IngredientsEupatorium perfoliatum, known as common boneset or just boneset, is a North American perennial plant in the family Asteraceae. It is also known as boneset, feverwort, agueweed, Indian sage, or thoroughwort, and bears the synonyms Eupatorium connatum Michx. and Eupatorium glandulosum Michx. Additional common names include agueweed, feverwort, and sweating-plant.
The genus name Eupatorium is derived from Eupator, a first-century BCE king of Pontus, famed for his herbal skills. The species name perfoliatum means "through the leaf," since the stem seems to grow through the paired leaves. The genus Eupatorium includes about 38 species, which are found mostly in East Asia and North America.
Eupatorium perfoliatum grows up to 100 cm (39 inches) tall, with opposite, serrate leaves that clasp the stems (perfoliate). The perfoliate foliage is quite distinctive: the bases of the pairs of wrinkled, opposite, lance-shaped, medium green leaves unite to surround the hairy stems. Flat-topped clusters (compound corymbs) of small, fluffy, white flowers appear above the foliage in late summer to fall.
It is a common native to the Eastern United States and Canada, widespread from Nova Scotia to Florida, west as far as Texas, Nebraska, the Dakotas, and Manitoba. Common boneset is native to moist lowlands and meadows, flood plains, and occasionally to wetlands.
Eupatorium perfoliatum should not be confused with Ageratina altissima (white snakeroot, tall boneset), which has a similar appearance and blooming period but is more shade-tolerant and aggressive.
The aerial parts are harvested during or just before flowering for medicinal use, when the concentration of active constituents is highest. Boneset is available in several forms:
Boneset has a long history of use in North America, particularly among Indigenous peoples of the eastern woodlands, where it was regarded as an important remedy for fever and systemic illness. Native American tribes used the plant extensively for influenza, febrile conditions, and severe musculoskeletal pain. Boneset has documented use as an antipyretic agent by the Cherokee, Delaware, Menominee, Seminole, Nanticoke, and Mohegan tribes. Native Americans used boneset to treat "break-bone fever" (dengue fever). Infusions were also used to treat colds, fever, and the pain from arthritis and rheumatism.
It was introduced to American colonists by natives who used the plant for breaking fevers by means of heavy sweating, and was commonly used to treat fever by the African-American population of the southern United States. By the early 20th century, it was reported as commonly used by rural African-Americans in the Deep South to treat fever, including dengue fever, though it was considered less effective for yellow fever and typhoid fever.
The name "boneset" comes from the use of the plant to treat dengue fever, which is also called "break-bone fever." Though some authorities claim the name boneset refers to a former use of the plant to aid the healing process for broken bones, others claim that the name is in reference to the plant's use as a diaphoretic in the treatment of an 18th-century influenza called break bone fever. In the early years of medicine, Eupatorium perfoliatum was placed on bandages of broken bones. The rationale behind this therapy was one of the Doctrine of Signatures: users believed that the jointed appearance of the leaves was an indication that this plant healed broken bones.
During the 18th and 19th centuries, boneset was adopted into European-American medical practice and became a well-established remedy in Eclectic and Physiomedical medicine. It was used in the treatment of intermittent fevers, including malaria, as well as serious infectious diseases such as typhoid and yellow fever. Boneset appeared in the United States Pharmacopoeia from 1820 until 1916, where it was classified as a stimulant and diaphoretic, reflecting its perceived ability to promote sweating and support the resolution of fever during acute illness.
Native Americans used boneset for a large variety of medicinal purposes, and European settlers considered it something of a cure-all in the 18th and 19th centuries when they learned of it. Historically, boneset was commonly included in medical herb gardens and used as a folk medicine for treatment of flus, fevers, colds, and a variety of other maladies.
In addition to its role in febrile conditions, boneset was traditionally used for muscular rheumatism, dyspepsia, and digestive weakness, particularly in older adults. Its bitter properties were used to improve digestive function and appetite during convalescence. Other historical applications included the treatment of cutaneous diseases and the elimination of intestinal parasites, such as tapeworm.
The infusion taken cold was used as a bitter tonic; the hot tea was used to induce sweating. An early 19th-century preparation is documented in a historical medical text preserved in PubMed: one and a half ounces of the dried leaves in one pint of boiling water.
Boneset originates from North America, where it has been widely used for centuries by native Indians. Additionally, extracts are used in Europe as an immunostimulating agent for the treatment of fever and cold. Today E. perfoliatum is mainly used in Europe as an "immunostimulant" for colds.
Eupatorium perfoliatum leaves and roots contain mixed phytochemicals, including polysaccharides (containing xylose and glucuronic acid), tannins, volatile oil, sesquiterpene lactones, sterols, triterpenes, alkaloids, and various flavonoids, such as quercetin, kaempferol, and caffeic acid derivatives.
A detailed breakdown of phytochemical classes, as characterized in peer-reviewed phytochemical reviews, is as follows:
The sesquiterpene lactones reported belong to the groups of guaianolides (euperfolide, 11,13Ξ±-dihydroeuperfolide, eufolitin, eufoliatorin) and germacranolides (euperfolitin, euperfolin). The flavonoid eupafolin is also frequently cited as a lead compound. Sesquiterpene lactones identified include eupafolin, euperfolitin, eufoliatin, eufoliatorin, euperfolide, eucannabinolide, and helenalin.
Flavonoids identified include quercetin, kaempferol, hyperoside, astragalin, rutin, and eupatorin. Recent studies on the polar constituents revealed the existence of caffeoylglucaric acid derivatives.
The herbal material contains about 1.1% of polysaccharides with inulin-like Ξ²-2-1-D-fructosylfructose features. An alkaline-soluble polysaccharide fraction was shown to exhibit immunostimulating activities under in vitro conditions.
The herbal material contains about 0.05β0.2% of volatile oil, with anethole and carvone as lead compounds. The plant also contains caffeic acid derivatives, flavonoids, sesquiterpene lactones, triterpenes, phytosterols, polysaccharides, and volatile oil.
Forty-nine samples of Eupatorium perfoliatum were shown to contain dehydropyrrolizidine alkaloids (0.0002β0.07% w/w), the majority dominated by lycopsamine and intermedine, their N-oxides and acetylated derivatives. This is of toxicological significance and is discussed in the safety section below.
Anti-inflammatory activity of Eupatorium perfoliatum extracts was confirmed by a combination of techniques on gene and protein level by significant down-regulation of cytokines CSF-3, IL-1Ξ±, IL-1Ξ², and chemokines CCL2, CCL22, and CXCL10. TNF was also moderately down-regulated. The anti-inflammatory effects can be seen as a verification of the traditional use against inflammatory diseases. Additionally, free radical-scavenging components were found in the ethanolic extract of Eupatorium perfoliatum.
Extracts and isolated compounds were tested for inhibition of nitric oxide (NO) production and modulation of pro-inflammatory cytokines and chemokines. The dichloromethane extract and the isolated compounds showed significant inhibition of NO and reduced expression of cytokines including IL-1Ξ±, IL-1Ξ², CCL2, CCL22, and CXCL10, while TNF-Ξ± was moderately affected. These experiments were conducted entirely in vitro using LPS-stimulated RAW 264.7 macrophage cells.
Studies evaluated extracts with different polarity and defined lead compounds from the herbal material on potential in vitro activities concerning immune cell activation, phagocytosis, and inflammation-related processes. Methanol, ethanol, and DCM extracts, as well as several subfractions and isolated polysaccharides, sesquiterpene lactones, and flavonoids were prepared from the aerial parts. Immunological activity was tested within a lymphocyte transformation test on peripheral blood mononuclear cells (PBMC), and tests on enhancement of phagocytosis and NO production by murine RAW 264.7 macrophages. Although the postulated immunostimulating properties of E. perfoliatum have not been confirmed, the anti-inflammatory effects can be seen as a verification of the traditional use against inflammatory diseases.
In herbal medicine, the plant is a diaphoretic β an agent to cause sweating. This traditional mechanism, by which a hot infusion promotes perspiration and is believed to assist in "breaking" fevers, has not been mechanistically elucidated in controlled human studies.
An in vitro study tested a hydroalcoholic extract for its ability to inhibit viral attachment, plaque formation, and hemagglutination against influenza A virus. It significantly reduced viral binding and plaque formation at concentrations of approximately 1β10 Β΅g/mL, with low cytotoxicity; high-molecular-weight polyphenols were identified as likely active compounds.
A separate study examined the action of E. perfoliatum extract and its bioactive components β quercetin, caffeic acid, and eupafolin β against wild primary clinical isolate of dengue virus-2 (DENV-2) infection in an in vitro model. Among the bioactive components, quercetin showed the most significant preventive action against DENV infection. In molecular docking analysis, quercetin showed the strongest binding affinity towards the DENV membrane receptor TIM-1 protein.
Overview of evidence: There is no clinical evidence to guide the use of boneset. Limited in vitro experimental data suggest anti-inflammatory, antiviral, and cytotoxic activity.
Key clinical study: 53 outpatients suffering from common cold/flu were randomly assigned to either therapy with acetylsalicylic acid (ASA) or the homeopathic drug Eupatorium perfoliatum D2 in a controlled clinical trial. The efficacy of the drugs was assessed on day 1, 4, and 10 of the infection by symptom check lists and physical examinations. Neither subjective complaints nor body temperature or laboratory findings showed any significant differences between groups, which was taken as evidence that both drugs were equally effective. However, only one clinical investigation describing positive effects of Eupatorium perfoliatum against common cold is documented β this non-placebo-controlled, open study with 53 patients. One group was treated with a homeopathic preparation (D2, meaning 1:100 dilution titer), the other group was treated with acetylsalicylic acid (3Γ500 mg/day). The efficacy of the drugs was assessed after 1, 4, and 10 days.
Evidence quality: Clinical data on the use of Eupatorium perfoliatum do not meet modern Good Clinical Practice (GCP) requirements, but do indicate positive tendencies for use of ethanolic extracts for treatment of common colds. The single clinical trial used a highly diluted homeopathic preparation (not a phytotherapeutic extract), lacked a placebo arm, and had a small sample size. The results cannot be interpreted as evidence for the efficacy of botanical boneset preparations. Overall evidence for this use is very weak.
Animal studies and in vitro experiments with plant extracts indicate anti-inflammatory effects, alongside an antiplasmodial effect against Plasmodium falciparum. Such anti-inflammation caused by ethanolic extracts can be correlated with clinical symptoms related to diseases such as common cold, rheumatism, and arthritis. These results demonstrate measurable anti-inflammatory activity at the cellular level, providing experimental support for boneset's traditional use in inflammatory conditions, although no human or animal subjects were involved. Evidence for anti-inflammatory use is preclinical only (in vitro); no clinical trials have been conducted.
One study investigated the antiviral activity of hydroalcoholic extracts from Eupatorium perfoliatum against influenza A virus in MDCK II cells in vitro. No human participants were involved. Pre-treatment with E. perfoliatum at a concentration of 100 Β΅g/mL and IC50 of 7 Β΅g/mL significantly inhibited influenza A virus (IAV) replication by 100%, while no antiviral activity was observed during post-treatment assay. These results suggest that boneset extracts can inhibit influenza A virus attachment in cell culture, supporting further investigation as a potential antiviral agent. Evidence is in vitro only; no human data exist.
One in vitro study found that E. perfoliatum extract has marked antiviral activity during pre-treatment against DENV infection in the HepG2 cell line. The extract also significantly reduced DENV-induced autophagy in the HepG2 cell line. The findings suggest that E. perfoliatum extract has significant potential as an anti-DENV therapeutic agent, and quercetin may have a prophylactic role in its antiviral activity against DENV infection. These findings are in vitro only.
A community-based, prospective, open-label cohort study (Nayak et al., 2023, published in Complementary Medicine Research) examined homeopathic Eupatorium perfoliatum 30C for dengue prevention, assessing effectiveness on the incidence of dengue fever and acute febrile illness (AFI) during the 2017 dengue outbreak. The study enrolled apparently healthy individuals in urban slums of Delhi in two cohorts: a medicine cohort (MC) given weekly one dose of EP 30C for 10 weeks plus IEC material, and a control cohort (CC) given IEC material only. This study involved a highly diluted homeopathic preparation, lacked blinding and a true placebo arm, and does not constitute evidence for conventional botanical boneset extracts. Its relevance to phytotherapeutic preparations is negligible.
The postulated immunostimulating properties of Eupatorium perfoliatum have not been confirmed by in vitro data, but animal studies and in vitro experiments with plant extracts indicate anti-inflammatory effects alongside an antiplasmodial effect against Plasmodium falciparum. There are no human clinical trials evaluating boneset for malaria treatment. Evidence is preclinical only.
Laboratory studies suggest that polysaccharides and sesquiterpene lactones can enhance white blood cell production and stimulate phagocytosis, providing measurable immune support. However, research into the effects of boneset in humans has not been conducted. Possible effects of E. perfoliatum for these uses remain undefined by adequate scientific research, and are unconfirmed by high-quality clinical research. Evidence is in vitro / preclinical only.
Some constituents, including sesquiterpene lactones and eupatorin, exhibit cytotoxic activity in vitro, although these effects are not applied clinically. One study found an extract of Eupatorium perfoliatum to have high cytotoxic effects, similar to a standard cytotoxic agent, chlorambucil. No human oncology research has been conducted.
There is no clinical evidence to guide the dosage of boneset. Traditional use was 2 g of leaves and flowers.
No standardized, evidence-based dosing protocol exists for boneset as a phytotherapeutic agent in conventional medicine. All dosage figures from traditional or historical sources should be understood in that context.
Pro-toxic dehydropyrrolizidine alkaloids are associated with liver disease in humans. The potential for long-term, low-level, or intermittent exposures to cause or contribute to chronically developing diseases is of international concern.
While the presence of dehydropyrrolizidine alkaloids in some Eupatorium species is well established, reports on Eupatorium perfoliatum specifically are scant and contradictory. Forty-nine samples of Eupatorium perfoliatum were shown to contain dehydropyrrolizidine alkaloids (0.0002β0.07% w/w), the majority dominated by lycopsamine and intermedine, their N-oxides and acetylated derivatives.
The identification of pyrrolizidine alkaloids in Eupatorium species is cause for concern. This class of alkaloids is known to cause hepatic impairment after long-term ingestion. While direct evidence for a hepatotoxic effect from boneset does not exist, there is sufficient evidence to indicate that any plant containing unsaturated pyrrolizidine alkaloids should not be ingested. Concerns associated with dehydropyrrolizidine alkaloids provide a compelling reason for preclusive caution until further research can better define the toxicity and carcinogenicity of the dehydropyrrolizidine alkaloid content of Eupatorium perfoliatum.
The ingestion of large amounts of teas or extracts may result in severe diarrhea. Nausea and vomiting have also been associated with use at higher doses, consistent with the plant's historical classification as a mild emetic.
E. perfoliatum and several of its related species are listed on the Poisonous Plants Database of the US Food and Drug Administration, with E. perfoliatum described as an "unapproved homeopathic medicine" with unknown safety by the US National Library of Medicine. Holistic health companies marketing fraudulent supplement products that contained E. perfoliatum with claims of benefit against COVID-19 were warned by the US Food and Drug Administration in 2020 about making illegal health claims.
Drug interactions with boneset are not well documented. Boneset is broken down by the liver. Some chemicals that form when the liver breaks down boneset can be harmful. Given the presence of pyrrolizidine alkaloids, co-administration with hepatotoxic drugs or agents metabolized extensively by the liver represents a theoretical concern warranting caution, though this has not been studied directly in humans.
Sampling issues, low and high alkaloid chemotypes of Eupatorium perfoliatum, or interspecies hybridization could cause the wide variation in dehydropyrrolizidine alkaloid concentrations or the different profiles observed. Alcoholic tinctures and hot water infusions and decoctions have been shown to contain high concentrations of these alkaloids.
Documented adverse effects include cytotoxic constituents. The sesquiterpene lactone helenalin, present in boneset, is known across the Asteraceae family for cytotoxic and allergenic potential, and individuals sensitive to other Asteraceae members (e.g., ragweed, chrysanthemums) may exhibit cross-reactivity.
Boneset appeared in the United States Pharmacopoeia from 1820 until 1916, where it was classified as a stimulant and diaphoretic. It was subsequently removed and is no longer included in the USP. The German Homeopathic Pharmacopoeia does not list specific chromatographic methods for the unambiguous identification of Eupatorium perfoliatum. There is no current monograph from the European Medicines Agency (EMA), ESCOP, or WHO for boneset as a phytomedicine, reflecting the limited clinical evidence base.
Possible effects of E. perfoliatum for all these uses remain undefined by adequate scientific research, and are unconfirmed by high-quality clinical research.
Health conditions that Boneset may help support.
In vitro studies document meaningful anti-inflammatory activity in E. perfoliatum extracts. A 2011 study (Maas, Deters & Hensel, J Ethnopharmacology) showed that dichloromethane and ethanolic extracts significantly inhibited NO/iNOS production in LPS-stimulated macrophages and downregulated pro-inflammatory cytokines including IL-1Ξ±, IL-1Ξ², CSF-3, and chemokines CCL2 and CXCL10. The flavonoid eupafolin and sesquiterpene lactones have been identified as key mediators. No human clinical trials for chronic inflammatory conditions have been conducted.
Boneset has a deep traditional history as a remedy for influenza and the common cold, and limited scientific evidence partially supports this use. A 1981 controlled clinical trial (Gassinger et al.) found that a homeopathic preparation of E. perfoliatum D2 reduced common cold symptoms comparably to aspirin in 53 outpatients. In vitro work (Derksen et al., 2016, Journal of Ethnopharmacology) demonstrated that hydroalcoholic extracts inhibit influenza A virus attachment to host cells. No modern, well-powered RCTs exist for the whole-herb preparation.
In vitro research demonstrates that E. perfoliatum hydroalcoholic extracts inhibit influenza A virus (IAV) attachment to host cells, with polyphenolic compounds acting on viral hemagglutinin. Separately, polysaccharide fractions have shown immune cell stimulation including enhancement of phagocytosis in murine macrophage assays. These mechanistic findings rationalize the herb's traditional role in febrile viral illness, but no human clinical trials of the antiviral effect have been performed.
Boneset was historically used by European settlers and Eclectic physicians for sub-acute and chronic rheumatic conditions and arthritis. A 19th-century medical report (Lockwood, 1847, now archived in PMC) specifically listed 'sub-acute and chronic rheumatic affections' among indications. The in vitro anti-inflammatory data for E. perfoliatum extracts lends biological plausibility, but no clinical trials for arthritis exist.
Boneset is traditionally used to support bronchial health through its expectorant and anti-inflammatory properties, particularly during acute infections with fever. Historical medical literature including Lockwood (1847) describes it as valuable in bronchitis and catarrhal conditions. Its bitter sesquiterpene lactones and diaphoretic action are proposed to relieve bronchial congestion and inflammation. No clinical evidence specifically for bronchial health exists.
Boneset has a documented traditional role in acute bronchitis, attributed to its diaphoretic and mild expectorant actions. Lockwood's 1847 medical report (archived in PMC) listed bronchitis among its primary indications. Modern herbalists continue to use it for acute bronchitis with fever and mucus congestion. No clinical trials for bronchitis specifically have been performed.
Boneset (Eupatorium perfoliatum) is one of North America's most historically important febrifuge herbs, used by multiple Native American tribes and later American physicians for fever, influenza, and dengue ('break-bone') fever. It is documented as an antipyretic by the Cherokee, Delaware, Menominee, Seminole, and other tribes. Clinical evidence remains absent but traditional use is extensively documented.
Boneset is traditionally classed as a mild expectorant that helps loosen and clear mucus from the respiratory tract. This expectorant action is noted across multiple historical sources including Lockwood (1847) and modern herbalist references. It is commonly used as a hot infusion to promote expectoration during colds, flu, and bronchitis. No clinical trials exist specifically assessing its expectorant effect.
Early American settlers used boneset to treat pneumonia, as documented in historical sources. Drugs.com's clinical monograph records that 'the early settlers used the plant to treat rheumatism, dropsy, dengue fever, malaria, pneumonia, and influenza.' Traditional use also documents its role in preventing pulmonary complications during influenza. No clinical trials for boneset in pneumonia exist.
Boneset has a well-documented traditional role in supporting the upper respiratory tract during acute infections, including nasopharyngeal catarrh, colds, coughs, and allergic rhinitis. Herbal Reality's monograph records its use for these conditions as a hot infusion acting via diaphoretic and expectorant mechanisms. A 19th-century medical text confirmed its use for catarrh. No clinical trials for upper respiratory tract conditions specifically have been conducted.
Body systems that Boneset may help support.
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