Pleurisy Root
ApocynaceaeAsclepias tuberosa
Also known as: Butterfly Weed, Butterfly Milkweed, Chigger Flower
clinical_notes Clinical Summary
Pleurisy Root (Asclepias tuberosa) is a flamboyantly orange-flowered North American perennial milkweed whose tuberous root was a cornerstone remedy among Indigenous and Eclectic practitioners for pleurisy, pneumonia, bronchitis, and febrile respiratory illness.
Its diaphoretic, expectorant, antispasmodic, and mild cardiotonic actions derive from cardenolide and pregnane glycosides and flavonoids.
Because of its cardiac glycoside content, it must be avoided in pregnancy, lactation, and alongside digoxin or cardiac drugs; use only short-term at therapeutic doses.
Pregnancy Safety
Contraindicated due to animal evidence of uterotonic activity and cardenolide content. Historical use in Aztec medicine as a purgative.
Lactation Safety
Avoid due to cardenolide glycoside content and lack of safety data.
warning Contraindications
- Pregnancy (avoid)Theoretical
- Concurrent digoxin or cardiac glycoside therapy (contraindicated)Theoretical
- Cardiovascular disease (heart failure, arrhythmia, hypertension) (caution)Theoretical
- Lactation (avoid)Theoretical
- Concurrent antidepressants (caution)Theoretical
vital_signs Clinical Profile
Primary Indications
- check_circle Pleurisy
- check_circle Pleuritic pain
- check_circle Bronchitis
- check_circle Pneumonia (adjunctive)
- check_circle Influenza
- check_circle Dry febrile coughs
- check_circle Catarrh of respiratory tract
- check_circle Costal pain with breathing
Therapeutic Actions
System Affinities
- check_circle Respiratory system
- check_circle Serous membranes (pleura, pericardium)
- check_circle Skin (via diaphoresis)
labs Active Constituents
Cardenolide glycosides
Pregnane glycosides
Uzarigenin
Coroglaucigenin
Corotoxigenin
Flavonoids
Choline
Friedelin
α- and β-amyrin
Lupeol
history_edu Traditional Use
No TCM data available for this herb yet.
Traditional Uses Across Healing Systems
While many herbs lack controlled clinical trials, centuries of traditional practice across cultures provide valuable insight into their therapeutic applications.
Used by multiple Native American peoples (including the Omaha, Ponca, Lakota, Menominee) for pulmonary complaints, pleurisy, dysentery, and as a diaphoretic to break fevers. Root chewed or decocted.
One of the most widely used respiratory remedies among Indigenous peoples of North America.
Eclectic physicians (19th century) considered pleurisy root one of the best remedies for catarrhal conditions of the pulmonary and gastrointestinal tract, especially from recent colds. Small doses for infant snuffles.
Specifically indicated for hot dry skin, shortness of breath, strong pulse, acute pleuritic pain worsened by motion.
Aztec Herbal (Libellus de Medicinalibus Indorum Herbis, 1552) recommended Asclepias as a purgative, laxative, and remedy for chest congestion.
Called 'inmortal' in Mexican traditional medicine referring to ability to regrow from root.
spa Parts Used
root
- Pleurisy
- Bronchitis
- Pneumonia
- Influenza
- Fever
Tuberous root is the only part used medicinally; harvested in spring (March-April) when cardenolide content is most consistent. Unlike other milkweeds, contains little or no milky juice.
shield Safety
Contraindications — Evidence Basis
Pregnancy
Uterine stimulation and uterotonic activity reported in animal studies (Costello & Butler 1949). Traditionally considered inappropriate for 'delicate pregnancies.'
Concurrent digoxin or cardiac glycoside therapy
Asclepias contains cardenolide (cardiac) glycosides; additive toxicity with digoxin and related drugs.
Cardiovascular disease (heart failure, arrhythmia, hypertension)
Cardenolide content may affect cardiac rhythm and contractility. Not recommended except under experienced practitioner supervision.
Lactation
Cardenolide content poses theoretical risk to infant; no safety data. Pregnancy and nursing women and infants should avoid.
Concurrent antidepressants
Pleurisy may alter brain amine concentrations; theoretical interaction with antidepressants and serotonergic drugs.
Monitoring Parameters
Monitor during use, especially with prolonged or high-dose therapy.
Cardiac rhythm (heart rate, for patients on cardiac medications)
Baseline and during useCardenolide content may interact with digoxin, beta-blockers, calcium channel blockers, or antiarrhythmics.
flagThreshold: Bradycardia (<50 bpm) or new arrhythmia: discontinue and evaluate.
Toxicity
Doses exceeding 1 tablespoon (~5 g) of dried root at once may cause GI distress. Very high doses theoretically digitalis-like in cardiac effect.
Nausea, vomiting, diarrhea, intestinal cramping, possible arrhythmia or bradycardia at very high doses (digitalis-type toxicity).
Discontinue; supportive care; ECG monitoring if cardiac symptoms; consider digoxin Fab fragments for severe cardiac glycoside poisoning.
Adverse Effects
CYP Metabolism
No specific CYP450 data. Theoretical interaction with drugs metabolized by CYP2D6 or CYP3A4 based on cardenolide chemistry.
swap_horiz Interactions
Digoxin
Class: Cardiac glycoside
Asclepias tuberosa contains cardenolides (afroside, asclepin, asclepiadin, calactin, calotropin, uzarigenin, coroglaucigenin, corotoxigenin) that inhibit the Na+/K+-ATPase pump analogously to digoxin, producing additive inotropic and dysrhythmic effects. Concurrent use can precipitate digoxin-like toxicity (nausea, vomiting, visual disturbances, dysrhythmias, heart block). Interference with plasma digoxin immunoassays is also documented.
Contraindicated. Do not combine pleurisy root with digoxin or any cardiac glycoside. If exposure has occurred, monitor serum digoxin levels (though assays may be unreliable), ECG, and serum potassium. Treat digoxin toxicity with supportive care and Fab fragments if severe.
Metoprolol
Class: Beta-blocker
Cardenolides in pleurisy root inhibit the sodium-potassium pump, leading to elevated intracellular calcium and increased contractile force, with concomitant vagal tone effects that can slow heart rate. Combined with beta-blockers, additive bradycardia, AV nodal blockade, and heart failure exacerbation may occur.
Avoid combination. If exposure occurs, monitor heart rate, blood pressure, and ECG. Counsel patient to stop pleurisy root immediately and report palpitations, dizziness, or syncope.
Diltiazem
Class: Calcium channel blocker
The cardenolides of Asclepias tuberosa produce digitalis-like effects on myocardial contractility and AV nodal conduction. Combined with non-dihydropyridine calcium channel blockers (diltiazem, verapamil), severe bradycardia, AV block, and hypotension may result. Dihydropyridines (amlodipine) pose lower but still significant risk of additive hypotension.
Avoid combination with any calcium channel blocker. If used, monitor ECG, heart rate, and blood pressure. Counsel patient to report symptoms of bradycardia or hypotension.
Furosemide
Class: Loop diuretic
Loop and thiazide diuretics induce hypokalemia, which sensitizes the myocardium to the cardiotoxic effects of cardenolides in pleurisy root. Hypokalemia markedly increases susceptibility to cardiac glycoside-induced dysrhythmias, even at normally non-toxic cardenolide doses.
Avoid combination. Monitor serum potassium and magnesium. Correct electrolyte disturbances before considering any cardiac-active herb. Use potassium-sparing diuretic alternative if cardiac glycoside-like herb exposure unavoidable.
Amitriptyline
Class: Tricyclic antidepressant
Pleurisy root may alter amine concentrations in the brain, theoretically interacting with antidepressants (TCAs, SSRIs, MAOIs). Although not well studied in humans, concurrent use could affect serotonergic/noradrenergic signaling or produce unpredictable CNS effects. Additionally, the cardiotoxic TCAs plus cardenolides compound arrhythmia risk.
Avoid combination with antidepressants, particularly TCAs which carry their own cardiotoxicity. Monitor ECG, mood, and mental status if co-exposure is unavoidable.
Amiodarone
Class: Class III antiarrhythmic
Cardenolides in Asclepias tuberosa produce unpredictable effects on cardiac rhythm via Na+/K+-ATPase inhibition. Combined with antiarrhythmics (especially those affecting repolarization like amiodarone, sotalol, dofetilide), risk of life-threatening dysrhythmias including torsades de pointes, ventricular fibrillation, and heart block is significantly elevated.
Absolutely contraindicated. Pleurisy root should not be used in any patient with underlying cardiovascular disease or on antiarrhythmic therapy.
hub Combinations
Synergistic pairings can enhance therapeutic outcomes, while knowing suitable substitutes helps when specific herbs are unavailable or contraindicated.
Synergistic Combinations
5Boneset
Traditional UseClassic Eclectic pairing for influenza and febrile respiratory illness: both diaphoretic and bitter, with Boneset reducing aches and Pleurisy Root easing chest pain.
Long-established traditional pairing.
Elderberry
Traditional UseElder (flower or berry) pairs as diaphoretic/immune herb for febrile flu; Pleurisy Root adds chest-specific action.
Traditional diaphoretic triad (pleurisy root, yarrow, elder).
Lobelia
Traditional UseLobelia's antispasmodic action complements pleurisy root in spasmodic respiratory conditions like asthmatic bronchitis. Use caution — both are potent.
Eclectic formulation for respiratory spasm.
Wild Cherry Bark
Traditional UseWild cherry sedates the cough reflex while pleurisy root supports expectoration and eases pleuritic pain — good for productive coughs with chest pain.
Traditional combination in cough formulas.
Yarrow
Traditional UseBoth are diaphoretics; traditionally combined in composition powder and hot infusions for fever and early respiratory infection.
Well-known Western herbal pairing.
science Studies
New 8,12;8,20-diepoxy-8,14-secopregnane hexa- and hepta-glycosides from the roots of Asclepias tuberosa
In VitroThis phytochemical study identified eight new minor steroidal glycosides from Asclepias tuberosa roots, expanding the known catalog of characteristic 8,12;8,20-diepoxy-8,14-secopregnane glycosides unique to this species. Using NMR spectroscopy, mass spectrometry, and chemical degradation, the structures of six hexa-glycosides and two hepta-glycosides were fully characterized, all containing the aglycone tuberogenin with varying 2,6-dideoxy-hexopyranose sugar chains. The authors note that these secopregnane-type glycosides are found exclusively in A. tuberosa and represent chemotaxonomic markers for the species. This study contributes to the phytochemical foundation needed for understanding the plant biological activity profile and developing standardized preparations.
8,12;8,20-diepoxy-8,14-secopregnane glycosides from roots of Asclepias tuberosa and their effect on proliferation of human skin fibroblasts
In VitroThis study isolated and characterized 21 pregnane glycosides from the roots of Asclepias tuberosa and evaluated their biological activity on normal human skin fibroblast proliferation. The pregnane glycoside fraction induced fibroblast proliferation in cell culture, and several individual glycosides were confirmed to stimulate cell division. All aglycones were identified as 8,12;8,20-diepoxy-8,14-secopregnanes (tuberogenin or 5,6-didehydrotuberogenin), with structures established by NMR and chemical evidence. This in vitro finding raises the possibility that A. tuberosa root glycosides may contribute to tissue repair processes, though no respiratory or anti-inflammatory activity was directly demonstrated in this study.
medication Dosing
decoction
1 teaspoon (~2 g) dried root per cup
1 cup 3 times daily (TID)
Warm infusion/decoction preferred for diaphoretic action. Do not exceed 1 tablespoon (5 g) per dose due to cardenolide content.
tincture
10-30 drops (0.5-1.5 mL) of 1:1 fresh liquid extract, or 2-4 mL of 1:5 tincture in 40% alcohol
1-4 times daily
Lower doses (10-20 drops) preferred for infants and children with catarrh; short-term use only.
infusion
1 tsp dried bark per cup, infuse 10-15 min
TID
Less intense extraction; good for children and elderly.
Disclaimer: This information is largely AI-generated and reviewed by human experts at Evara Health. It is intended for educational and clinical reference purposes only and should not replace professional medical advice.
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