Veratrum album, White Hellebore Veratrum nigrum, Li Lu 藜芦 Li Lu 藜芦 (TCM)

Ortus Sanitatis, Meydenbach, 1491

Veratrum album
Flora von Deutschland, Kohler, 1886

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.

The above suggests the traditional Western, Chinese and modern American sources to be largely synonymous in action.

Parts used:

Prepared Root and Rhizome (gathered in Autumn)
“The best variety of white hellebore is that which spreads moderately and is white in colour, easy to break, thin and voluminous in quantity.! t should not be severely irritant to the tongue immediately and produces saliva. But the White Hellebore, which causes irritation immediately, produces suffocation”. (Avicenna)
‘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)
“White Hellebore is Hot and Dry in the middle stage of the Third degree”. (Avicenna)

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)
-topically for Toothache

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, most often used externally.
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.
5. Avicenna gave this as a safe method of use: “one ratl (450 gm) of the same chopped Hellebore is soaked in two
qust (2700 ml) of rain water for three days. Then it is cooked till it is reduced to its one-third in quantity. The pieces of Hellebore should then be removed from the decoction and two ratl (900 gm) of pure and clean honey water be added to it. After being thickened it should be taken orally in one large spoonful either as it is or with tepid water. This is a very safe way of its use”.
6. “The next safe and harmless way of its use is to crush its peel, coarsely grind it and then mix it with Barley water to prevent its sticking to the throat and stomach”. (Avicenna)
7. “Another safe way of its use is to pulverize it and mix the powder with honey water”. (Avicenna)

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 [Epilepsy]’. (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)
11. Toothache, White Hellebore root, Iberis, Pyrethrum (equal parts), decoct in vinegar and use as a wash. (Pharmacopoeia Persica, 1681)

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)
4. “Excessive use of white hellebore is fatal for Human beings. It is a poison for the Dogs and Swines. Ingestion of the feces of the persons who have used it, kill Hens”. (Avicenna)

Antidotes:
1. “If, however, they exhibit convulsions and weakness [from its use], they should take bread soaked in wine or honey water”. (Avicenna)
2. Water Lily root or Parmsip root with Wormwood wine
3. Aniseed, Cumin, Indian Spikenard with wine
4. Theriac or Mithridate
5. For strangulation caused by taking White Hellebore, Galbanum (half dram) is commended. (De Venenis, Ramesey, 1663)

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)