Echinacea: From Native American Panacea to Modern Phytopharmaceutical

Medicinal herbs play an important role in health care throughout the world—especially in non-industrialized continents such as Africa, South America, and parts of Asia. However, even in many industrialized countries, a number of traditional herbs are still used by a majority of people for minor to moderate every-day ailments for self-medication. In Germany, for instance, one can find a rich assortment of herbal-based extracts in modern blister packs—looking very much like Dristan—their American pharmaceutical counterpart. Although many traditional European herbal remedies do not undergo extensive scientific testing, and are simply popular and still allowed to be sold by government regulatory agencies, many do have substantial laboratory and clinical testing. Herbal remedies that fall into this category are being called phytopharmaceuticals. These preparations are strictly controlled as to purity and levels of active constituents. Just as with OTC products in the U.S., there are very specific therapeutic claims, dosage guidelines, and contraindications which can and must be made. A number of the most popular phytopharmaceutical preparations in Europe contain an American herb by the name of echinacea, or purple Kansas coneflower. The first commercial European preparation of echinacea was made over 50 years ago by Gerhard Madaus under the name Echinacin. Since then, this preparation has undergone numerous clinical trials, which has supported its traditional use by Native American people as a sovereign remedy for colds, flu, and infections.

Nomenclature

Linnaeus, the great Swedish botanist and physician, gave us the first “modern” generic name for any of the species of Purple Coneflower, Rudbeckia purpurea (1753), after Olaf Rudbeck and son, a fellow botanist and physician. This name was used in the botanical and horticultural literature as late as 1860 and even today, one can occasionally find it. Echinacea has a few common names in English. This is in contrast to an herb like Dandelion, which has many. Echinacea was known to the whites for only 200 years or so, as opposed to centuries for Dandelion. The most widely encountered common name is Purple Coneflower, for obvious reasons—the flowers are purple (except one odd species), and they are crowned with a prominent cone. One also sees Purple Kansas Coneflower, Black Sampson, Red Sunflower, Comb Flower, Cock Up Hat, Missouri Snakeroot, and Indian Head (Lyons 1907). E. purpurea has been popular in American horticulture as a border plant or as a plant in wild gardens for many years.

Ethnobotany

As one reviews the many articles written between the middle 1800s and the middle 1900s on the medicine of the Native Americans, one gets a sense of a wide range in sophistication and skill among the various cultures. Some authors feel that the Native Americans were abandoned to primitive rites and magic charms as a way to cure the ails of tribal members, others that they had a very advanced system of health care based on sound natural healing methods. Some authors stress incantations, blood-letting, scarifying, and power objects as the main methodology, while others emphasize the sweat lodge, fasting, diet, and a complex system of herbal compounding. It does seem certain that many tribes did have a substantial pharmacopoeia, and some used herbs and other internal medicines.

Summary of Uses of Echinacea by Native Peoples

Tribe	AREA	USES	NAME
CHEYENNE	e Col., w Kan.	sore mouth, gums, etc.	mohk ta
CHOCTAWS	s Miss., s Ala.	coughs, dyspepsia	?
COMANCHE	n, ne Tex.	toothache, sore throat	?
CROW	Mont., e Wyom.	colds, toothache, colic	“Like Comb”
DAKOTA (Oglala)	S Dak.	cool inflammation	ichahpe-hu
DAKOTA	n Neb., s S. Dak.	—	chahpe-hu
DELAWARE	se N. Y.	gonorrhea	?
HIDATSA	—	stimulant	—
KIOWA	sw Kan.	coughs, sore throat	dain-pai-a
MESKWAKI (Fox)	se Wis.	cure cramps, fits	shika’wi
OMAHA	e Neb.	septic diseases, etc.	inshtogahtehe
OMAHA-PONCA	ne Neb.	eye wash	mika-hi
PAWNE	cen. Neb.	stalks- children’s game	Ksapitahako
SIOUX (Dakota)	n Neb.	bowels, tonsillitis	?
—	S Dak.	hydrophobia, sepsis	?
WINNEBAGO	e Wis.	anesthetic against heat	?

Early American Uses & Pharmaceutical Preparations: The Eclectics and Regulars

The Eclectics were a group of doctors who depended heavily on botanical medicine in their practices and were prominent from the 1830s to the 1930s. They had a number of medical schools, notably in Cincinnati, and practitioners in every part of the country. Several of their journals are good sources of information on the medicinal uses of herbs: The Eclectic Medical Journal, The Eclectic Medical Gleaner, and the California Eclectic Medical Journal. Several of their larger works on materia medica and therapeutics have been reprinted and are available today. The Eclectic school was a major force in bringing Echinacea to the forefront of herbal medicine, and the Lloyd Brothers, suppliers of herbal medicines to the Eclectics, made “Specific Medicine Echinacea” and “Echafolta”, probably the most respected preparations of the day. It is beyond the scope of this present article to enumerate the history of the Eclectics, but this information can be found elsewhere (Wilder). One of the best-known Eclectic doctors and author of an important work, The American Dispensatory (King 1852), in print for over sixty years, was John King. King, along with one of the Lloyd brothers, John Uri Lloyd, a prominent pharmacist, writer, and manufacturer, were instrumental in the introduction of Echinacea to the medical profession in 1887. Ironically, King mentions Rudbeckia (Echinacea) purpurea and R. laciniata in the first edition of his Dispensatory in 1852, saying, “Both of the above plants deserve a full and thorough investigation from the profession.” Little did he suspect that he would be championing E. angustifolia 35 years later. The section in his Dispensatory about E. purpurea provides a few uses, as well as botanical information and range. He wrote about its properties: “The root is very pungent to the taste, and has been popularly used in medicine under the name of Black Sampson; it is stated to have been employed with much benefit in syphilis.” The history of the introduction of E. angustifolia into the medical profession has been quoted widely—the best account is John Lloyd’s “History of Echinacea angustifolia” and the Lloyd Brother’s “A Treatise on Echinacea“, both of which have been reprinted and are still available (1904, 1917). Around 1870, a H.C.F. Meyer, also of Pawnee City and a German lay physician, learned of Echinacea’s use and later began making and selling a patent medicine containing it, called “Meyer’s Blood Purifier”. It is uncertain if Meyer was a graduate of any medical school, though he did place an M.D. after his name in his correspondence. Sixteen years later, Meyer became convinced enough of the efficacy of his preparation, which also included Hops and Wormwood, that he wrote to two eminent medical men of the Eclectic school, King and Lloyd, sending them samples of his blood-purifier. Perhaps Meyer truly believed in this preparation, and he thought Echinacea to be the most important ingredient, but he no doubt hoped to expand his business sales as well. King wrote back, saying that he could not consider introducing or trying his preparation unless all the ingredients were made known. Lloyd thoroughly believed that the whole affair was unworthy of interest and considered Meyer a fraud, especially after reading the fantastic claims that were enumerated on the medicine’s label. Neither King nor Lloyd recognized the root Meyer sent to them in May of 1886, after King requested identification of the drugs Meyer was using. It wasn’t until September, 1886, that Meyer sent the whole plant, whereupon C.G. Lloyd, an eminent botanist, identified the plant as Echinacea angustifolia. This further convinced Lloyd that the preparation was worthless, for he knew that E. purpurea was considered to be of small value. Even more, shortly after the identification of E. angustifolia, Meyer wrote back to Lloyd and King, “urging (them) to give the profession the benefit of his discovery”. Lloyd writes of his letter (in the drug treatise), In view of our incredulity as to the virtues of the drug in the direction of the bites of poisonous serpents, he offered to come to Cincinnati and, in the presence of a committee selected by ourselves, allow a rattlesnake of our selection to bite him wherever we might prefer the wound to be inflicted, proposing then to antidote the poison by means of Echinacea only. This offer (or rather, challenge) we declined. Dr. Meyer, thinking this was because we had no serpent at our command, again offered not only to come to Cincinnati and submit to the ordeal formerly proposed, but to bring with him a full-sized rattlesnake, possessed of its natural fangs… This they also declined. Later Lloyd sorely regretted having dismissed Echinacea so quickly, to the point where he publicly wrote of his ‘humiliation’ over the affair. Especially after he considered the results of a study he did in 1912 regarding the popularity of vegetable drugs among medical practitioners of the day. He sent out 30,000 questionnaires to doctors of all kinds, both Eclectic and Regular, listing more than 200 herbal medicines, both official and non-official, asking them to rate them as to importance in their practice. The results showed that Echinacea, from its humble beginnings in 1886 when it was introduced, until 1915, had risen from obscurity to rank 11th among all the contestants! Fortunately, King had a premonition about Echinacea, and he was known to be interested in promoting native U.S. drug plants, for he decided to give it a trial. He soon developed a strong interest in the plant, for a preparation of it (made by Lloyd at his request) was the only remedy that he found effective for his wife, who had cancer at the time. Echinacea both retarded the progress of the disease and provided relief from the pain she was experiencing. This led King to continue his investigation of the plant, by having Lloyd send out preparations to doctors whose judgement he trusted, as well as using it more extensively in his own practice. Finally, two years later, in 1887, King wrote the first journal article on E. angustifolia, in collaboration with Meyer, who, being German, had little command of the language. From this article, until the last eclectic article on Echinacea in 1937, many were written, mostly by doctors extolling its virtues in clinical situations. In 1898, King’s standard work, King’s American Dispensatory was revised and edited by Felter and Lloyd. Much new and up-to-date material was added. In the same year, Felter published another similar monograph on Echinacea in the Eclectic Medical Journal under the title “The Newer Materia Medica: I. Echinacea“. These articles provide very good summaries of the history, botany, chemistry, and uses up to that time. The Felter-Lloyd Dispensatory is still available. Felter considered the pharmacological action of Echinacea “antiseptic” and “alterative”, but he recognized that these terms are not specific enough and makes a further statement about its action: “A corrector of the depravation of the body fluids;” and further: Its extraordinary powers—antifermentative and antizymotic—are well shown in its power over changes produced in the fluids of the body, whether from internal causes or from external introductions. Felter was grappling with unexplained actions of an herb that would, years later, with increased understanding of the biochemistry and physiology of the human body, be understood to stimulate and modify many amazingly complex chemical reactions, especially within the immune system. He goes on to say that as a stimulant to the capillary circulation, no remedy is comparable with it, and that it endows the vessels with a recuperative power or formative force, so as to enable them to successfully resist local inflammatory processes due to debility and blood depravation. This action, as we now understand it, is at least in part related to the polysaccharides of Echinacea combining with, and protecting, the matrix surrounding our tissue cells, thus limiting bacterial and other pathogenic access—while at the same time, stimulating phagocytosis and other local immune functions to counteract infection and remove toxic by-products; and to stimulate granulation and growth of healthy tissue. It is obvious that the Eclectics were enamored with this remedy, but the Regulars, or allopaths, were critical and unconvinced that it was anything but inert. In 1905, in The Lancet-Clinic, an allopathic medical journal, a talk given by C.S. Chamberlin was reported, along with a following discussion including the allopathic attenders. Chamberlin speaks, sardonically, about some of the profession accepting at face value remedies which emanate from some dye-works in Germany and are not so protected by our patent laws; and that the herb, which is profitably sold in Germany at $1.00 per pound, may be gently unloaded upon the confiding medical profession of America at $1.00 per ounce. Aniline dyes were the source of the so-called coal tar analgesics and antipyretics. Today, acetanilide is still used widely. The Allopaths were unconvinced after the talk, where Chamberlin enumerated the uses of Echinacea, giving several clinical examples. Chamberlin notes that. More than ten thousand medical practitioners hold this remedy in such high esteem, it seems impossible to awaken any interest in it among the regular profession. Personally, I have within the past three years, written to more than one thousand physicians, calling attention to the medicinal value of Echinacea.

J.H. Stealy has this to say in the following discussion:

I have given this Echinacea a trial. Take the average case of local sepsis from an injury, and if you use any moist lotion, as of boric acid or alcohol or plain sterile hot water or arnica, and often they will get along very well…..I have used it to my heart’s content, and found it not worth any more than any other preparation we have that is inert.

One researcher, at least, had an idea that Echinacea was operating on a deeper level, within the very workings of the body’s defense system. In 1915, V. von Unruh, M.D., in the National Eclectic Medical Association Quarterly, wrote an extensive article on his tuberculosis treatment, using a preparation of E. angustifolia and Inula helenium. The compound he used was a “special colloidal compound…and does not contain an excess of alcohol”. This is an interesting report for two reasons. Lloyd and others were in the habit of making Echinacea extract with a high percentage of alcohol. His recipe was 75% alcohol and 25% water added to dry root. Echafolta, his surgical preparation, was even higher in alcohol and had all the color, sugars, and starches removed. Today, after H. Wagner’s (of Munich, Germany) studies on natural products affecting immune function (1985), it is known that Echinacea contains water-soluble polysaccharides that strongly affect the immune system. Unruh’s preparation must have contained a much higher concentration of these polysaccharides than either of Lloyd’s preparations, “Specific Medicine Echinacea” or “Echafolta”. And yet, even these preparations were effective for a wide range of complaints. Notice, however, that Felter and Ellingwood stress its antiseptic and stimulating powers, which parallel that of Xanthoxylum, while Unruh stresses its power on the phagocytes. This question may be an important one, for even today there is much controversy about whether a low-alcohol or high-alcohol preparation is more effective. Although the official organizations and publications of the Regular, i.e. allopathic, doctors (Journal of the American Medical Association), criticized the use of Echinacea, as Lloyd’s study indicates, many used Echinacea in their practice, and some allopathic medical journals published articles favorable to Echinacea. Between 1891 and 1923, there were over a hundred published articles on this herb (Hobbs). It is fitting that the first published report on the chemical constituents of Echinacea was by John Uri Lloyd, in 1897. Before that time, 11 years after its introduction into general medical practice, little was known. References were made only that it was at first “sweet”, and then “acrid”. This in itself says something about its makeup, for we could surmise that the root might contain sugars and perhaps essential oil or resin, which it does. The methods of assay were crude, however, as was evidenced by Couch and Giltner’s study (1921a, 1921b). They had no idea at that time the rich depth of Echinacea’s chemical makeup and physiological activity. Despite the crude methods available to him, Lloyd was thorough in his investigation of E. angustifolia and submitted it to extensive tests. He also had the advantage of being thoroughly familiar with its nature, for he had been making pharmaceutical preparations from it for at least 10 years. After Lloyd, one of his students, S.H. Culter, worked on the analysis of Echinacea for several years, as his doctoral thesis, published in 1931. He provides the most complete account of what was known then, as well as a good summary of previous work. Other notable research was carried out in this country by Heyl and Staley, Heyl and Hart, Bischoff, Woods, and Martin Jacobson on the insecticidal and juvenile hormone activity of the essential oil. After the 1930s, most commercial preparation of Echinacea ceased, along with chemical investigations. The few exceptions are noted below. Meanwhile, beginning in the 1930s, the Germans, with their penchant for minute investigations became interested in Echinacea, and Gerhard Madaus, as well as others, published many studies over the next 55 years. After the prolific amount written about Echinacea over a 50-year period, it seems remarkable that after 1937 there is not one mention of it in the U. S. medical or pharmaceutical literature. Considering the usefulness of Echinacea today, it is fortunate that interest in it did not completely disappear. Rather it moved to Germany, where the flame, so to speak, has been carried for over 50 years. Today, as we are even more enamored with the prodigal son, our own native herb echinacea—so much so that it has become the number-one selling herb on the U.S. medicinal herb market. With a tremendous amount of new pharmacological and chemical research published on echinacea showing that it is indeed an effective immune stimulant, helping to protect one against colds, flu, and infections of all kinds, its future as a world phytopharmaceutical star seems assured.