Boneset in Traditional Chinese Medical Terms
From the perspective of Traditional Chinese Medicine I have classified boneset as follows:
- Energy and flavors: Cold, bitter, slightly acrid
- Organs and channels affected: Liver, Large Intestine
- Properties and actions: Diaphoretic, febrifuge, expectorant, diuretic, bitter tonic, nervine, diuretic, antispasmodic. It treats exterior Wind-Heat, clears damp-heat (considered to be an issue with coronavirus requiring the addition of diuretics to the fromula used by the Chinese).
- Dosage: ½ to 1 teaspoon infused in a cup of hot water 20 minutes. Of the tincture I recommend no more than 10 to 20 drops per dose.
(Excerpted with some edits from the East West Herb Course, Pesson 14, page 4)
While the combination of these properties coincide closely for the symptoms of influenza, boneset is also a remedy of choice for pneumonia, which can be a complication of influenza. It is also used for bronchitis, sore throat and muscular pain also associated with influenza.
Boneset, fresh ginger, perhaps with echinacea, elder, yarrow and peppermint tea is a compact formula that can be used for the above disease patterns and symptoms.
During flue season, it’s a good idea to keep your immune system toned and at the ready. Take elderberry juice daily and Planetary Jade Screen formula for protection.
Traditional Uses of Boneset by Mariann Garner-Wizard
The American Herbal Pharmacopeia
Herbal Medicine by Dr. Sharol Marie Tilgner 3rd edition, published by Wise Acres
Chinese Treatment of Flu-like Virus
 Acetaminophen toxicity https://www.ncbi.nlm.nih.gov/books/NBK441917/
 Potentially toxic pyrrolizidine alkaloids in Eupatorium perfoliatum and three related species. Implications for herbal use of boneset. Pu Me. https://www.ncbi.nlm.nih.gov/pubmed/29968391
A very encouraging, hopeful, and insightful article! Thank you!
Thank you so much for sharing your knowledge and wisdom Dr.Michael Tierra. May God bless you.
Great article Michael, thank you!