Bethroot

Bethroot (Trillium erectum L.): A Comprehensive Reference

1. Identity: Botanical Classification, Names, and Natural Source

Trillium erectum, the red trillium, is also known as wake robin, purple trillium, bethroot, or stinking benjamin, and is a species of flowering plant in the family Melanthiaceae. It was first described by the Swedish botanist Carl Linnaeus in 1753.

Common names include: Bethroot, Birthroot, Cough root, Ground lily, Indian balm, Jewsharp, Purple trillium, Snake bite, Stinking Benjamin, Trillium, Trillium pendulum, and Wake-robin. The root was traditionally used as an aid in childbirth, hence the name "Bethroot," which is a corruption of "birth root." The names "Stinking Benjamin," "Wet Dog Trillium," and related epithets reference the flowers' unpleasant, fetid scent, which attracts flesh flies, carrion beetles, and similar insects to act as pollinators.

The genus name Trillium comes from the Latin trilix, meaning "triple," because all parts of these plants are tripartite. The specific epithet erectum means "upright, erect," a reference to the erect pedicel of some forms of this species.

In addition to T. erectum, the name "bethroot" has historically been applied to closely related species. Scientific names associated with the term in the literature include Trillium erectum L. and Trillium grandiflorum (Michaux) Salisb. The broader genus as covered in pharmacological literature includes Trillium erectum L., Trillium govanianum Wall., Trillium grandiflorum (Michaux) Salisb., and Trillium tschonoskii Maxim.

Botanical Description and Natural Habitat

Trillium erectum is a perennial, herbaceous, flowering plant that persists by means of an underground rhizome. T. erectum is a low-growing perennial that reaches a height of 40 to 45 cm and is native to North America. It has three dark green diamond-shaped leaves, each about 18 cm long. From April to June it produces a solitary, odiferous, yellow to reddish-brown flower. The unpleasant smell is the reason for the name "stinking Benjamin." Like all trilliums, it has a whorl of three bracts (leaves) and a single trimerous flower with three sepals, three petals, two whorls of three stamens each, and three carpels fused into a single ovary with three stigmas.

It is native to the eastern United States and eastern Canada from northern Georgia to Quebec and New Brunswick. It is a spring ephemeral plant whose life cycle is synchronized with that of the forests in which it lives. It is a slow-growing species that occurs in eastern Canada and the eastern United States at middle to high elevations in moist woods and on wooded slopes.

Medicinal Part and Common Preparations

Review of the literature suggests the medicinal component of the plant is the rhizome. Historically, the root/rhizome has been prepared and administered in several forms. According to eclectic medical sources, the dose of powdered bethroot was 1 drachm given in hot water; of the strong infusion, which was the most common form of administration, from 2 to 4 fluid ounces. A strong tincture of the fresh root (8 ounces in 76% alcohol, 1 pint) was given in doses of from 1 to 20 drops. Externally, the root was made into a poultice and used topically on tumors, indolent or offensive ulcers, anthrax, buboes, and insect stings; in some instances its efficacy was said to be increased by combination with bloodroot. The leaves of the plant, boiled in lard, were also used in some regions as an application to ulcers and tumors.

2. Traditional and Historical Use

Indigenous North American Traditions

Various trillium species have been used by American Indians to treat gynecological conditions including irregular menstrual periods, menstrual pain, excessive vaginal discharge, and to aid childbirth (hence the name birthroot), as well as for diarrhea and as an expectorant. The white-flowered variety (T. erectum var. album) was preferred by native North Americans for treating sore nipples, inducing labor, and controlling postpartum hemorrhage, vaginal discharge, and heavy menstruation.

The Cherokee peoples used a poultice of the whole plant to treat tumors, inflammation, and ulcers. Traditionally, Native American tribes such as the Cherokee and Iroquois valued bethroot for its astringent and anti-inflammatory properties. Topical preparations were used to relieve insect bites and skin irritations. T. erectum is a popular folk remedy for bleeding, snakebites, and skin irritations.

Integration into Euro-American Herbal and Eclectic Medicine

Bethroot was introduced to formal herbal medicine by Constantine Rafinesque in his Medical Flora (2 vols., 1828–30) and was listed in the U.S. National Formulary (1916–47). Trillium was first introduced by Stephen W. Williams in 1820 as a plant with hemorrhage-reducing, pain-relieving, and sedative properties. In 1856, an active natural compound deemed a "saponin" was first isolated from T. erectum.

In colonial and early American medicine, bethroot was used for its supposed astringent properties to treat bleeding, diarrhea, and other conditions involving mucosal inflammation. According to 19th-century eclectic medical sources, bethroot was described as astringent, tonic, and antiseptic; it was employed in hemoptysis, hematuria, menorrhagia, uterine hemorrhage, metrorrhagia, leucorrhoea, cough, asthma, and difficult breathing. The astringent varieties of Trillium were found useful in hemorrhages; the acrid species in chronic affections of the respiratory organs. All varieties were said to be efficient, either internally or externally, in chronic mucous discharges, bronchorrhoea, leucorrhoea, and menorrhagia.

Boiled in milk, it was administered for diarrhea and dysentery; and an infusion of equal parts Trillium and Lycopus virginicus was recommended in historical sources for the treatment of diabetes.

Traditional Use in Asia

The roots of T. erectum, named beth roots, have been used in folk medicine for the treatment of hemorrhages from the uterus, urinary tract, and lungs. T. tschonoskii has been traditionally used in China for at least one thousand years, where dried rhizomes of this plant species have been used as an herbal remedy for treatment of hypertension, neurasthenia, giddiness, headache, removing carbuncles, and ameliorating pains.

3. Key Constituents and Phytochemistry

Steroids and saponins are the main classes of phytochemicals present in Trillium plants. Tertiary literature documents trillium species containing a fixed and volatile oil, a saponin (trillarin, which is a diglycoside of diosgenin), a glycoside resembling convallamarin, tannic acid, a resin, and considerable starch.

Reports from 1942 to 1947 indicated the presence of a number of sapogenins in the roots of T. erectum: pennogenin, nologenin, fesogenin, bethogenin, trillogenin, and kryptogenin. Only one additional steroidal saponin, hypoglaucin A (possessing a yamogenin aglycone), had been reported in more recent early research. A 2009 study isolated and elucidated the structure of three new steroidal saponins along with eight known saponins, two known ecdysones (polypodine A and B), and linoleic acid from T. erectum.

The rhizomes contain steroidal saponins that have hormonal effects, which explains their traditional use in gynecological and obstetric medicine. Steroidal saponins of the spirostanol and furostanol types have been identified, some of which may possess cytotoxic, antifungal, antioxidant, and cyclooxygenase-2 (COX-2) inhibitory activities.

The biological activities of steroidal saponins in Trillium depend mainly on their aglycone moieties (steroidal sapogenins) as well as the number and structure of monosaccharide units in their sugar chains. A slight structural diversity endorses a significant difference in their antifungal and cytotoxic properties; spirostanol saponins exhibit a higher antifungal potential in comparison to their analogous furostanol saponins.

Earlier analyses of the root recorded fixed oil (about 8 percent), starch, tannin, and an acid crystalline principle, probably a decomposition product of saponin.

The traditional actions attributed to bethroot are generally assigned to two major compound families: steroidal saponins and tannins, supported by a broader mix of plant constituents such as starches and fixed oils.

4. Mechanisms of Action (Proposed)

Although trillium has been used for many years as an herbal means of controlling postpartum bleeding as well as other uterine bleeding problems, a clear mechanism for this systemic effect has not been identified. The plant may have astringent properties that account for its ability to limit topical bleeding and irritation. This astringent action was also the proposed basis for its historic use in diarrhea. No chemical basis has been identified for its traditional use as an expectorant.

Modern research has shown that the root contains steroidal saponins, which have hormonal effects on the body, and these saponins are used in gynaecological and obstetric medicine.

Research on TTB2, the pennogenin steroid from the closely related Trillium tschonoskii, has shown cytotoxic, anti-proliferative, and morphological effects on lung cancer cell lines. Results indicated that TTB2 led to apoptosis of cancer cells with a significant increase in the level of intracellular reactive oxygen species and a concomitant loss of mitochondrial membrane potential, with accumulation of cells in the G2/M phase of the cell cycle.

5. Scientific Evidence by Area of Use

Overall evidence statement: Modern scientific research on bethroot's efficacy and safety is very limited. There are no clinical trial data supporting use for any indication. The available scientific data is almost entirely confined to in vitro (cell-based) studies and phytochemical analyses. The sections below describe what the scientific literature does and does not establish.

5.1 Reproductive Health and Hemostasis (Uterine/Gynecological Use)

Although there are no studies to support these uses, trillium has been used to stop postpartum bleeding and it also may play a role in the topical control of bleeding and relief from insect bites. Although trillium has been used for many years as an herbal means of controlling postpartum bleeding as well as other uterine bleeding problems, a clear mechanism for this systemic effect has not been identified.

Evidence strength: Entirely traditional/ethnobotanical. No human clinical trials, no animal models demonstrating uterine or hemostatic activity specifically for T. erectum have been documented in the current scientific literature. Extensive historical use as "birthroot" for gynecological support lacks modern clinical validation.

5.2 Cytotoxic / Anticancer Activity

Six steroidal glycosides, along with 14 known compounds, were isolated from the underground parts of Trillium erectum L. The structures were determined on the basis of extensive spectroscopic analysis, including two-dimensional NMR data and chemical transformations. The isolated compounds were evaluated for their cytotoxic activity against HL-60 human promyelocytic leukemia cells. This study, by Yokosuka and Mimaki (2008, Phytochemistry 69:2724–2730), represents the primary peer-reviewed laboratory investigation directly conducted on T. erectum extracts.

Some research indicates there may be cytotoxicity in T. erectum effective against cancer cell lines. Among the tested steroidal saponins — both spirostanol and furostanol types — many exhibited relevant cytotoxicity against different cancer cell lines, few showed high potential against tested fungal strains, while some possessed antioxidant and COX-2 inhibitory activity.

Evidence strength: Preliminary; in vitro only. No animal studies or human clinical trials have been conducted. Results from cell-line experiments cannot be directly extrapolated to clinical outcomes. Much of the anticancer data in the genus Trillium comes from related species (T. govanianum, T. tschonoskii), not from T. erectum itself.

5.3 Antifungal Activity

The saponin glycosides of Trillium species have been shown to have antifungal activity. Ethanol extract from rhizomes and aerial parts of T. grandiflorum exhibited antifungal activity in laboratory studies.

Evidence strength: Preliminary; in vitro only. No clinical antifungal studies have been conducted with bethroot preparations.

5.4 Anti-inflammatory and COX-2 Inhibitory Activity

Ethanol, ethyl acetate, and butanol extracts of T. tschonoskii significantly suppressed edema of rat hind paw swelling elicited by injection of carrageenan in animal studies. COX-2 inhibitory activity has been attributed to steroidal saponins identified within the genus.

Evidence strength: Preliminary; limited to in vitro assays and animal models using related Asiatic species. No clinical data exists for T. erectum specifically.

5.5 Astringent and Topical Applications

The plant may have astringent properties that account for its ability to limit topical bleeding and irritation. Topical preparations were historically used to relieve insect bites and skin irritations.

Evidence strength: Plausible mechanism (tannin-mediated astringency is a well-established pharmacological principle), but no controlled clinical trials have validated this use specifically for bethroot.

5.6 Respiratory / Expectorant Use

No chemical basis has been identified for trillium's traditional use as an expectorant. Historical eclectic sources described its use in cough, asthma, and respiratory conditions, but no pharmacological studies have confirmed a mechanistic basis for these effects.

Evidence strength: Traditional only; no scientific support.

5.7 Snoring

There is no evidence to support the use of trillium for the treatment of snoring.

6. Body Systems and Health Areas Associated with Bethroot

• Reproductive / gynecological system: Bethroot has been employed in menorrhagia, uterine hemorrhage, metrorrhagia, and leucorrhoea, and was said to have been used by Indigenous women to promote parturition.
• Hemostatic (bleeding control): The roots of T. erectum have been used in folk medicine for the treatment of hemorrhages from the uterus, urinary tract, and lungs.
• Gastrointestinal system: The astringent action of trillium was the historical basis for its use in diarrhea.
• Respiratory system: The acrid species of Trillium were used in historical sources for chronic affections of the respiratory organs, phthisis, and hectic fever.
• Integumentary (skin) system: Externally, bethroot has been used to treat excessive vaginal discharge, ulcers (especially varicose), skin complaints, gangrene, and insect bites and stings.
• Oncological (experimental): Cytotoxic activity against cancer cell lines has been demonstrated in vitro for steroidal glycosides isolated from T. erectum and related species, but no clinical applications have been established.

7. Dosage Forms and Reported Dosages

There is no clinical evidence to guide dosage of trillium. The only dosage figures available in the literature are historical, derived from 19th-century eclectic medical compilations:

• Powdered bethroot: 1 drachm in hot water. Strong infusion (the most common form of administration): 2 to 4 fluid ounces. Strong tincture of the fresh root (8 oz. root in 76% alcohol, 1 pint): 1 to 20 drops.

No randomized controlled trials, dose-finding studies, or pharmacokinetic studies in humans exist for any preparation of T. erectum. These historical dosage figures are recorded as a matter of ethnobotanical and medical history and do not constitute clinical dosage guidance.

8. Safety Considerations and Interactions

Uterine Stimulant / Emmenagogue Activity

Documented adverse effects of trillium include emmenagogue and uterine stimulant properties, and avoidance is recommended. It is strongly contraindicated during pregnancy and lactation due to uterine stimulant effects.

Potential Cardiac and Membrane-Irritating Effects

Although not yet clinically observed, trillium could have potential membrane-irritating effects and induce some cardiac activity. This concern is based on the saponin content of the plant; saponins as a chemical class are known to interact with cellular membranes.

Calcium Oxalate Content

The leaves contain calcium oxalate as raphides and should not be consumed by humans.

Toxicity of Berries and Roots

The berries and roots are considered inedible and are said to be poisonous. Although the leaves of the plant have been considered edible by some, there remains a possibility of toxicity from the plant.

Drug Interactions

No drug interactions are well documented for trillium. Given the documented uterotonic and emmenagogue properties, and the presence of steroidal saponins with hormonal activity, interactions with hormonal medications, anticoagulants, and cardiac drugs are theoretically possible but have not been studied in humans.

Contraindications

Formal contraindications have not yet been determined through clinical study, though pregnancy is the most prominently noted contraindication in the historical and contemporary herbal literature on the basis of its uterotonic effects.

9. Conservation Status and Ethical Sourcing

Trilliums are notoriously fragile plants, and picking any part of the plant can result in death, even if the rhizome remains untouched. Because of this, wild-harvest of any kind is detrimental to the health of the species. T. erectum is classified as "Threatened" in Rhode Island, "Exploitably Vulnerable" in New York, and "Endangered" in Illinois.

United Plant Savers (UpS) currently defines Trillium (Trillium spp.) as "Critical" — a category reserved for species that are federally or state protected and/or at very high risk of extinction — alongside peyote and Venus flytrap. UpS recommends that these plants should never be wildharvested or purchased under any circumstances except for plant research or for use by Indigenous societies with a traditional history of connection with that plant.

Because it takes so long to germinate and flower, trillium is not a profitable plant for most nurseries, which means there is a market for poached plants from wildharvesters. A few people can decimate a healthy trillium colony in very little time, and the colonies rarely recover.

This species is commercially traded as a medicinal plant, and is also harvested for ornamental uses, though the severity and scope of this threat to wild populations are not fully known.

10. Summary of Evidence

The evidence base for bethroot in humans is thin; most guidance is historical or based on the known actions of its compound families. The plant has a well-documented ethnobotanical record extending across multiple Indigenous North American cultures and was incorporated into 19th-century eclectic and Euro-American herbal medicine, as well as the U.S. National Formulary. A 2017 review in the journal Molecules summarizes the current knowledge on the chemistry of the genus Trillium, as well as in vitro and in vivo studies on extracts, fractions, and isolated pure compounds, focusing on cytotoxic, antifungal, and anti-inflammatory activities. Among tested steroidal saponins from the genus, many exhibited relevant cytotoxicity against different cancer cell lines, few showed high potential against tested fungal strains, and some possessed antioxidant and COX-2 inhibitory activity — all in laboratory, not clinical, settings. No randomized controlled trials or systematic reviews of human clinical data exist for any indication. The plant's documented uterotonic properties and conservation-critical status are the most practically significant facts for contemporary reference.

References

• Wikipedia: Trillium erectum
• Drugs.com Natural Product monograph: Bethroot (Trillium erectum), medically reviewed Dec 22, 2025
• Drugs.com Natural Product monograph: Trillium (multiple species), medically reviewed Dec 22, 2025
• King's American Dispensatory (Eclectic): Trillium — Bethroot | Henriette's Herbal Homepage
• USDA Forest Service: Red Trillium (Trillium erectum) — Plant of the Week
• Hayes P.Y., Lehmann R., Penman K., Kitching W., De Voss J.J. (2009). Steroidal saponins from the roots of Trillium erectum (Beth root). Phytochemistry 70(1):105–113. ScienceDirect
• Yokosuka A., Mimaki Y. (2008). Steroidal glycosides from the underground parts of Trillium erectum and their cytotoxic activity. Phytochemistry 69(15):2724–2730. PubMed
• Ur Rahman S. et al. (2017). Bioactive Steroids and Saponins of the Genus Trillium. Molecules 22(12):2156. PMC
• Trilliumosides K and L, two novel steroidal saponins from rhizomes of Trillium govanianum, as potent anti-cancer agents targeting apoptosis in the A-549 cancer cell line. Frontiers in Chemistry (2023). PMC
• Trillium – toward Sustainable Utilization of a Biologically Distinct Genus Valued for Traditional Medicine. The Botanical Review (2019). Springer Nature
• PRCUPCC Herb Database: Bethroot (Trillium erectum)
• United Plant Savers: Trillium (Trillium spp.) — Species At-Risk List
• NatureServe: Iconic Wildflowers in Peril — New Report Highlights Threats to Trillium in North America
• NatureServe Explorer: Trillium erectum Conservation Status
• Wild Adirondacks: Purple Trillium (Trillium erectum)
• Steroidal sapogenins from genus Trillium: Chemistry, synthesis, and opportunities in neuro-active steroids designing. ScienceDirect (2021)
• ScienceDirect Topics: Trillium — Pharmacology, Toxicology and Pharmaceutical Science overview
• Plants For A Future (PFAF): Trillium erectum — Beth Root