Heartsease

Heartsease (Viola tricolor L.): A Comprehensive Reference

1. Identity and Botanical Description

1.1 Scientific Classification and Nomenclature

Heartsease belongs to Kingdom Plantae, Order Malpighiales, Family Violaceae, Genus Viola, Species Viola tricolor. Its accepted synonyms include "Wild pansy" and "Heartsease." The official pharmacopoeial designation used in regulatory documentation is Violae herba cum flore, referring to the aerial parts with flowers. The EMA Community Herbal Monograph covers Viola tricolor L. and/or subspecies Viola arvensis Murray (Gaud) and Viola vulgaris Koch (Oborny), herba cum flore.

The species is also known by a remarkable number of vernacular names, including wild pansy, Johnny Jump Up, heartsease, heart's ease, heart's delight, tickle-my-fancy, Jack-jump-up-and-kiss-me, come-and-cuddle-me, three faces in a hood, love-in-idleness, and pink of my john.

1.2 Botanical Description

Viola tricolor is a common European wild flower, growing as an annual or short-lived perennial. It is a small plant of creeping and ramping habit, reaching at most 15 centimetres (6 in) in height, with flowers about 1.5 cm (½ in) in diameter. The flowers can be purple, blue, yellow, or white. It is the progenitor of the cultivated pansy, and is therefore sometimes called wild pansy; before cultivated pansies were developed, "pansy" was an alternative name for the wild form.

The heartsease, or wild pansy, is abundantly met with almost throughout Britain. Though found on hedgebanks and waste ground, it seems in especial degree a weed of cultivation, found most freely in cornfields and garden ground. It has been introduced into North America, where it has spread.

1.3 Part Used and Common Preparations

The part used in herbal medicine is the aerial portion of the plant. Heartsease extracts are applied topically to the affected area of the skin or ingested orally, and the leaves are used to make tea. Young leaves and flower buds are used to thicken soups, and the flowers are used to garnish salads and desserts. Additional preparation forms documented in the herbal and regulatory literature include tinctures, decoctions, dried herb capsules, ointments, compresses, and skin washes.

Violet and Heartsease were the 2022 International Herb of the Year. There are three main species in cultivation: Sweet Violet (Viola odorata), Heartsease (Viola tricolor), and Pansy (Viola × wittrockiana). These beautiful flowers, all members of the Violaceae family, are well known to most, and being related, there is an overlap in their uses.

2. Traditional and Historical Use

2.1 Ancient Greco-Roman and Early European Use

Heartsease has a storied past stretching from medieval Europe to early Persian herbalists. The Greeks and Romans prized it as a poultice for skin blemishes; Galen's writings briefly note "purple Pansies" for scrofula and eye inflammations. By the 12th century, Hildegard of Bingen recommended "wild pansie" for respiratory issues.

Ancient Greeks and Romans also used pansy to relieve heart-related ailments, hence the name "heartsease." As an ornamental and medicinal plant, the wild pansy has been cultivated since the Middle Ages and bred in Britain since 1810.

2.2 European Herbal Traditions

It has been described and used for centuries in Europe for the therapy of inflammatory lung diseases and for the treatment of inflammatory skin disorders, such as atopic dermatitis or psoriasis. Its traditional use as a herbal remedy is documented in the Pharmacopoeia of Europe.

Its traditional use as herbal remedy is documented in several handbooks of phytotherapy, as well as in complementary medicine, especially in Anthroposophical Medicine, and is furthermore registered in the German Commission E Monograph of the German Federal Institute for Drugs and Medical Devices (Bundesanzeiger 1986), as well as described in the Pharmacopoeia of Europe (European Pharmacopoeia 2011).

Medicinal use included a rejuvenating tonic and treating epilepsy, skin diseases, and as an expectorant for respiratory issues ranging from colds to bronchitis and asthma. It was traditionally used for rheumatism and cystitis due to its diuretic properties.

2.3 Iranian, Ayurvedic, and Unani Traditions

Viola tricolor and other plants in the Viola genus have a long history of use in herbalism and folk medicine, particularly Iranian, Greco-Arab, Ayurvedic, and Unani traditional health systems.

Traditionally, it has been used to treat cardiovascular conditions, epilepsy, skin diseases, burns and eczema, and as an expectorant for respiratory problems such as bronchitis, asthma, and cold symptoms, and modern research has begun to corroborate these traditionally held knowledges and uses.

2.4 Literary and Cultural Significance

Heartsease appears in Shakespeare's A Midsummer Night's Dream and is referred to as a pansy in Hamlet. Grieve writes expansively on violets, covering various traditions and more modern use, this latter being mainly as a colouring agent and perfume and as a source of the medicinally employed syrup of violets. The laxative properties are covered, syrup of violets being found in the British Herbal Pharmacopoeia for infants.

3. Chemical Constituents and Active Compounds

3.1 Flavonoids

Viola tricolor is well-known to contain flavonoids, polysaccharides, phenylcarbonic acids, salicylic acid derivatives, catechins, and coumarins. The flavonoid fraction is particularly diverse and well-characterized. Sephadex LH-20 column chromatography was used to separate flavonoid components in a heartsease methanol extract. One of the main components was identified by NMR as violanthin (6-C-glucosyl-8-C-rhamnosylapigenin). As a first approximation, the other main flavonoid component was considered to be rutin (3-O-rhamnoglucosylquercetin), based on comprehensive comparison of retention times and UV spectra of reference molecules, as well as molecular mass and fragmentation patterns obtained by mass spectrometry.

Heartsease plants contain aglycones apigenin, chrysoeriol, isorhamnetin, and kaempferol. Pharmacognostic research on V. tricolor confirmed the presence of high amounts of saponins, mucilages, flavonoids, and phenolic compounds such as kaempferol, luteolin, quercetin, violanthin, and rutin, which placed V. tricolor in the list of plants with promising sources of natural antioxidants.

The methanol extract of its flowers has an abundant amount of flavonoids (such as rutin and violanthin) and carotenoids (such as lutein and β-carotene).

3.2 Cyclotides

V. tricolor is one of many viola plant species containing cyclotides. Cyclotides are a unique class of circular, cysteine-rich peptides with exceptional structural stability. Viola is highly rich in different natural products, out of which about 200 compounds have been isolated and identified in the past few decades; these include flavonoids, coumarins, alkaloids, triterpenoids, saponins, anthocyanins, phenols, tannins, phytosterols, terpenoids, lignans, sesquiterpenes, cyclotides, and phenyl propanoids of different pharmacological activities such as antibacterial, antioxidant, anti-inflammatory, and antihypertensive effects, among others.

3.3 Mucilages, Salicylates, and Other Constituents

The fresh plant contains approximately 10 percent mucilages, consisting of glucose, galactose, arabinose, and rhamnose, as well as tannins, salicylic acid, and its derivatives. Anthocyanidins and coumarins, such as umbelliferone, were also detected in V. tricolor.

Heartsease constituents include flavonoids (antioxidants) including violanthin, violaquercitrin, and rutin (which strengthens capillaries), methyl salicylate (with aspirin-like properties), alkaloids, and volatile oils.

4. Established Mechanisms of Action

4.1 Immunomodulatory and Anti-inflammatory Actions

Cyclotides mutated in a hydrophilic inter-cysteine loop 1 and 2 region lost their immunosuppressive activity, while the active ones acted antiproliferatively by reducing the expression of the interleukin (IL)-2 surface receptor and IL-2 cytokine secretion.

Studies optimized the isolation procedure to improve the yield of cyclotides and compared the cellular effects of violet-derived organic solvent-extracts, aqueous preparations, and an isolated cyclotide from this plant on primary human T lymphocytes and macrophages — cells that are crucial for the initiation and progression of inflammatory bowel disease. Hot water herbal decoctions demonstrated stronger immunosuppressive activity towards proliferation, interferon-γ, and interleukin-21 secretion of primary human T cells than a DCM/MeOH cyclotide-enriched extract, and the isolated cyclotide kalata S appears as one of the active components responsible for the observed effects. This effect was increased by a longer boiling duration.

In contrast, the DCM/MeOH cyclotide-enriched extract was more effective in reducing the levels of cytokines interleukin-6, interleukin-12, interleukin-23, tumor necrosis factor-α, and C-X-C motif chemokine ligand 10, secreted by human monocyte-derived macrophages.

Salicylates in heartsease are anti-inflammatory. Saponins and mucilage are demulcent, especially in the upper respiratory tract.

4.2 Antioxidant Mechanisms

The antioxidant capacity of different flavonoid fractions was determined using both Trolox equivalent antioxidant capacity (TEAC) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) in vitro antioxidant assays. The highest electron-donor capacity was found for the major flavonoid component (rutin), whereas one minor component-rich flavonoid fraction exhibited the highest hydrogen-donor activity.

4.3 Apoptotic and Antiangiogenic Pathways

Apoptosis induction by an ethyl acetate (EtOAc) fraction of V. tricolor was confirmed by an increased sub-G1 peak of propidium iodide (PI)-stained cells. This fraction triggered the apoptotic pathway by increased Bax/Bcl-2 ratio and cleaved caspase-3 level. Moreover, treatment with EtOAc fraction significantly decreased the diameter of vessels on chicken chorioallantoic membrane, while the number of newly formed blood vessels was not suppressed significantly.

5. Scientific Evidence by Area of Use

5.1 Skin Conditions (Eczema, Seborrhoea, Psoriasis, Acne)

The HMPC monograph classifies the traditional use of Viola tricolor internally and externally for mild seborrhoeic skin conditions, while the ESCOP monograph encompasses eczema, seborrhea, impetigo, acne, cradle cap, and diaper rash (internal and external).

Key clinical trial (combination product): Only a few clinical trials have been published on the topical treatment of atopic dermatitis with herbal ointments. An ointment containing extracts from Mahonia aquifolium, Viola tricolor, and Centella asiatica had previously been studied in open uncontrolled trials with children. However, no data existed on adult patients in a randomized controlled trial. A total of 88 patients with mild-to-moderate atopic dermatitis were enrolled in a double-blind, vehicle-controlled, randomized, half-side comparison. Patients between 18 and 65 years of age were treated for 4 weeks with an ointment containing Mahonia aquifolium, Viola tricolor, and Centella asiatica. A further study compared a topical preparation of Mahonia aquifolium, Viola tricolor, and Centella asiatica with the vehicle cream in 88 patients and could not find significant differences. A subgroup analysis revealed superiority of the plant preparation under dry and cool weather conditions.

Evidence strength: The available clinical evidence for skin use is limited and consists primarily of combination-product trials rather than studies of Viola tricolor alone. The EMA assessment determined that available data are sufficient to support the traditional uses of Viola tricolor herb in the European context, classified as a traditional herbal medicinal product for symptomatic treatment of mild seborrhoeic skin conditions. Although human clinical trials remain limited, early results suggest that the plant's bioactive compounds may play a supportive role in skin health.

5.2 Respiratory Conditions (Cough, Bronchitis, Asthma)

Due to its anti-inflammatory properties, heartsease is regarded as a traditional remedy against skin diseases and is also used in the treatment of inflammation of the lungs and chest such as bronchitis or asthma. The current primary use in modern practice is as a cough remedy, for coughs, colds, and catarrh.

Violet is used as supportive care for cough with difficult sputum clearance: it may help mucus move more easily and reduce irritation as part of complex therapy. Species of the genus Viola (including Viola tricolor) are associated with flavonoids, phenolic acids and salicylate derivatives, mucilage (polysaccharides), tannins, carotenoids, and specific peptides (cyclotides). The combination of mucilage, flavonoids, and phenolic compounds is commonly used to explain a mild soothing effect on mucous membranes, support for mucus clearance (expectorant support), and anti-inflammatory potential as part of complex herbal therapy.

Evidence strength: There are no standalone human clinical trials evaluating heartsease specifically for respiratory conditions. Much of the herb's reputation is based on centuries of traditional use, supported by preliminary laboratory and pharmacological studies. The respiratory indications rest on traditional use documentation and mechanistic plausibility from the saponin and mucilage content, not on controlled clinical evidence.

5.3 Immunomodulation

A plant extract from Viola tricolor inhibited the proliferation of human lymphocytes by suppressing IL-2 secretion. This in vitro finding aligns with the mechanistic understanding of cyclotide action described in section 4.1. Several studies have elucidated the immunomodulatory properties of cyclotides. The immunomodulatory functions of cyclotides were also shown in vivo, namely in the experimental autoimmune encephalomyelitis (EAE) mouse model of multiple sclerosis.

Evidence strength: Immunomodulatory effects have been demonstrated in vitro and in animal models. No randomized controlled clinical trials in humans have established immunomodulatory efficacy for any specific condition. This area remains at the preclinical research stage.

5.4 Anticancer / Cytotoxic Properties

In one study, the cytotoxic and apoptogenic properties of hydroalcoholic extract and ethyl acetate, n-butanol, and water fractions (0–800 μg/mL) of Viola tricolor were investigated in Neuro2a mouse neuroblastoma and MCF-7 human breast cancer cells. In addition, the antiangiogenic effect of the EtOAc fraction was evaluated on chicken chorioallantoic membrane. Cytotoxicity assay revealed that the EtOAc fraction was the most potent among all fractions with maximal effect on MCF-7 and minimal toxicity against normal murine fibroblast L929 cells. Apoptosis induction by the EtOAc fraction was confirmed by an increased sub-G1 peak of propidium iodide (PI)-stained cells. This fraction triggered the apoptotic pathway by increased Bax/Bcl-2 ratio and cleaved caspase-3 level.

Both Chevallier and Hoffman cite recent application for cancer. The British Herbal Pharmacopoeia specifies it as expectorant and antineoplastic.

Evidence strength: All anticancer evidence is in vitro and in animal/membrane models only. The result of the present study showed that the ethyl acetate fraction of V. tricolor has potential cytotoxic properties by decreasing proliferation of tumor cells, inducing apoptosis, and inhibiting angiogenesis on CAM. These findings mean that further studies should be conducted in experimental animal models to evaluate the potential anticancer properties of V. tricolor. No human oncology trials exist.

5.5 Antimicrobial Activity

The antimicrobial activity of infusion, decoction, ethanol extract, and fractions obtained by successive extraction of Viola tricolor herb with dichloromethane, ethyl acetate, and methanol was evaluated. The infusion, decoction, and ethanol extract were found to be most effective against the tested microorganisms. Extracts from the plant are anti-microbial.

Evidence strength: Antimicrobial activity is established only at the in vitro level. No controlled human studies have investigated heartsease as an antimicrobial agent for any infection.

5.6 Neuroprotective Properties

Previous studies indicated that Viola tricolor and Viola odorata are rich sources of antioxidants. One study aimed to determine whether these plants protect neurons against serum/glucose deprivation (SGD)-induced cell death in an in vitro model of ischemia and neurodegeneration. PC12 neuronal cells were pretreated for 4 hours with 1 to 50 μg/ml of V. odorata or V. tricolor hydroalcoholic extracts, followed by 24 hours incubation under SGD conditions.

Evidence strength: Preliminary in vitro only. No clinical or animal in vivo studies specifically on neuroprotection by V. tricolor alone have been published in peer-reviewed literature available at the time of writing.

5.7 Antiprotozoal Activity

The antiprotozoal and antioxidant activities of Viola tricolor have been reported. One study assessed the growth inhibition effect of a methanolic extract of V. tricolor (MEVT) against five Babesia parasites and Theileria equi in vitro and in vivo. MEVT suppressed Babesia bovis, B. bigemina, B. divergens, B. caballi, and T. equi growth at IC50 values of 75.7, 43.3, 67.6, 48, and 54 μg/mL, respectively.

Evidence strength: Preliminary. These findings are of potential veterinary interest but have not been translated into human antiparasitic applications.

6. Body Systems and Health Areas of Association

• Dermatological: Due to its anti-inflammatory properties, heartsease is regarded as a traditional remedy against skin diseases, for example for the treatment of scabs, itching, ulcers, eczema, or psoriasis.
• Respiratory: The aerial parts of the plant have been traditionally used as an herbal remedy in the treatment of asthma and bronchitis.
• Immunological: T-lymphocyte suppression and cytokine modulation, as documented in in vitro models described above.
• Cardiovascular: Heartsease contains compounds proven to be useful in prophylaxis and treatment of some medical conditions such as cardiovascular problems, complications of diabetes, inflammations, immune disorders, and liver problems, among other indications. These associations are primarily traditional and mechanistic; clinical human evidence is lacking.
• Urinary: Hoffman describes its alterative and anti-inflammatory properties as useful in urinary tract infections.
• Musculoskeletal: Traditional use for rheumatism and gout is documented across multiple European herbal traditions.

7. Dosage Forms and Reported Dosages

Dosage data are drawn from herbal medicine references and naturopathic databases where specific figures have been stated. Because the EMA HMPC monograph specifies dosages are "to be specified for the individual finished product," exact regulatory figures are not available from that source.

• Dried herb (oral): 2–4 g, three times daily.
• Tincture (oral): Tincture at a ratio of 1:5 in 25% ethanol, 2–4 ml, three times daily.
• Infusion (oral): 1 tablespoon per cup, infused for 15 minutes, three times daily.
• Capsules: 250 mg, 2 capsules three times daily.
• Decoction / long infusion (oral, traditional Chinese-influenced practice): Long infusion or decoction: 3–9 grams.
• Topical wash: As a wash: 20 grams in 500 mL; in a bath: 50–150 grams.
• Topical ointment: Used in the clinical study described in section 5.1, applied over 4 weeks, though the exact concentration of Viola tricolor extract in the multi-herb preparation was not separately reported.

The EMA Community Herbal Monograph specifies that heartsease preparations used cutaneously should not be applied to open wounds or large areas of damaged skin.

8. Regulatory Status

The traditional use of heartsease is registered in the German Commission E Monograph of the German Federal Institute for Drugs and Medical Devices, and is described in the Pharmacopoeia of Europe. The EMA assessment concluded that available data are sufficient to support the traditional uses of Viola tricolor herb in the European context. The traditional herbal medicinal product indication is symptomatic treatment of mild seborrhoeic skin conditions.

The plant material complies with the European Pharmacopoeia monograph (ref.: 01/2008: 1855). The plant is also covered by an ESCOP monograph and the Altmeyers Phytotherapy encyclopaedia cross-references both HMPC and ESCOP monographs for clinical guidance.

9. Safety Considerations and Interactions

9.1 General Safety Profile

There are no observed health hazards or side effects at the appropriate therapeutic doses. Acute toxicity testing after 48-hour oral administration of 10 ml/kg of 1, 3, and 5 g/kg doses of violet leaf extract in BALB/c mice showed no toxic effect; there was no recorded lethargy, death, or changes in behavior. Toxicity studies after 24-hour oral administration showed that organic solvents (methanol, butanol, and n-hexane) and aqueous extracts of violet are non-toxic at 2000 mg/kg.

9.2 Dose-Dependent Adverse Effects

High doses may cause nausea and vomiting and allergic skin reactions. The root is emetic in high doses and has been used to induce vomiting in cases of poisoning. Possible reactions include allergies (including skin rash), as well as gastrointestinal symptoms such as nausea, vomiting, or diarrhea. Overdose or prolonged use may increase the risk of GI upset and allergic reactions.

9.3 Salicylate Content and Contraindications

Wild pansy belongs to herbs to be used with caution due to its salicylate content. Those with a known hypersensitivity to salicylates should avoid using violets.

Patients with G6PD deficiency can be at risk of haemolysis after Viola tricolor treatment. This specific caution is noted in the EMA assessment report.

9.4 Additional Contraindications

Main contraindications commonly listed for standard use include: hypersensitivity to the plant's active substances or to salicylates; glomerulonephritis; and hepatitis. Pregnancy and breastfeeding: only on a doctor's advice when the expected benefit outweighs the potential risk. In children, use from 3 years of age as prescribed by a doctor.

9.5 Topical Use Precautions

The EMA monograph contraindicates use on open wounds or large areas of damaged skin.

9.6 Drug Interactions

No drug interactions have been reported in the EMA assessment for Viola tricolor. However, given the plant's salicylate content, caution is theoretically warranted in individuals taking anticoagulants or other salicylate-containing medications, consistent with the broader caution noted about salicylate-class herbs.

9.7 Data Gaps

Due to the lack of data on acute and chronic toxicity, repeated dose toxicity, mutagenicity, carcinogenicity, and reproductive and developmental toxicity, the EMA list entry for Viola tricolor is classified as traditional use only. This classification reflects the absence of comprehensive preclinical safety data, not confirmed harm.

10. Summary of Evidence Quality

Much of the herb's reputation is based on centuries of traditional use, supported by preliminary laboratory and pharmacological studies. Modern research has focused primarily on the plant's anti-inflammatory, antioxidant, and antimicrobial properties. The body of clinical evidence for any single indication remains limited. The most clinically grounded use — topical application for mild seborrhoeic skin conditions — is supported by traditional use sufficient for a traditional-category regulatory monograph in Europe but has not met the evidentiary threshold for a "well-established use" designation under EMA criteria. All other investigated areas (anticancer, neuroprotective, antiprotozoal, immunomodulatory) remain at the in vitro or animal model stage and require controlled human trials before clinical conclusions can be drawn.

References

• Hellinger R, et al. "Immunosuppressive activity of an aqueous Viola tricolor herbal extract." J Ethnopharmacol. 2014;151(1):299-306. PMC3918579
• Retzl B, et al. "Exploring Immune Modulatory Effects of Cyclotide-Enriched Viola tricolor Preparations." Planta Med. 2023;89(15):1493–1504. PMC10684336
• Sadeghnia HR, et al. "Viola tricolor Induces Apoptosis in Cancer Cells and Exhibits Antiangiogenic Activity on Chicken Chorioallantoic Membrane." BioMed Research International. 2014. PMC4163403
• Systematic Review: Phytochemistry, Nutritional Composition, and Pharmacologic Application of Species of the Genus Viola in Noncommunicable Diseases. PMC10630019
• Protective effect of Viola tricolor and Viola odorata extracts on serum/glucose deprivation-induced neurotoxicity. PMC4967839
• Vukics V, Kery A, Guttman A. "Major flavonoid components of heartsease (Viola tricolor L.) and their antioxidant activities." PubMed PMID: 18259733
• Klövekorn W, Tepe A, Danesch U. "A randomized, double-blind, vehicle-controlled, half-side comparison with a herbal ointment containing Mahonia aquifolium, Viola tricolor and Centella asiatica for the treatment of mild-to-moderate atopic dermatitis." Int J Clin Pharmacol Ther. 2007;45:583–591. PMID: 18077922
• Witkowska-Banaszczak E, et al. "Antimicrobial activity of Viola tricolor herb." Fitoterapia. 2005;76(5):458–461. PMID: 15893888
• Gas chromatography-mass spectrometry analysis, phytochemical screening and antiprotozoal effects of the methanolic Viola tricolor extract. PMC7077018
• European Medicines Agency (EMA). Community Herbal Monograph on Viola tricolor L., herba cum flore. EMA/HMPC/131734/2009. Adopted 25 November 2010.
• EMA Final Assessment Report on Viola tricolor L., herba cum flore.
• Wikipedia: Viola tricolor (Chemical constituents and medicinal uses sections, cross-referenced with primary literature therein)
• Phytojournal 2025, Vol 14 Issue 4: Viola tricolor L. — Taxonomical, Chemical, and Pharmacological Review
• The Naturopathic Herbalist: Viola tricolor monograph
• The Herb Society of America: Heartsease, Viola tricolor
• ScienceDirect Topics: Viola (overview of traditional and current herbal uses)