Of all the herbs that I've learnt about during my time studying Herbalism with the S.N.H.S, lobelia (Lobelia inflata) is the one that caught my attention more than any other. This herb is something of an enigma, seeming to range from 'the ultimate wonder herb' in the views of some, to a 'dangerous poison' in the views of others. This would appear to be reflected in its availability in various countries across the globe, being restricted to usage by qualified herbalists in some, yet freely available to the general public in others. 

Such conflicting views and thoughts about one herb really got me thinking. Are those in favour of the herb playing with fire and ultimately putting their patients at risk? Or is it the case that those who shun away from its use simply don't have the knowledge or understanding to use it to its full potential?

Of course, its not just lobelia that has this controversy about it, there are many other herbs that have been the subject of debate, being good for you one minute, and bad for you the next. In all truthfulness, this seems to happen with just about anything consumed by the general public in today's society (as salt users, egg eaters and red wine drinkers can all testify!) It just seems to me that lobelia hangs very much in the balance, between being the best herb on the planet, to being one of the most harmful. I have to say that I already have my own thoughts and views on lobelia as a healing herb, and I have to say that so far I fall
very much in favour of its use. I personally think that if used in the proper dosages, and with the correct amount of care and caution, it is a marvellous healer, and one that any self-respecting Herbalist would loathe to be without. And so, I intend to explore these two, conflicting areas of thought on this herb, and ultimately, see whether my own views can be shifted or not.

The first time I ever heard of lobelia was as a child, watching my Dad make up his hanging baskets, using these beautiful little blue flowers. Lobelia (Lobelia inflata) is an erect, flowering annual or biennial plant, growing between 1 and 2 feet in height, with an angled and branched stem. It has yellowish to light-green leaves, which are alternate, ovate-lanceolate in shape, and are hairy. It bears pale violet to blue flowers, and has oval, two-celled fruit capsules, which contain a number of small, brown seeds. The plant has a slight, somewhat irritating smell, and its taste is strongly acrid, resembling tobacco. It has many common names, including Pukeweed, Indian tobacco, emetic weed, vomitwort, gagroot and asthma weed to name but a few, (the reason behind most of these less than attractive common names will be discussed further on, although it really wouldn't take a genius to figure it out!). 

Lobelia inflata is native to the Eastern United States, Canada and Russia's Kamchatka Peninsula, it can be found growing on wasteland, dry grassland, near ditches and along the edge of forests. There are several other varieties, including a couple that are British strains, (Lobelia dortmanna and Lobelia urens) popular in English gardens because of their beautiful purple, blue and pink colours. The generic name Lobelia is after the Flemish botanist Matthias de L'obel (1538-1616), whilst inflata is in reference to the way the seed capsule inflates during ripening. The leaves and the seeds are both used medicinally, the seeds being the stronger of the two.

Lobelia has a long, if not chequered history of medicinal usage. It has been widely used by Native Americans, especially those living in the eastern United States, such as the Penobscot Indians of New
England, who used it for many reasons, not all medicinal.  It is used ceremoniously in rain dances and conversely to ward off storms. It is placed on graves, and even burned to keep annoying gnats at bay. Some make use of it in love potions, whilst others use it as an antidote to such charms. Medicinally, the Native Americans use it for a number of ailments. It is smoked like tobacco (hence its common name of Indian tobacco), and used in this manner to combat asthma, coughs and other ailments of the
respiratory system. It is also used to treat venereal disease, earache, stiff necks and fevers to name but a few.

And so it was that by the time early European settlers appeared on the shores of North America, lobelia already had its place as a medicinal marvel. Early American doctors considered lobelia to be one of the most important medicinal plants that they had, so much so, that it was used very much as their primary medicine. They used it to treat coughs and spasms in the lungs from a variation of causes, as well as spasms elsewhere in the body, such as in the intestines. Its powerful antispasmodic properties had not gone unnoticed, even way back then. It was considered to be a powerful pain reliever and was also used in high amounts to induce vomiting in people who had ingested poison (its highly emetic nature has led to its many descriptive common names!). Cutler, who in 1813 spent time examining its anti-asthmatic properties, brought lobelia into general usage.

It was introduced into British medicine in 1829. For many people, Samuel Thomson (1769-1843) is the one name that they immediately associate with lobelia. He is the man who is commonly credited with its discovery, although of course, the Native American Indians had been using it medicinally for years prior to his 'discovery'. Thomson was born in New Hampshire, U.S.A. on February 9th. 1769. The information I have found on Thomson has been taken from an autobiographical account of his life, which has been researched and published by John Uri Lloyd. It was found on the Internet website Medhist, (the guide to history of medicine resources on the Internet). In this article, Thomson describes how his family were poor, and how his father struggled to make ends meet farming a small piece of land.

Doctors, as we know them, were unheard of when Thomson was a boy, and the local wisewoman, Widow Benton, treated the Thomson family in times of sickness. She did this using a selection of herbs and roots that she found growing in the surrounding countryside. The young Samuel had long had an interest in the plants growing round his home, something that came of him spending lots of time in the field helping his father with livestock and farming. It wasn't long before he was going along with Widow Benton when she
went on her foraging expeditions to top up her pharmacopoeia.  Thomson goes on to explain how, at four years old, he was out in the field and came across a plant he'd never seen before.

Out of curiosity, he decided to chew some of the pods that were present on this strange plant. The result was that he was violently sick. The strong, very quick emetic action of this plant stuck in his mind, and he even admits to encouraging the local boys to chew  the pods "merely by way of sport", knowing that they would vomit. And so, in this way, lobelia was 'discovered'. He was to make the discovery of its medicinal potential, after witnessing a man 'overdose' on the herb and vomit violently, after which he claimed to feel better than he had in a long time. As a man, Thomson went on to develop a system of healing that
involved the use of diaphoretic herbs and hot steam baths. He believed that all illness was as a result of 'cold', and so, to him, logic stated that heat and warmth were needed to encourage the patient to 'sweat out' their illnesses.

This is never more apparent than in a few lines of a poem that Thomson wrote:

See, when the patient's taken sick,
Coldness has gained the day
And fever comes as nature's friend,
To drive the cold away.

He appeared to have a certain amount of success with his system, and even went on to patent it and call it " Thomson's improved system of Botanic practice of Medicine".

Throughout his autobiography, however, it is clear that Thomson had a deep hatred for the 'Doctors' who had by now made an appearance, and were prevalent in his adult years. Thomson was very much against the way the Doctors of the time approached medicine. The use of mercury, violent laxatives, and the process of bleeding patients were all fairly barbaric as far as Thomson was concerned. From reading his autobiography, it is plainly evident that Thomson was under the impression that these Doctors were out to
ruin his profession and reputation, because they were jealous of and threatened by his success.

They quickly condemned lobelia as being a 'deadly poison' and in 1809 Thomson was charged with the murder of Ezra Lovett, who had been a patient of his who had died in his care. There were some
additional charges, pertaining to further counts of murder, on people whose identities were unknown. His murder weapon was his wonder herb, lobelia, which he was accused of wilfully poisoning his patients with. Thomson was found not guilty of these charges, and was acquitted.

Another famous trial which surfaced in Thomson's heyday, was that of Dr. R. K. Frost, who was
accused of the manslaughter of Tiberius .G. French by means of a Thomsonian course of lobelia in 1837, for which Frost was found guilty of manslaughter in the fourth degree. The jury recommended he was put to the mercy of the court, and he was duly sentenced to three months imprisonment. Samuel Thomson died on October 4th 1843, but the arguments for and against his beloved lobelia which had raged throughout his life, were never to go away.

One has to wonder why some people continue to see lobelia as being a deadly poison. Is it because the man credited with its discovery, amongst others, was tried for murder, accused of poisoning his patients with it? Had he been founds guilty, then yes I would see this as probably being the main reason. But he was found not guilty and acquitted. Whatever had killed these people, it probably wasn't, in all fairness all down to Thomson's lobelia. Thomson stood firm with his theory that lobelia was a safe medicine, he even used it himself when he was sick on his deathbed. Thomson used the herb many times without implications, and indeed with a great degree of success. At the trial of Dr Frost, one particular witness was asked, "How much lobelia would it take to kill a man?" to which the witness replied, " I have said that I have given half a pound, and that it did not kill".

So why, in today's modern society, are we still so divided over the safety of this herb? I was amazed to find that two sources of my research had completely differing views as to the safety of this herb. On
the one hand, from the book " Dr. Stuart's Encyclopaedia of Herbs and Herbalism", written by the acclaimed Herbalist Dr. Malcolm Stuart, in his write up on lobelia, he clearly states at the end of the section that lobelia is 'POISONOUS - may be fatal'.  However, on one particular commercial website I visited, they had a newsletter entitled 'Lobelia - native American wonder herb', which stated "Lobelia is so free from any destructive side effects, that it can also be used successfully on new-born children". It hardly seems possible that they can be talking about the same herb. To study this further, I feel it is prudent to look much closer at the herb itself, and examine its constituents to see if the answer lies with them.

Lobelia contains something in the region of fourteen alkaloid constituents, as well as lobelic acid, resins, lipids, an essential oil and inflatin. The most notable of lobelia's alkaloids is lobeline (chemical formula C22H27NO2) which is a yellow oil, having a tobacco-like taste and smell, and being insoluble in water. It is a pyridine-derived alkaloid, (an alkaloid group commonly found in the tobacco group of plants), which is
acrid, irritating and unstable, having pharmacological actions similar, though less potent and less addictive, than nicotine. It is lobeline that is responsible for most of lobelia's actions, and has been used as a
traditional herbal approach to stop people smoking, with differing reports of success.

Proctor first extracted lobeline from lobelia in 1838. Lobeline exists in combination with lobelic acid, which was discovered by Pereira, and the pair work together, being exceedingly active emetics. Though stable
when combined with lobelic acid, and its other constituent parts, lobeline readily decomposes when freed from contact with the other constituents of the plant. If heat is applied to either an aqueous preparation or an alcoholic tincture of lobelia, the lobeline is destroyed and the herbal preparation then becomes unstable. Lobelia also contains a non-basic substance called inflatin. Unimportant medicinally, it is odourless,
tasteless and insoluble in water. Lobelianin is also present, this being a non-acrid volatile oil, which has a pungent smell and little taste.

Lobeline, being the main active principle, is responsible for the majority of the effects on the human body that lobelia has. Lobelia is an exceedingly quick-working remedy, being extremely diffusive and affecting
all parts of the body very quickly. Because of its highly diffusive nature, it is nearly always used in conjunction with a more stable stimulant herb, such as Cayenne (Capsicum frutescens), as stated by Thomson's method of healing. The whole leaf, as opposed to the isolated constituents, is known to be antispasmodic, but it can also cause dermatitis when in contact with the skin. The herb can add expectorant, anti-asthmatic, diaphoretic, emetic, sialagogue, pectoral, counter irritant and relaxant to its list of therapeutic properties.

It has been shown that lobeline stimulates the respiratory centre within the brain's stem, producing stronger and deeper breathing, which goes some way to help explain why lobelia is useful for respiratory complaints. It also has a more direct effect on the lungs, relaxing the muscles of the smaller bronchial tubes, and so opening the airways, stimulating breathing and promoting the coughing up of phlegm. It is this action that makes it invaluable in the treatment of many respiratory disorders such as croup, bronchitis, asthma, whooping cough and pleurisy. Not only will it have this relaxing effect on the bronchioles in the lungs, its diffusive nature means that it will quickly relax any contracted parts of the respiratory system, including the oesophagus, glottis and larynx, allowing oxygenated blood to flow freely. 

It also helps to strengthen the walls of the blood vessels, which in turn then help to propel the blood along, helping with the flow of oxygen throughout the body. Its reputation as a very effective relaxant, has
led to its use in years gone by, by midwives during childbirth, where it is used to clear passages and to greatly reduce the level of pain due to the muscle contractions. It can be used equally well externally, the infusion being used in cases of opthalmia, the tincture being used as a local application to sprains, strained muscles, bruises or some skin diseases, and it has been used in combination with cayenne (Capsicum frutescens) as a chest and sinus rub. 

The oil is of value in the treatment of tetanus. Lobelia has been referred to as the 'smart' or 'thinking' herb, due to its ability to almost make conscious decisions, and be selective about how to respond to a certain ailment or condition. For example, in pregnancy, if the foetus is not thriving or in deformed, or even dead, then lobelia will abort that foetus. If however, the foetus is strong and healthy but the mother is weak and ailing, it will cause the mother to improve and strengthen until her baby is born.

Having explored the therapeutic effects of lobelia and its chemical constituents, it seems logical to me that the next step should be to look at therapeutic dosage of the herb. The effects listed above are all, I think its fair to say, positive effects, aimed at helping the patients to regain their health, and not at harming them. In researching this subject, one phrase that kept appearing, in conjunction with the therapeutic properties of the herb was 'low dosage'. So, in order to make the best use of lobelia as a healing herb, what constitutes a low - and therefore apparently safe - dose?

On one Internet site (Henriette's Herbal Homepage), I found a list of classic herbal works, and one of these was King's American Dispensatory. On this page there was a lot of information about lobelia, and
one part I found very interesting, was a piece describing the affects of lobelia on the body from the first introduction of the herb orally. Though not an exact copy of what was written, the following gives the general gist of the affect of the lobelia as it is taken.

It is important to take a minute or two to compare some of these dosages. In my own opinion, Sources 1 to 4 are all very much the same, in some cases (as with Source 1), giving no indication of frequency of the dosage mentioned. Sources 5 and 6 proved particularly interesting to me on further examination, and it is for this reason that I have chosen to look at them in more depth, rather than the other 4. When comparing the dosages stated in source 5 and source 6, there seems to be a noticeable difference in dosage levels. 

This small dosage of Lobelia (0.2-0.6 grams) is something in the region of ten times larger than the recommended dosage (0.02-0.05 grams) in source 6. I would consider a 'recommended' dosage to be the most favourable or advisable amount of that herb to administer to a patient at any one time, however this 'recommended' dosage is ten times smaller than the small dosage in source 5.

For an herb known to be as potent and fast acting as Lobelia, I found it quite astounding that there could be such a difference between a recommended dose from one source and a small dose from another source. This is especially so when the recommended dosage was ten times smaller than the small dosage. I personally would have expected a small dose and a recommended dose to have been pretty much the same, with perhaps the small dosage being a little smaller than the recommended one. Knowing the very
nature of lobelia as a healing herb, it has become obvious that tiny amounts can produce profound effects, and it would make sense to me that a recommended dosage should be standard across the board. To me, this would make sense wherever lobelia is used, but this just doesn't seem to be the case.

The next area of comparison I wanted to look at was between the moderate dosage of Source 5 (0.4-1.5 grams ) and the Maximum permitted dosage of Source 6 (0.6 grams (daily total)).

Unfortunately, the information given for this source did not clarify whether these figures in Source 5 comprise the daily total (i.e. no more than 1.5 grams to be given in 1 day) or if 1.5 grams could be given 3 times daily (making a daily total of 4.5 grams). This maximum permitted dosage in Source 6 is given in individual doses of 0.2 grams of Lobelia given 3 times daily. This individual dosage is half the size of the lower end of the moderate dose.

In the above example, the lack of information regarding the regularity of dosages in Source 5 makes interpreting the data a bit more difficult. It can be seen, however, that the maximum permitted daily dosage in Source 6 is about comparable to the smaller end of the moderate dosage in Source 5. Indeed, the top end of the moderate dosage of Source 5 is over six times larger than the maximum permitted in Source 6 (if both are taken as individual doses). 

If considering the lower ends of both ranges, the lower dosage of Source 5 is still twice the amount of the individual dosage of Source 6. This again I find quite astounding, as to my mind 'moderate' means 'not going to extremes, medium'. This to me would imply a dose that was of fairly average proportions, however quite clearly the moderate dosage of Source 5 would be considered 'extreme' in Source 6. Of course, I am assuming that the dosages given in Source 5 are the individual doses, but even if taking the doses in Source 5 to be the maximum daily totals, at the higher end it is still over twice the amount.

When I went on to examine these sources further. Another feature came to my attention, which I think can shed a whole lot of light on this anomaly. Source 5 came from a book written by an American author,
whilst source 6 was from a book with an English author. Now, this may seem like a fairly unimportant point, but it does in fact show us an awful lot about different countries attitudes towards this herb. As just stated above, source 6 is a book written by the British herbalist Simon Mills MA, F.N.I.M.H. At the time of publishing (1989), the dosages for Lobelia given in this book were true according to the 1968 Medicines Act in the U.K. The presence of the alkaloid lobeline has led to the control of the herb under
the terms of the above mentioned act, in the UK (unfortunately I was unable to find out whether these dosage restrictions have changed any since then or whether they still remain the same). This means it is not permitted to be sold to members of the general public, but only to qualified herbalists.

In America however, there are no such regulations restricting the use of lobelia, and so it is readily sold to the general public and qualified therapists alike. This has been obvious to me when scouring the Internet for
herbal suppliers. The British sites I've visited, including my main herbal supplier, do not stock lobelia in any form. American sites have the dried herb, as well as the tincture and liquid extract readily available to anyone who should care to try it. It is no wonder then, that with these differing attitudes in two different countries, that there should be noticeable differences in what is considered a safe dose. So who is right?

It seems to me that there are a number of factors that need to be considered when trying to establish what constitutes a safe dose of lobelia. Opinions are clearly influenced by where in the world you live but what is or is not safe depends to a greater extent on your personal knowledge and experience with using the
herb. Where in the world you are practicing from can mean the difference between there being a legal limit to the herb's use and the freedom to use it as you see fit. Where legal limitations exist, dosage is set to a clearly defined limit.

Where there are no legal limitations, one has to rely on one's own knowledge and experience. In my opinion, there is no set 'safe' dosage for this herb. I feel it must truly rest with the expansive knowledge and, probably more importantly, to the individual's experience of its use, to decide how much is safe to use. A safe dose is a dose that produces the therapeutic effects desired whilst producing the least amount of unwanted ones (something echoed in Source 2). I realise that this may seem like a cop-out, and that I haven't come up with a magic number that represents a safe level, but to my mind, if experienced practitioners are able to safely and successfully utilise doses upwards of the maximum permitted dosage of
the UK, then that counts as using the herb in a safe dosage.

Having looked at what constitutes a safe dosage of lobelia, I think it is pertinent to consider what constitutes an overdose.  Of course, when considering the dosage of any medicinal herb, the health and condition, age, size, robustness etc. of the patient must be taken into consideration. What is a safe dose for one individual could be lethal to another.

Contra-indications also have to be taken into account, and along with this, any drug interactions that there could be, must be considered. Some of the contra-indications I have found for lobelia are nervous prostration, shock, paralysis, pneumonia or fluid around the lungs, heart disease and high blood
pressure. The use of lobelia is also contra-indicated in pregnancy, due to the similarity of lobeline to nicotine, although lobelia has been used with success and safety by midwives to assist mothers during labour. 

It is suggested that lobelia should not be used alongside nicotine based products (such as the readily available nicotine patches, marketed to help smokers give up smoking). One assumes that this is because using the two agents together would lead to something like a 'nicotine overdose'. I have also seen it said that lobelia should not be used on children under the age of six years, unless absolutely necessary, and even then with extreme caution. It is also stated that the herb should not be used for more than one month consecutively. So, now I have looked at the contra-indications of this herb, I feel I should now look at what the symptoms might be should an overdose be given in error.

From the research I have done, it would appear that an overdose of lobelia would constitute some of the following; weakness, stupor, tremors, paralysis, rapid breathing and pulse, hypothermia, pinpoint pupils, sweating, prostration, unconsciousness, convulsions, coma and eventually death, usually as a result of respiratory paralysis. A fairly standard set of symptoms that one might expect had they been given or taken an overdose of a 'poison' medicine. Some might readily argue that taking enough of the herb to induce vomiting would be consistent with an overdose. This might be considered true, however vomiting used to be a common herbal practice in the treatment of many ailments where it was felt beneficial to allow the patient to rid themselves of harmful toxins by the act of vomiting.  This was also done to clear the system of stubborn mucous in cases of asthma and other respiratory problems. There is also the idea that the vomiting caused by lobelia is, in itself, an overdose limiting function, wherein small amounts of the herb are ejected from the body before an overdose level can be ingested.

However, when considering the very nature of the herb, it certainly crossed my mind that perhaps giving an overdose of lobelia would be harder than some of those opposed to the herb, would be prepared to
admit. I'm not saying that an overdose of lobelia isn't possible - of course it is.  As with any other herb it's possible to give a dose that would overwhelm certain patients, such as the very young or very old. In such
cases, these patients may be viewed as unsuitable for treatment with lobelia and would be treated with a more suitable alternative. I would, however, be prepared to say that I would think it somewhat difficult to give anyone an overdose level of lobelia that would cause the above symptoms. The extremely emetic nature of the herb would act almost as a natural antidote to overdose, simply because a small amount can cause emesis and so the plant would be ejected from the system before toxicity could occur and any of the
above symptoms were able to manifest. It would seem plausible that overdose would only happen if a large amount of the plant were consumed and vomiting occurred but the plant was not fully ejected from the body.

To conclude, it would seem to me that lobelia is as much a poison as any other herbal, or indeed alkaloid drug can be. There are many herbs that can cause serious side affects if used incorrectly or abused.
There are many that can be given in 'overdose' measures, but which are still deemed admissible today. There are probably many more 'orthodox' medicines being prescribed in huge numbers today that are far more deadly. The likes of Aspirin and Paracetamol are so readily available today that it's almost impossible to go to a supermarket or corner shop without seeing them on the shelves. Chances are, more people have died overdosing on the likes of Paracetamol and Aspirin than have died from lobelia poisoning. 

Its all a matter of knowing how lobelia works, recognising that it is extremely powerful and quick working, and knowing the right dose for the effect you are hoping to achieve. It is interesting to note that one of the first things it is recommended to do in the case of an aspirin overdose is to induce vomiting. Lobelia will do this for you naturally, and yet this action is not usually recognised to be the herbs anti - overdose mechanism, instead it is all to often seen as one of its worst, debilitating side effects.

One of the areas where I've seen the most conflict is between the world of herbal medicine and that of so called  'orthodox' medicine. It is clear that the persecution of successful herbal remedies was certainly prevalent in Thomson's time, and for the most part it is still around today. Orthodox doctors are still of the belief that herbal medicines are of no use as the amounts of the useful compounds contained in the plants are not standardised. They tend be under the impression that any people that claim to be cured by herbal remedies are probably just experiencing a placebo effect, that its all in their minds. 

This is, of course, despite the fact that many of the modern drugs that these doctors are probably in the habit of giving out on a daily basis will be derived from plants. To them, herbs such a lobelia are exactly the justification they need to say that there is no room in this modern world for such practices as herbal medicine, where dangerous poisons exist to be used on the unsuspecting patient.

Although in countries like the Britain where the use of plants like lobelia is restricted, modern day herbalist are still aware of the positive uses of the herb, although some do tend to play these down. They are bound by rules and regulations, which prevent them from perhaps using it as gleefully as their American counterparts. Perhaps because of this, some British herbalists tend towards thinking of it as more of a poison than as a help - although they always make reference to its beneficial use in asthma and its wonderful relaxant abilities. 

Restriction has meant that their experiences with the herb have been few, and if they had been allowed a
freer rein, they might have learnt to understand it better, understood how to use it to its full potential and found it as marvellous as the Americans seem to. One has to wonder if things would have been different if Thomson had been British, if lobelia had been native to these shores and if it had a long history of medicinal use by our indigenous people.

Surely if it was such a poisonous plant, the Native American people would not have used it so readily for so many years? If high numbers of their tribes and family's had been consistently poisoned, and perished
and died after using the herb, then surely its continued usage would have stopped. Its safe to say that the Native American people would not have been highly trained doctors or herbal practitioners as you see in the world today, although they would of course, have years of experience of using healing herbs. The knowledge and experience gained from generations of people living in equality with the natural world would have been passed down through family lines, and this would be considered by some, far superior to
the training available to those who choose to learn the art today.

However, they would have had no concept of what a milligram was, or a 'maximum permitted dosage'. They would have seen that giving this herb to those with asthma or similar complaints showed considerable improvement and that if too much was taken, that person would quickly complain of nausea and then vomit the herb back up. In their eyes it would have been a wonder herb, able to cure in the right quantity, but also containing a foolproof method of stopping the administration of overdoses. I feel that sometimes, we need to stop and think, and reflect upon what we can learn from those who went before us, as they didn't have modern technology to help them heal themselves, and only those remedies that were of significant benefit will have stood the test of time.