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Two species of echinacea are primary remedies for fighting infections

Echinacea

Echinacea purpurea / E. angustifolia

Asteraceae

During the early 20th century, echinacea was the most popular remedy in the USA for managing infections and was only eclipsed by the arrival of antibiotics after the Second World War.

Last reviewed 12/08/2020

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Key benefits
  • Prevention against upper respiratory infections
  • Persistent and chronic infections
  • Wound healing
  • As a mouthwash

  • How does it feel?

    Echinacea remedies come in many different forms, with two dominant species, a third (E. pallida) and others sometimes encountered, as well as significant levels of adulteration with completely different plants. It is very important first to locate a reputable supplier with a defined product. Then having been assured that the echinacea is of good quality there will still be a range of forms and tastes to encounter. In North American tradition the benchmark was provided by the root of Echinacea angustifolia, as this has the strongest characteristic ‘tingle’ effect, but it is also harder to grow in commercial quantities. Particularly in Europe the leaves and aerial parts of Echinacea purpurea are most common; the root of that species is the most widely sold worldwide.

    To get the strongest impact try to obtain a product made from E. angustifolia root. The effect of even a small taste is dramatic! The first impact is fiery, a quick very sharp astringency that covers all surfaces of the mouth, even the lips. There follow waves of sour and bitter tingling, and a very persistent long acrid, dry astringent aftertaste, leading to reflex increased salivation.

    With E. purpurea aerial parts the taste is gentler, initially sweet, then some bitterness and a little tingling and astringency. The root of E purpurea will be somewhere in between.

    The tingling effect is produced by alkylamides, the subtle sweetness by polysaccharides. Both have been implicated in helping to improve the body’s defences.

    Echinacea (Echinacea purpurea)
    Echinacea (Echinacea purpurea)

  • What can I use it for?

    Echinacea (Echinacea angustifolia)
    Echinacea (Echinacea angustifolia)

    Use echinacea as a preventative if you are prone to upper respiratory problems like frequent colds, sore throats, sinuses, middle ear pain, or viral infections like flu.

    Echinacea is the herbal practitioner’s favourite for any infectious condition, where it is seen to support balanced immune responses, including moderating over-reactions (the idea that it could worsen auto-immune problems for example is based on a misunderstanding of its activity). Importantly however infections should be treated with due respect and echinacea should not be a substitute for expert medical help: consider it a great complement to frontline conventional treatments, becoming more important the more infections keep coming back or are resistant to standard antibiotic and other prescriptions

    It has local action in other areas, and a brilliant mouth wash for any inflammation in the mouth, throat and gums. It is a useful remedy applied externally to boils, carbuncles and abscesses, and as a . douche for vaginal infections.

  • Into the heart of echinacea

    Echinacea (Echinacea purpurea)
    Echinacea (Echinacea purpurea)

    Echinacea is best understood as defending from the outside in, supporting immune functions and reducing inflammation and infection by mobilising defences on mucosal surfaces.

    It contains constituents known as isobutylamides, which are types of alkylamides. They act as insecticide defences for the plant and are found particularly in the roots. They can be clearly identified when good echinacea is tasted, as they create a ‘tingling’ or numbing effect upon the tongue. From laboratory studies it appears they may directly influence inflammatory cytokine production among defensive white blood cells found close to mucosal surfaces. Among other possible mechanisms they activate a type of cannabinoid receptor (CB2) that is involved in immune and inflammatory modulation.

    Echinacea is considered as one of the primary remedies for assisting the body in clearing infection and strengthening the overall efficiency of the immune system. Echinacea reduces the severity and duration of symptoms, whilst also helping the body to deal with infection and stimulate the immune response. It will effectively target microbial, bacterial and viral infections throughout the body, but has a specific focus within the upper respiratory system and in conditions such as cold and flu, tonsillitis and laryngitis.

    Echinacea is effective where immune system has become compromised by being ‘run-down’ as a result of stress or over-work.

  • Traditional uses

    Echinacea (Echinacea purpurea)
    Echinacea (Echinacea purpurea)

    The roots of echinacea comes with a formidable reputation from the annals of the settler tradition in North America, with one writer M.R Gilmore observing the native population using it as a “remedy for more ailments than any other plant” and others reporting in often rapturous tones their own experiences with the remedy. In particular it was recommended for the bites of snakes and other venomous creatures (to the extent that one researcher publicly volunteered to allow himself to be bitten by rattlesnakes to prove the point to his colleagues!), and for infected and poisonous conditions generally, to treat burns and wounds, and for toothache and sore throats. Septic problems were widely treated with nothing more than echinacea, and most herbalists of the day would go far to ensure a good supply.

    The Native Americans, and the 19th century ‘Eclectic’ physicians who adopted their use of echinacea, preferred E. angustifolia root, which is high in alkylamides that impart a persistent tingling sensation in the mouth and stimulate the flow of saliva, long used as a sign of good quality (and likely to be a key part of the echinacea reputation).

    The world-wide reputation of echinacea was cemented when the German homoeopathic physician Dr Madaus visited the USA in the 1930’s and observed that it was the most popular home remedy for infections across the country. Probably because of the difficulty of mass cultivation of Echinacea angustifolia, he created a new prescription medicine from using the aerial parts of E. purpurea.

  • Traditional actions

    Herbal actions describe therapeutic changes that occur in the body in response to taking a herb. These actions are used to express how a herb physiologically influences cells, tissues, organs or systems. Clinical observations are traditionally what have defined these actions: an increase in urine output, diuretic; improved wound healing, vulnerary; or a reduction in fever, antipyretic. These descriptors too have become a means to group herbs by their effects on the body — herbs with a nervine action have become the nervines, herbs with a bitter action are the bitters. Recognising herbs as members of these groups provides a preliminary familiarity with their mechanisms from which to then develop an understanding of their affinities and nuance and discern their clinical significance.

    Western actions

  • Traditional energetic actions

    Herbal energetics are the descriptions Herbalists have given to plants, mushrooms, lichens, foods, and some minerals based on the direct experience of how they taste, feel, and work in the body. All traditional health systems use these principles to explain how the environment we live in and absorb, impacts our health. Find out more about traditional energetic actions in our article “An introduction to herbal energetics“.

  • What practitioners say

    Echinacea (Echinacea purpurea)
    Echinacea (Echinacea purpurea)

    Upper respiratory

    Use to fend off tendencies to cold, flu, tonsillitis, pharyngitis, laryngitis, general mucous and sinus congestion. The immune stimulating properties of echinacea are focussed on throat surfaces and immediately underlying lymphatic tissues, which is where most upper respiratory battles are waged.

    Immune

    Echinacea works mainly in innate immunity (rather than the acquired immunity of antibody production) and is appropriate for any acute and chronic infections, whether due to bacterial, viral, protozoal or other organisms. It is likely to be particularly effective in infections on or near accessible surfaces, including the upper gut wall, though has also been used to modulate immune responses including in moderating allergies and hypersensitivity reactions.

    External uses

    Echinacea is especially effective as a mouth wash for gum disease where the tingle factor from the alkylamides is most valued. It has traditionally been used to bathe infected and open wounds, bites or poisonous attack, especially when healing is impaired. It has also been used for hot and irritated skin conditions such as eczema and psoriasis, and as a douche for vaginal infections.

  • Research

    Because of the European adoption of the aerial parts of Echinacea purpurea the evidence base is largely linked to this version. For example a Cochrane review pointed marginally in favour of Echinacea purpurea  aerial parts: “Our exploratory meta-analyses suggest that at least some Echinacea preparations may reduce the relative risk of catching a cold by 10% to 20%.

    A risk reduction of 15% would mean that if 500 out of 1000 persons receiving a placebo would catch a cold this figure would be 425 of 1000 persons with an echinacea product. This is clearly a small effect of unclear clinical relevance. This review points out a familiar complaint among reviewers of the evidence: that they could not well distinguish between echinacea products (2).  An earlier (more positive) Cochrane review by some of the same authors had pointed in favour of Echinacea purpurea aerial parts (3). However, a later meta-analysis by other reviewers also did not differentiate between echinacea preparations (4).

  • Did you know?

    The name ‘echinacea’ is derived from the Greek word ‘echino’ which means ‘sea urchin’ or ‘hedgehog’. This was chosen because it aptly described the spiny central disc of the echinacea flowers. Traditionally, echinacea was used in Native American medical traditions to treat snake bites and blood poisoning.

Additional information

  • Botanical description

    Echinacea purpurea is a perennial growing up to 2 metres high with simple rough stems, hollow near the base and thickening slightly close to the flowerhead. The leaves are broad, ovate to ovate-lanceolate and often toothed, covered in coarse hairs and protruberances, stalked at ground level and almost sessile up the stem. The flower is in the form of a high purple cone surrounded by roughly hairy bracts and then short spreading purple, crimson, pink or white ray florets. E. angustifolia is smaller and the leaves are more more elongated, slightly elliptical with entire margins; it has relatively straight ray florets.

    Both species are native to eastern and central North America where they commonly grow in moist to dry woodlands or prairies. This plant is now cultivated across the globe for both medicinal and horticultural purposes. Echinacea angustifolia is threatened in the wild and harder to grow than E. purpurea.

    Alternate botanical names:

    Echinacea pallida (Nutt) Britt is a separate species that has sometimes been confused with E. angustifolia (and has been seen as the parent species in some classifications). It is likely to have less efficacy than the other two species.

  • Common names

    • Echinacea
    • Rudbeckia
    • Snakeroot
    • Broad-leaved purple cone flower
    • Narrow-leafed purple cone flower

  • Safety

    Safe for most people, including those with immune problems, though wise to avoid if on strong immunosuppressive prescriptions.

    Echinacea is in the Asteracea plant family, and occasionally people exhibit allergic reactions to plants in this family (including daisies and chamomile). If a child has a known allergy to this plant then it is best to avoid giving them echinacea.

    In 2012 a warning was issued by the MHRA that as a precautionary measure the remedy echinacea should not be given to children under 12 years old, due to a small risk of a severe allergic reaction which outweighed any benefits (5). However, since this time there has been research demonstrating the significant benefits of echinacea for children in reducing RTI’s and subsequent antibiotic use with minimal allergic reactions within the study group (6). This was based on a specific extract of echinacea, but suggests that unless there is a specific known allergy to this plant family then echinacea can have many benefits to children’s immunity.

  • Dosage

    1g-3 g of the root per day.

  • Constituents

    • Alkylamides (alkamides) incl. isobutylamides
    • Caffeic acid derivatives echinacoside and cynarin (E. angustifolia); chicoric acid (E. purpurea)
    • Polysaccharide ‘echinacin’ (although identification and consistency of various polysaccharides not clear)
    • Polyacetylenes: incl. echinalone in (E. purpurea)
    • Essential oil (trace)

    Of these constituents there is evidence for immunological activity of the polysaccharides though as these are quickly broken down on digestion such activity will be confined to surface defences in the mouth and throat. Most interest recently has been in the activity (1) of the alkylamides, in modulating the activity of cannabinoid receptors (CB2) which have immune-modulating activity. The alkylamides, especially the isobutylamides have a characteristic tingling effect in the mouth and have long been considered a mark of quality of echinacea and are particularly prominent in E. angustifolia. Caffeic acid derivatives from the latter have also shown antihyaluronidase activity: hyaluronidase is an enzyme that some infective bacteria use to penetrate mucosal surfaces.

Echinacea illustration

  • Recipe

    Elderberry & Echinacea Winter Warmer tea

    This ‘Elderberry & Echinacea Winter Warmer’ tea targets the cause of seasonal infections by strengthening both short- and long-term immunity.

    Ingredients:

    • Echinacea root 2g
    • Elderberry 2g
    • Elderflower 2g
    • Rosehip 2g
    • Peppermint leaf 2g
    • Orange peel 2g
    • Aniseed 1g
    • Ginger root powder 1g
    • Licorice root 1g
    • Orange essential oil a drop per cup

    Method:

    Put all of the ingredients (except for the orange essential oil) in a pot.
    Add 500ml/18fl oz freshly boiled filtered water.
    Leave to steep for 10–15 minutes, then strain.
    Add a drop of orange essential oil to each cup.

    This will serve 2-3 cups of good health

    This recipe is from the book Cleanse, Nurture, Restore by Sebastian Pole

  • References

    1. Gertsch J. (2008) Immunomodulatory lipids in plants: plant fatty acid amides and the human endocannabinoid system. Planta Med. 74(6): 638-650
    2. Karsch-Völk M, Barrett B, Kiefer D, et al. (2014) Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2(2): CD000530.
    3. Linde K, Barrett B, Wölkart K, et al. (2006)  Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2006;(1):CD000530
    4. David S, Cunningham R. (2019) Echinacea for the prevention and treatment of upper respiratory tract infections: A systematic review and meta-analysis. Complement Ther Med. 44: 18–26
    5. Pizzorno J, Murray M, Joiner-Bey H, The Clinician’s Handbook of Natural Medicine. 2nded. St Loius, Missouri: Churchill Livingstone Elsevier; 2008.
    6. F, Paparo L, Nocerino R. et al. Specific gut microbiome signatures and the associated pro-inflamatory functions are linked to pediatric allergy and acquisition of immune tolerance. Nat Commun, 12:5958;2021. https://doi.org/10.1038/s41467-021-26266-z

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Cold and flu

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Aromatic
An ‘aromatic’ remedy, high in volatile essential oils, was most often associated with calming and sometimes ‘warming’ the digestion. Most kitchen spices and herbs have this quality: they were used both as flavouring and to ease the digestion of sometimes challenging pre-industrial foods. Many aromatics are classed as ‘carminatives’ and are used to reduce colic, bloating and agitated digestion. They also often feature in respiratory remedies for colds, chest and other airway infections. They are also classic calming inhalants and massage oils, and are the basis of aromatherapy for their mental benefits.
Astringent
The astringent taste you get with many plants (the most familiar is black tea after being stewed too long, or some red wines) is produced by complex polyphenols such as tannins. Tannins are used in concentrated form (eg from oak bark) to make leather from animal skins. The process of ‘tanning’ involves the coagulation of relatively fluid proteins in living tissues into tight clotted fibres (similar to the process of boiling an egg). Tannins in effect turn exposed surfaces on the body into leather. In the case of the lining of mouth and upper digestive tract this is only temporary as new mucosa are replenished, but in the meantime can calm inflamed or irritated surfaces. In the case of open wounds tannins can be a life-saver – when strong (as in the bark of broadleaved trees) they can seal a damaged surface. One group of tannins, the reddish-brown ‘condensed tannins’ are procyanidins, which can reduce inflammation and oxidative damage.
Bitter
Bitters are a very complex group of phytochemicals that stimulate the bitter receptors in the mouth. They were some of the most valuable remedies in ancient medicine. They were experienced as stimulating appetite and switching on a wide range of key digestive functions, including increasing bile clearance from the liver (as bile is a key factor in bowel health this can be translated into improving bowel functions and the microbiome). Many of these reputations are being supported by new research on the role of bitter receptors in the mouth and elsewhere round the body. Bitters were also seen as ‘cooling’ reducing the intensity of some fevers and inflammatory diseases.
Cooling
Traditional ‘cold’ or cooling’ remedies often contain bitter phytonutrients such a iridoids (gentian), sesiquterpenes (chamomile), anthraquinones (rhubarb root), mucilages (marshmallow), some alkaloids and flavonoids. They tend to influence the digestive system, liver and kidneys. Cooling herbs do just that; they diffuse, drain and clear heat from areas of inflammation, redness and irritation. Sweet, bitter and astringent herbs tend to be cooling.
Hot
Traditional ‘hot’ or ‘heating’ remedies, often containing spice ingredients like capsaicin, the gingerols (ginger), piperine (black or long pepper), curcumin (turmeric) or the sulfurous isothiocyanates from mustard, horseradich or wasabi, generate warmth when taken. In modern times this might translate as thermogenic and circulatory stimulant effects. There is evidence of improved tissue blood flow with such remedies: this would lead to a reduction in build-up of metabolites and tissue damage. Heating remedies were used to counter the impact of cold, reducing any symptoms made worse in the cold. .
Mucilaginous
Mucilages are complex carbohydrate based plant constituents with a slimy or ‘unctuous’ feel especially when chewed or macerated in water. Their effect is due simply to their physical coating exposed surfaces. From prehistory they were most often used as wound remedies for their soothing and healing effects on damaged tissues. Nowadays they are used more for these effects on the digestive lining, from the throat to the stomach, where they can relieve irritation and inflammation such as pharyngitis and gastritis. Some of the prominent mucilaginous remedies like slippery elm, aloe vera and the seaweeds can be used as physical buffers to reduce the harm and pain caused by reflux of excess stomach acid. Mucilages are also widely used to reduce dry coughing. Here the effect seems to be by reflex through embryonic nerve connections: reduced signals from the upper digestive wall appear to translate as reduced activity of airway muscles and increased activity of airway mucus cells. Some seed mucilages, such as in psyllium seed, flaxseed (linseed) or guar bean survive digestion to provide bulking laxative effects in the bowel. These can also reduce rate of absorption of sugar and cholesterol. .
Pungent
The pungent flavour refers to the powerful taste of hot spices including mustard (Brassica spp.), ginger (Zingiber officinale), horseradish (Amoracia rusticana), chilli (Capsicum spp.), and garlic (Allium sativum). These herbs act to enliven and invigorate the senses, and they often also have heating qualities. Unlike other tastes, the effect is not linked to a specific receptor on the tongue and instead acts through direct irritation of tissues and nerve endings. Energetically, pungent herbs are known to disperse energy (qi) throughout the body. Pharmacologically, pungent herbs dry excess moisture and mucus, as well as stimulate digestion and metabolism.
Resinous
Resins are most familiar as tacky discharges from pine trees (and as the substance in amber, and rosin for violin bows). They were most valued however as the basis of ancient commodities like frankincense and myrrh (two of the three gifts of the Three Wise Men to the baby Jesus) and getting access to their source was one benefit to Solomon for marrying the Queen of Sheba (now Ethiopia). Resins were the original antiseptic remedies, ground and applied as powders or pastes to wounds or inflamed tissues, and were also used for mummification. With alcohol distillation it was found that they could be dissolved in 90% alcohol and in this form they remain a most powerful mouthwash and gargle, for infected sore throats and gum disease. They never attracted much early research interest because they permanently coat expensive glassware! For use in the mouth, gums and throat hey are best combined with concentrated licorice extracts to keep the resins in suspension and add extra soothing properties. It appears that they work both as local antiseptics and by stimulating white blood cell activity under the mucosal surface. They feel extremely effective!
Salty
The salty flavour is immediately distinctive. A grain dropped onto the tongue is instantly moistening and a sprinkle on food enkindles digestion. This easily recognisable flavour has its receptors right at the front of the tongue. The salty flavor creates moisture and heat, a sinking and heavy effect which is very grounding for the nervous system and encourages stability. People who are solid and reliable become known as ‘the salt of the earth'.
Sharp
The sharp taste of some fruits, and almost all unripe fruits, as well as vinegar and fermented foods, is produced by weak acids (the taste is generated by H+ ions from acids stimulating the sour taste buds). Sour taste buds are hard-wired to generate immediate reflex responses elsewhere in the body. Anyone who likes the refreshing taste of lemon or other citrus in the morning will know that one reflex effect is increased saliva production. Other effects are subjective rather than confirmed by research but there is a consistent view that they include increased digestive activity and contraction of the gallbladder.
Sour
The sour taste occurs because of the stimulation of hydrogen ions which trigger the sour taste receptors on the tongue. The more acidic a substance, the more hydrogen ions will be released. The sour taste comes from acidic substances including citrus, fermented foods, tannins, and vinegars. Sour foods and herbs absorb excess moisture, whilst also increasing the production of saliva. Energetically, sour substances tonify the lungs, playing a role in disease prevention. Excessive use, however, can result in malabsorption of nutrients. Examples of sour herbs include, rosehips (Rosa canina), raspberry (Rubus idaeus), rhubarb (Rheum palmatum), schisandra (Schisandra chinensis), hawthorn (Crataegus monogyna) and ginkgo (Ginkgo biloba).
Sweet
In the days when most people never tasted sugar, ‘sweetness’ was associated with the taste of basic foods: that of cooked vegetables, cereals and meat. In other words sweet was the quality of nourishment, and ‘tonic’ remedies. Describing a remedy as sweet generally led to that remedy being used in convalescence or recovery from illness. Interestingly, the plant constituents most often found in classic tonics like licorice, ginseng are plant steroids including saponins, which also have a sweet taste.
Umami
The umami taste was originally discovered in 1985 in Japan and is directly translated from the Japanese as a ‘pleasant savoury taste’. It is referred to as the ‘fifth taste’ and is a salty, rich, and meaty flavour. The umami flavour is produced by amino acids (glutamic acid and aspartic acid) found in many food and plant sources including tomatoes, mushrooms, seaweeds and soy-based foods. Umami foods can improve nutritional absorption and digestion as there are also umami receptors in the gut as well as the mouth. Examples of umami herbs include green tea (Camellia sinensis), reishi (Ganoderma lucidum), nettle (Urtica dioica), cordyceps (Ophiocordyceps sinensis), shitake (Lentinula edodes) and bladderwrack (Fucus vesiculosus).

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