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Veratrum album, White Hellebore

Veratrum nigrum, Li Lu 藜芦

Li Lu 藜芦 (TCM)
Picture
Picture
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Ortus Sanitatis, Meydenbach, 1491

Picture
Veratrum album
Flora von Deutschland
, Kohler, 1886

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Rhizome and rootlets of V.eratrum viride
Notes on Pharmacognosy
, Otto Augustus Wall, 1902
Botanical name:
Veratrum album
Other species used include:
  1. V. nigrum (TCM)
  2. V. schindleri (TCM)
  3. V. grandiflorum (TCM, Sichuan)
  4. V. rnaackii (TCM, NE China)
  5. V. taliense (TCM, Yunnan)
  6. V. japonicurn (TCM, Anhui, Zhejiang, Jiangxi, Taiwan, Guangxi, Guizhou, Yunnan)
  7. V. viride (US)
  8. V. lobelianum (US)

V. nigrum is used in TCM (called Li Lu). A local variety used for it is V. grandiflorum which is considered a variety of V. album. This suggests that V. album (–type) and V. nigrum are used interchangeably in TCM. In TCM Li Lu is principally used as an Emetic and to kill parasites and stop Itching.

Veratrum album was largely replaced by the American V. viride during the 19th century, the two being very similar in action: 'Veratrum viride Alton, a plant in every respect closely resembling V. album, of which it is one of the numerous forms. In fact, the green-coloured variety of the latter (V. Lobelianum Bernh.), a plant not uncommon in the mountain meadows of the Alps, comes so near to the American V. viride that we are unable to point out any important character by which the two can be separate'. (Pharmacographia, Fluckiger & Hanbury, 1879

Parts used:
Prepared Root and Rhizome (gathered in Autumn)
'Oblong tuberous Root, sometimes as thick as a thumb and thicker, of a brown color on the outside and white within, and full of white Fibres, disagreeable and nauseous taste'. (A Treatise on Foreign Drugs, Geoffroy and Thicknesse, 1749)
In some parts of China the whole herb is reportedly used.

Temperature & Taste:
Hot, dry. Bitter, pungent. Toxic (Considered Cold in TCM)

Classifications:
3O. EMETICS

Uses:
1. Purges Melancholy, Opens Obstructions:
-Madness, Mania, Frenzy, Insanity, Melancholy
-Hydrophobia
-Scrofula, Fibroids, Cancer

2. Settles Wind, Stops Spasms:
-Arrhythmia, Bradycardia
-Vertigo, Epilepsy, Apoplexy
-Nervousness
-Hypertension
-Rheumatism

3. Emetic:
-formerly used to induce vomiting (TCM, West)

4. Externally:
-principally as an Errhine to promote sneezing
-externally for various toxic skin conditions, especially with flaking and itchiness
-applied to the ear for Deafness
-Kills Parasites, Lice, Tinea, Scabies (TCM, West)


PREPARATION:
It is required to be prepared before internal use:
1. Usually steeped 24 hours in Vinegar and dried. This can be repeated 3 times to greatly reduce the toxic principles.
2. Some prepared it as Black Hellebore and steeped it in Quince juice for 3 days, then drying.
3. In TCM it has been recommended to lightly dry-fry the root before use.
4. Some impregnated water with a little Sulphuric acid (just to give it a sour taste), then steep the roots in for 24 hours, then drying, and repeating this 3 times. The acid corrects the emetic quality of the root.

DOSE:
1. Rarely used internally today, more often used externally, even in the past.
2. Always begin with smaller doses, increasing as needed.
3. Most commonly used in pills, powders or tinctures.
4. Avicenna said before using White Hellebore the patient should take something like Chicken soup, Syrup of Hyssop with Mint, Rue, Lentil, aromatic oils etc. He said those is poor health were especially liable to siuffer from 'suffocation' if it is taken on an empty stomach.
Of the Prepared Veratrum nigrum Root: 100–150mg (TCM)
From 1 grain (65mg), gradually increased up to 24 grains has been recommended in the West.
Infusion (usually in White Wine): ½ scruple–½ dram for Melancholy, Madness etc.

American Veratrum viride:
Fluid Extract: 1–4 mls.;
Tincture (1:5): 5–20 drops.

SUBSTITUTE:
1. Elaterium
2. Turpeth

COMMENT:
1. 'With this root have ancient Physicians done great marvels, and have had many strange opinions of it, that it should strengthen memory, sharpen the wit, and should be very commodious against the falling sickness'. (Wirtzung)
2. Hiera Logadii, the famous medicine used for obstinate diseases of the Brain and Nerves, including Mental illness, is a good example of how it could be used internally. Only 6 grains are added to over 25 drams in formula.

Main Combinations:
1. Melancholy, Madness, Mania, prepare an infusion of Senna (½ oz.) in White Wine (½ pint); strain and add prepared White Hellebore root (½ scruple–½ dram). Take as a dose every morning. (Pharmacopeia Bateana)
2. Mania, Lunacy, Epilepsy, Fearful, prepared White Hellebore root with Amber, Storax, Galbanum, Myrrh, Dragons Blood, Veronica, Musk (equal parts) prepared into an Electuary with Honey. (as in Antidote Proven for Diverse Diseases of Nicholas)
3.
Madness, Melancholy, Anger, Dizziness, Vertigo, Epilepsy, Headache, Migraine, Trigeminal Neuralgia, Paralysis, Parkinsonism: prepared White Hellebore root with Colocynth, Euphorbium, Poley Montane, Wormwood, Myrrh, Agaric, Indian Spikenard, Aloe, Cinnamon, Saffron (as in Hiera Logadii)
4. Polycrest Pills: prepared White Hellebore root with Opium, Licorice, Black Hellebore (1 oz. each), Soap (3 oz.). Dose: 3 grains, gradually increased. (Pharmacopoeia Generalis, 1783)
5. To promote Menstruation (formerly), prepared White Hellebore root with Gentian, Colocynth and Nigella (Wirtzung)
6. Scrofula, Neck Lumps, prepared White Hellebore root with Sponge burnt, Sea Balls burnt, Cuttlefish bone, Long Pepper, Black Pepper, Ginger, Cinnamon, Rock Salt, Pellitory, Gall, Pumice (as in Powder for Scrofula)
7. To promote Sneezing:
i. White Hellebore root with Orris root
ii. Asarum leaf (24 parts), White Hellebore root (1 part)
iii. Euphorbium (1 dram), White Hellebore root (4 scruples) (Memorial Pharmaceutique, 1824)
iv. White Hellebore root with Marjoram, Betony, Pyrethrum, Black Hellebore, Pennyroyal
8. Eczema and Psoriasis:
i. Prepared Black and White Hellebore, Sulphur, Vitriol, Litharge, unslaked Lime, Aloe, Galls, Chimney soot, Wood ashes (½ oz. each), Verdigris (quarter oz.); then take Juice of Borage, Scabious, Fumitory, Dock root (2 oz. each), mix with Olive oil and Vinegar (3 oz. each); seethe over a fire for half an hour, add the others in powder, then add Turpentine (1 oz.) and Wax, sufficient to make an ointment. (Wirtzung)
9. Lice, prepare an Ointment White Hellebore root with Stavesacre seed; Tobacco may be added.
10. Deafness, White Hellebore, Saffron, Salt Peter, Castoreum (1 dram each), Vinegar, Honey (1 oz. each). Boil, strain. To use, dip a lock of wool  into the warm decoction and apply warm. (The Secrets of Alexis, 1615)

Major Formulas:
Hiera Logadii
Powder for Scrofula (Bononiense)


Cautions:
1. Very Toxic. Strictly avoid overdose. Avoid full doses initially, beginning with minimum dose and increasing if needed.
2. Not used in marked debility, the very young, the old, or during Pregnancy.
3. 'White Hellebore is cathartic and emetic, but extremely violent in its Operation, producing great Uneasiness and Anxiety; and is therefore never given inwardly in the present Practice'. (A Treatise on Foreign Drugs, Geoffroy and Thicknesse, 1749)

INCOMPATIBILITIES:
According to traditional TCM texts, Veratrum is incompatible with:
1. Asarum Xi Xin,
2.
Paeonia Bai Shao and Paeonia Chi Shao
3. Ginseng Ren Shen
4.
Glehnia Bei Sha Shen and Adenophorae Nan Sha Shen
5.
Scrophularia Xuan Shen
6.
Sophorae Ku Shen

TOXICITY
Very Toxic. Side effects and vomiting can be experienced with therapeutic doses. Individual tolerance may vary.
Doses of less than 1 gram have reportedly caused fatality, Bensky reporting a fatal dose even at 600mg. Generally no longer used internally.

Main Preparations used:
Decoction, Tincture, Vinegar, Honey, Ointment

1. Decoction of White Hellebore
  Chopped White Hellebore (450 grams) is soaked for 3 days in 2700mls of rain water. Then it is boiled down to one-third (900mls). The Hellebore is removed and 900mls of Honey Water is added, and this is boiled until thick. 
'This is a very safe way of its use'.
Dose: 1 spoonful. (Avicenna)

2. Tincture of White Hellebore:
i. White Hellebore root, bruised (8 oz.), Proof Spirit (1½ lb.)

3. Vinegar of White Hellebore:
i. White Hellebore root (1 dram), Vinegar (20 oz.). Boil, strain. Used in Mania. Dose: a spoonful every 2 or 3 hours. (Niemann)

4. Honey of White Hellebore:
i. White Hellebore dried (1 lb.), Steep in 14 oz. water for 3 days; gently boil to half; strain, and with 3 lbs. of Honey, gently boil to the thickness of Honey. Used for Melancholy, Frenzy, Madness, Edema, Epilepsy etc. Dose: 1–2 drams in Senna decoction. (Salmon)

5. Ointment of White Hellebore:
i. Powdered White Hellebore root (2 oz.), prepared Lard (8 oz.), Oil of Lemon (20 drops). Mix. (London)

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