Petasites for Pain and Inflammation

Jillian Stansbury, ND

The Petasites genus comprises 15 to 20 species, and all have been used to treat pain, inflammation, and allergic hyperreactivity. Petasites species are large-leaved, moisture-loving plants native to temperate woodlands of northern Asia, Europe, and North America. They are sometimes referred to by the general name sweet coltsfoot because of similarity to Tussilago. Petasites are in the Senecioneae tribe of the Asteraceae family. Petasites hybridus, the most common Petasites species in the United States, goes by the common name butterbur, reportedly because the large leaves were convenient to wrap and preserve fresh butter in root cellars of pioneer farms. Petasites japonicus is found in Asia and is known as fuki in Japan and as giant butterbur and bog rhubarb in English-speaking locales where it has been introduced. Petasites frigidus grows in seasonal streambeds of the Pacific Northwest.

I have chosen to feature Petasites herein because its pain-relieving effects are often overlooked. In the modern era, medical conferences devoted entirely to Petasites have convened in Switzerland (such as one in March 1996) for scientists to share their research on the plant. I first started using Petasites for difficult types of pain such as that in patients with terminal cancer and for bone metastasis, as suggested by R. F. Weiss in his book Herbal Medication.1 Anecdotally, I have found that Petasites is helpful in reducing the need for other pharmaceuticals and sedatives, which in many cases may cause patients with terminal illness to spend their last months heavily sedated, if not asleep and unable to spend time with their families. While you will not find published studies on Petasites for cancer or general pain, numerous investigations have been performed on the plant’s anti-inflammatory, antiallergy, and antispasmodic effects, all possible contributors to an anodyne action. Petasites seems most specific for pain of the vasculature and for other smooth muscle spasms in hollow organs such as the bronchi and, to a lesser extent, the ureters and possibly the bladder.

Etymology and Ethnobotanical History

The word Petasites may derive from the Greek petasos, referring to a hat of the variety that the Greek god Mercury is usually pictured wearing. Because of the large, almost umbrellalike leaves, Petasites indeed may have come in handy as a hat.

Both the leaves and the roots of Petasites species are used as medicines, with the roots reported to have stronger antispasmodic effects. Petasites has been used as a general anodyne in both European and Asian folklore and is reported to be useful for asthma, allergies, hypertension, chest pain, migraine, vascular pain, and pain due to ulcers. Petasites was reportedly used during the Middle Ages for symptoms of the plague. Petasites is consumed as a vegetable in Japan, where folklore associates its intake with antiallergy and anti-inflammatory effects. The young spring stalks and growth are soaked in ashes or baking soda water to reduce the astringency, and they are then sliced and stir-fried with miso and spices to prepare a condiment to serve with soups and rice.

An overview of the constituents of Petasites is given in the Table. Also included are some of its folkloric indications.

Anodyne Mechanisms of Action

The butterbur plant, P hybridus, has been used for centuries for all manner of painful and inflammatory conditions and has been found to be anti-inflammatory by numerous mechanisms. Petasites inhibits cyclooxygenase and inflammatory prostaglandin and may inhibit the formation of inflammatory leukotrienes12; in particular, Petasites administration has been noted to induce the formation of peptidoleukotrienes released from macrophages. Animal models of asthma have shown P japonicus to inhibit the release of interleukins and tumor necrosis factor, without evidence of cytotoxicity.13 Petasites has also been shown to have effects on mast cells, with 1000 mg/kg reducing the release of histamine and leukotrienes from mast cells in animal investigations, as well as decreasing airway constriction typically induced by these substances.14

It has been proposed that Petasites may reduce general oxidative stress in the body by normalizing blood lipid levels and upregulating liver detoxification pathways. Petasites has been shown to support the antioxidant enzyme systems of the liver, including glutathione reductase, peroxidase, and transferases.15 Furthermore, Petasites reduced total cholesterol and low-density lipoprotein cholesterol levels and contributed to normalizing blood lipid profiles.15 By helping to reduce oxidative stress, Petasites can have neuroprotective and antiseizural effects.16,17

Petasites hybridus has a long history of use for migraine headaches, and more recent research shows that Petasites may reduce inappropriate vasoconstriction via a mechanism that involves blocking calcium-gated channels in the vasculature.18-22 Petasites may also relax bronchoconstriction via activity at muscarinic sites14,23 and may reduce corticosterone release from the adrenal gland and inhibit cyclic adenosine monophosphate–driven enzyme activation, serving to deter contraction of smooth muscles.24,25 Animal studies18,19 have shown Petasites to reduce excessive contractility in heart muscle fibers due to the effects of S-petasin on intracellular calcium. In effect, Petasites could be considered a negative chronotropic and inotropic agent, in contrast to cardiac glycosides, which are positive inotropic and chronotropic agents. While cardiac glycosides such as Digitalis and Convallaria are indicated for heart failure, Petasites might be considered for hypertension, excessive vasoconstriction, and tachyarrhythmias and excitability. Asthma is improved by a similar mechanism, relaxing the smooth muscle of the airways via calcium channel inhibition. This also suggests that Petasites may be contraindicated in patients with cardiomyopathy; however, some of the folkloric literature indicates the plant may be cardiotonic, and no adverse effects on the heart have been reported in any modern clinical trials to date.

Petasites for Migraines and Chronic Headaches

Several reviews of almost 300 research studies on various alternative nonsteroidal therapies for patients with migraine rate Petasites as a top-tier effective natural option for reducing the frequency and severity of migraine headaches.26-29 Several human clinical trials have demonstrated the efficacy of Petasites for migraine prevention. A randomized placebo-controlled trial30 showed that Petasites root extracts (dosed at 25 mg twice daily) reduced migraine frequency by 45% in 4 weeks among those receiving the verum and by 15% among those receiving placebo. A similar study31 among adults with chronic headaches reported a 48% reduction in headaches with a 75-mg twice daily dosage of Petasites root in 4 months’ time. In another study32 of Petasites for children and adolescents experiencing chronic headaches, 91% of participants reported some improvement after 4 months of treatment, and 77% demonstrated a 50% reduction in migraine attacks. The most common adverse effect reported was eructations, and no adverse events were serious.

Petasites and Allergic Airway Diseases

Petasites has numerous antiallergy effects, explaining the folkloric use of the plants for asthma, spastic cough, and airway reactivity. Leukotriene synthesis in eosinophils and neutrophils is inhibited, while elevated eosinophil and blood nitric oxide levels are reduced. Petasites also inhibits cyclooxygenase, an enzyme involved in the synthesis of inflammatory prostaglandins. Petasites japonicus reduces leukotriene and histamine-induced bronchoconstriction.

One clinical trial33 reported that Petasites alleviated symptoms of allergic rhinitis in a manner equal to antihistamine pharmaceutical agents, and another clinical trial34 showed a statistically significant reduction in symptoms of allergic rhinitis compared with placebo in as little as 7 days. Another human clinical study35 showed that Petasites (50 mg) for just 1 week reduced the symptoms of allergic rhinitis equivalent to the prescription medicine fexofenadine hydrochloride.

A small clinical trial36 of patients with asthma reported that P hybridus root extracts reduced the severity, frequency, and duration of asthma attacks. Among those using asthma medications and inhalers, 40% of study participants required less medication at the end of the 2-month study compared with baseline, and improved spirometry readings were demonstrated. A review of clinical trials on Petasites suggests efficacy for allergy and asthma,37 which warrants further investigation.

Petasites, Pyrrolizidine Alkaloids, and Hepatotoxicity

As is the case with other plants noted to contain pyrrolizidine alkaloids, P hybridus may have hepatotoxic effects. Many plants of the Senecioneae tribe of the Asteraceae family are noted to contain pyrrolizidine alkaloids, which are highest in the stalks and rhizomes and lowest in the leaves. Products prepared by a quality laboratory are recommended to ensure that the pyrrolizidine alkaloids do not become abnormally elevated.

One study38 of P hybridus showed no signs of hepatocellular toxic effects at serum levels of 69 ng/mL, a typical blood level with normal dosing. At 200 times this dosage, transient elevations in liver bilirubin and transaminases can be observed, which then return to normal when the overdosing is withdrawn. Any potential liver irritation has been credited to petasin, which is thought to impair bile acid transport and liver and protein metabolism, but only at therapeutic dosages that are significantly above normal.

Formulas for Conditions That May Respond to Petasites

Migraine and Chronic Head Pain

To reduce the frequency and severity of migraine and chronic headaches, a formula such as the following should be used: Petasites (25 mL), Tanacetum (15 mL), Curcuma (10 mL), and Hypericum (10 mL).

Vascular Spasm Due to Inflammation

A formula such as the following may help allay spasm pain due to tumors and vascular inflammation: Petasites (15 mL), Aesculus (15 mL), Angelica (15 mL), and Salvia miltiorrhiza (15 mL).

Acute Anginal Coronary Spasm

Petasites may be helpful for acute and episodic use in the treatment of angina, but circulatory-enhancing agents and cardiac glycosides such as Convallaria may be superior for long-term trophorestorative and supportive therapy in patients with heart failure. The following formula may be used for acute anginal coronary spasm (2 teaspoons every 5 minutes, reducing as symptoms improve): Petasites (20 mL), Lobelia (20 mL), Gingko (10 mL), Allium (8 mL), and Mentha essential oil (2 mL).

Acute Chest Pain and Tightness

Wheezing and a tight heavy sensation in the chest will often respond to the following formula, which is best used acutely with a separate protocol in place to help reduce allergic hyperreactivity via diet, antioxidant supplements, and long-term herbal therapies: Lobelia (18 mL), Petasites (18 mL), Angelica (10 mL), Gingko (10 mL), and Eucalyptus essential oil (4 mL).

Acute Spastic Cough

For cough-variant asthma and for spastic coughing due to infections and bronchitis, the following formula can be taken hourly, reducing as symptoms improve: Petasites (15 mL), Lobelia (15 mL), Tussilago (10 mL), Thymus (10 mL), Foeniculum (8 mL), and Eucalyptus essential oil (2 mL).


Jillian_Stansbury_HeadshotJillian Stansbury, ND has practiced in SW Washington for nearly 20 years, specializing in women’s health, mental health and chronic disease. She holds undergraduate degrees in medical illustration and medical assisting, and graduated with honors in both programs. Dr Stansbury also chaired the botanical medicine program at NCNM and has taught the core botanical curricula for more than 20 years. In addition, Dr Stansbury also writes and serves as a medical editor for numerous professional journals and lay publications, plus teaches natural products chemistry and herbal medicine around the country. At present she is working to set up a humanitarian service organization in Peru and studying South American ethnobotany. She is the mother of two adult children, and her hobbies include art, music, gardening, camping, international travel, and studying quantum and metaphysics.
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