Aesclepias sp. / Milkweed

According to Volume II of The Useful Wild Plants of Texas, the Southeastern and Southwestern United States, the Southern Plains, and Northern Mexico — a text that dedicates 75 pages to the milkweeds — “The genus Asclepias, many species of which occur in Texas, have so many, such varied, and such significant uses that the genus is one of the most highly valued in this work…. The number of medicinal uses of Asclepias, including cures and treatments for almost every system of the body, is nothing short of phenomenal.”5

As is common with many medicinal plants, the active chemicals in milkweed are responsible for the plant’s toxic properties as well as its therapeutic benefits. Within the milkweed latex are steroids called cardenolides, which exhibit cardiotonic — and sometimes cardiotoxic — properties. Some milkweed species, such as inmortal (A. asperula), have high levels of cardenolides, while others, such as showy milkweed (A. speciosa) and swamp milkweed (A. incarnata), have lower levels.5,6 Different populations within the same species can produce varying levels of cardenolides due to ecological factors. Additionally, the plant part containing the strongest cardenolide concentration often varies from species to species.
“In addition to the variation in cardenolides between species, there can be great variation within a species as well,” said Stenoien of the MonarchLab. “Whether plants are water-stressed, grown in sun or shade, fertilized, or have recently been grazed by herbivores all affect the concentration and localization of the cardenolides. Depending on these local factors, the toxicity of a single milkweed plant may fluctuate greatly on time scales ranging from minutes to months.”
Cardenolides, a type of cardiac glycosides, are found in many plants in addition to milkweeds, such as the highly toxic common oleander (Nerium oleander, Apocynaceae) and foxglove (Digitalis spp., Scrophulariaceae), which contains the important cardenolides digoxin, digitoxin, and lanoxin. Cardiac glycosides inhibit the sodium-potassium pump in the cell membranes, resulting in increased concentrations of intracellular sodium — which in turn causes increased calcium levels — and decreased potassium in the cells of the heart. According to Useful Wild Plants, “Combined with indirect vagal stimulation, this slows the heart and produces a more forceful beat.”5 These plant chemicals, which reportedly have been used in traditional medicine for about 1,500 years, are employed as pharmaceutical drugs to treat congestive heart failure and present potential as novel cancer therapeutic agents.7
Although a search of the PubMed database for “milkweed,” “Asclepias,” and “pleurisy root” suggests that no clinical research has been conducted on any of the milkweeds mentioned in this article,8 a few human trials in the 1960s and ’70s studied the potential asthma-reducing benefits of a species found in India known commonly as Indian ipecac (A. asthmatica), which was studied under its synonym, Tylophora indica.9,10

Uses by Native Americans. Milkweeds have been used traditionally to treat a multitude of conditions, and several in vitro studies have supported the plant’s antimicrobial and antiseptic activity.5 Numerous native tribes throughout the Americas — including the Navajo, Iroquois, Cherokee, Blackfoot, Meskwaki, and others — extensively employed various parts of milkweed species. Anthropologist Daniel Moerman, PhD, who has spent decades studying the usage of plants by Native Americans, told HerbalGram that there are over 300 milkweed uses documented in the University of Michigan’s Native American Ethnobotany database (email, September 12, 2013). Crushed milkweed leaves were used externally to treat skin ulcers, skin cancers, wounds, ringworm, and headaches, while the root was made into a powder or juice and applied topically to cure tumors and to treat wounds, boils, and rashes. The sap was used externally for leprosy, to make warts and freckles disappear (due to its caustic properties), to lighten skin, and to treat ear infections (by the Maya). The seeds were sometimes used on sores.
Internally, milkweed was often relied upon by Native Americans and European settlers to treat snakebites.5 Some tribes are reported to have made various milkweed concoctions, while others such as the Choctaw simply chewed on the root of whorled milkweed (A. verticillata).5 Due to the plants’ reported ability to draw out snake venom, some also used milkweed root, latex, leaves, or boiled seeds externally for snakebites.

Many tribes chewed milkweed root to treat sore throats and rashes, while native peoples in Mexico drank the latex or ate the flowers, leaves, or stems to treat rabies in humans and animals.5 Some ingested root preparations for hemorrhaging, and many native and settler groups throughout the Americas took the root — especially that of A. tuberosa — to treat respiratory conditions, including pleurisy, lung inflammation, colds, etc.5,11 Additional internal traditional uses included toothache; heart conditions; fever; headache; digestive conditions including gas, indigestion, diarrhea, and vomiting; and as a contraceptive and abortifacient (although the late, renowned Southwest herbalist Michael Moore contested the latter usage, claiming milkweed is strong enough to cause intense nausea and nothing more5).
Uses by 18th and 19th Century Physicians. Meanwhile, medicinal milkweed preparations had somewhat widespread usage, documentation, and recommendation in the 1800s and early 1900s by Eclectic physicians, the Canadian pharmaceutical industry, and American botanists and medical physicians, such as the 1880 vice-president of the American Medical Association Francis Peyre Porcher, MD. According to the milkweed chapter of Dr. Moerman’s 1981 book Geraniums for the Iroquois: A Field Guide to American Indian Medicinal Plants, “Native American enthusiasm for the milkweeds was widely shared by Euro-Americans from the earliest times until the turn of the twentieth century. One species or another was listed in the USP [United States Pharmacopeia] from the first edition in 1820 until at least 1905.”11
The 16th edition of The Dispensatory of the United States of America, published in 1888, documented numerous uses of pleurisy root, including as a diaphoretic, expectorant, and astringent; and to treat catarrh, pneumonia, pleurisy, consumption, diarrhea, dysentery, rheumatism, etc.12 In 1863, Dr. Porcher reported that some doctors in South Carolina used “A. asperula and A. tuberosa roots in tea or powder preparations as a salivary stimulant. Apparently in the middle of the nineteenth century, the soreness of the mouth caused by using Asclepias roots was much less severe than the side effects of using the then popular mercurial preparations.”5 In 1828, The New-England Farrier and Family Physician suggested milkweed for dropsy (edema), dysentery, and piles (hemorrhoids), while Massachusetts physician and Revolutionary War surgeon James Thacher, MD, recommended the root powder for gas and indigestion in 1813.
The Eclectic physicians of the late 19th and early 20th centuries used pleurisy root to treat respiratory conditions, particularly pneumonia, as well as pleurisy root tinctures or teas to treat fever in children.13 In the pandemic influenzas of the early 1900s, according to a 2006 article in the journal Alternative Complementary Therapy, A. tuberosa preparations were used for “chest pain, lung inflammation, coughing, and to reduce bronchial symptoms.”8 The Eclectics also used swamp milkweed root primarily as a diuretic, especially for cardiac edema, and for intestinal parasites in the formula King’s Entozoic.14

Uses by Contemporary Herbalists. 
More recent herbalists have continued to use milkweed for respiratory problems. Daniel Gagnon, RH (AHG) — a medical herbalist and owner of the herbal medicine company Herbs, Etc. in Santa Fe, NM — said that he “truly, deeply” knows and uses just two milkweed species: inmortal and pleurisy root. He noted that many American herbalists are familiar with pleurisy root from studying the Eclectic texts, including the 1854 King’s American Dispensatory (King), the 1898 King’s American Dispensatory (Felter and Lloyd), the 1922 The Eclectic Materia Medica, Pharmacology and Therapeutics (Felter), and the 1915 American Materia Medica, Therapeutics and Pharmacognosy (Ellingwood). Additionally, herbalists who have studied with Michael Moore or other teachers who were taught by Moore know and use inmortal, which is native to the Southwest United States.
Gagnon sees these two species as medicines for treatment of inflammation of the pleural membranes surrounding the lungs, removal of accumulating fluids at the bottom of the lungs, activation of phlegm excretion from the lungs, and restoration of inflamed membranes surrounding the heart (pericardium) and stomach (peritoneum).
“I know there are many other places where these two roots have been used, but lungs clearly come to mind when I think of inmortal and pleurisy root,” said Gagnon (email, July 28, 2013). “I personally have been using inmortal and pleurisy root in my clinical practice for over 30 years and have never had a client experience negative effects from these two herbal medicines.”
Gagnon noted that pleurisy root is used in the Herbs, Etc. formulation called Respiratonic®, which has been on the market for more than 40 years and consistently ranks in the company’s top-10 bestselling products.
“We have old-time wildcrafters that sell us inmortal root every fall,” he said. “One of my wildcrafters has been picking inmortal for over 60 years. At this time I don’t see that the adoption of these two herbs by the [conventional] medical profession will occur because of [the] way they use medicines. This plant/drug/therapy is good for this problem/disease/condition. One pill/one condition medical doctors are not trained to think of tissue conditions and working from an energetics point of view. I believe that herbalists are the ones that are going to keep using this medicine. So, in effect, I am saying that the use of this plant will remain relatively insignificant.”
Fellow herbalist David Winston, RH (AHG) — director of the Herbal Therapeutics Research Library and president of Herbalist and Alchemist, Inc. in Washington, NJ— reiterated American herbalists’ usage of pleurisy root as a tea or tincture and explained that it is often used according to the Eclectic indication “that it hurts to breathe,” as well as for lung conditions accompanied by fever, congestion, or sharp pain when coughing; as a diaphoretic especially for fevers with bronchial involvement; and to help reduce emotional agitation or irritability in people with high fevers.
“It can also be used for intercostal neuralgia (when the chest muscles hurt), and it is actually quite effective for that,” he said.
Additionally, Winston noted that the sap of common milkweed (A. syriaca) is occasionally used as a topical treatment for warts. If overdose of internally ingested pleurisy root does occur, Winston noted that it can cause nausea, vomiting, and diarrhea. He also cautioned that overdose of inmortal — which he said should not be used with conventional cardiac medications or by people with overt heart disease — may cause nausea and vomiting as well.
“These are strong medicines, not tonics, and are, in my opinion, best left to people who are knowledgeable about their use,” said Winston. “Small amounts of pleurisy root are relatively safe, especially when used in a larger formula. None of these should be used internally during pregnancy.”

Food and Fiber Uses. 
Milkweed also has been used extensively for non-medicinal applications. As Useful Wild Plants documents, Native American and Canadian First Nation tribes — including the Hopi, Kiowa, Zuni, Cheyenne, Menominee, and others — used many parts of the milkweed plant for food, cooking the stems like one would asparagus and to season soups, cooking the leaves with meat or eating them raw, making the dried latex into chewing gum, and boiling the seed pods alone or with meat.5 Flowers also were used to make preserves, added to venison broth soup and cornmeal, or eaten raw. Modern foragers in the United States sometimes use the flowers, seed pods, and detoxified greens in various dishes, such as stir-fries, soups, or casseroles, although others avoid milkweed due to perceptions of potential toxicity.5 
Native tribes also used milkweed as a dye for textiles and ceramics.5 Native Americans used the stem fiber to construct bowstrings, fish nets, baskets, twine, and other products. More recently, the fine-yet-durable seed pod fiber has been used for insulation and soundproofing and to absorb spilled oil, and a few select US companies use common milkweed seed floss to stuff hypoallergenic pillows and comforters.5 During World War II, the US government began subsidizing milkweed crops for the seed floss’s use as insulation in sleeping bags, helmets, pillows, and more. Hummingbirds use the seed fiber to build nests, and some have proposed that these tiny birds were the first to discover the insulation properties of the seeds.5 Unfortunately, despite its rich history as a traditional medicine and fiber product with bright commodity potential, milkweed is currently viewed by most farmers and ranchers as an obnoxious weed.