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{{Short description|Genus of flowering plants in the daisy family Asteraceae}}
:''This article is about the flowering plant. For Superorder Echinacea (Echinodermata) see [[Sea urchin]]''
{{About|the flowering plant|the sea urchins|Echinacea (animal)}}
{{Taxobox
{{Use shortened footnotes|date=October 2022}}
| name = ''Echinacea''
{{Automatic taxobox
| image = EchinaceaPurpureaMaxima1a.UME.JPG
|image = EchinaceaPurpureaMaxima1a.UME.JPG
| image_width = 240px
| image_caption = ''Echinacea purpurea''
|image_caption = ''Echinacea purpurea'' 'Maxima'
|display_parents = 3
| regnum = [[Plant]]ae
|taxon = Echinacea
| divisio = [[flowering plant|Magnoliophyta]]
|authority = [[Conrad Moench|Moench]], 1794
| classis = [[dicotyledon|Magnoliopsida]]
|synonyms = ''Brauneria'' <small>Necker ex T.C.Porter & [[Nathaniel Lord Britton|Britton]]</small><br/>
| ordo = [[Asterales]]
''Helichroa'' <small>[[Constantine Samuel Rafinesque-Schmaltz|Raf.]]</small>
| familia = [[Asteraceae]]
| tribus = [[Heliantheae]]
| genus = '''''Echinacea'''''
| subdivision_ranks = Species
| subdivision = See text
}}
}}
'''''Echinacea''''', commonly called '''Purple coneflower''', is a genus of nine species of [[herbaceous]] plants in the Family [[Asteraceae]]. All are strictly native to eastern and central [[North America]]. It was discovered in the Lewis and Clark Expedition, on August 13, 1805. The plants have large showy heads of composite flowers, blooming from early to late summer. Some species are used in [[herbalism|herbal medicines]].


'''''Echinacea''''' {{IPAc-en|ˌ|ɛ|k|ᵻ|ˈ|n|eɪ|s|i|ə|,_|ˌ|ɛ|k|ᵻ|ˈ|n|eɪ|ʃ|i|ə}}<ref>https://www.merriam-webster.com/dictionary/echinacea </ref> is a [[Genus Species|genus]] of [[Herbaceous plant|herbaceous]] [[flowering plant]]s in the [[Asteraceae|daisy family]]. It has ten species, which are commonly called '''coneflowers'''. They are native only in eastern and central [[North America]], where they grow in moist to dry [[prairie]]s and open wooded areas. They have large, showy [[Flower heads|heads]] of composite [[flower]]s, blooming in summer. The generic name is derived from the Greek word {{lang|grc|ἐχῖνος}} (''{{transliteration|grc|ekhinos}}''), meaning "[[hedgehog]]", due to the spiny central disk. These flowering plants and their parts have different uses. Some species are cultivated in gardens for their showy flowers. Two of the species, ''[[Echinacea tennesseensis|E. tennesseensis]]'' and ''[[Echinacea laevigata|E. laevigata]]'', were formerly listed in the United States as [[endangered species]]; ''E. tennesseensis'' has been delisted due to recovery<ref>{{cite web|url=https://ecos.fws.gov/ecp/species/6850|title=Tennessee purple coneflower (''Echinacea tennesseensis'')|website=Environmental Conservation Online System|publisher=U.S. Fish & Wildlife Service|access-date=19 June 2023}}</ref> and ''E. laevigata'' is now listed as threatened.<ref>{{cite web|url=https://ecos.fws.gov/ecp/species/3473|title=Smooth coneflower (''Echinacea laevigata'')|publisher=U.S. Fish & Wildlife Service|website=Environmental Conservation Online System|access-date=19 June 2023}}</ref>
[[Image:Echinacea-purpura-flower-closeup.jpg|thumb|left|''E. purpurea'' flower centre]]


''[[Echinacea purpurea]]'' is used in [[traditional medicine]]. Although commonly sold as a [[dietary supplement]], there is insufficient [[evidence-based medicine|scientific evidence]] that ''Echinacea'' products are effective or safe for improving health or treating any disease.
The genus name is from the [[Greek language|Greek]] ''echino'', meaning "spiny", due to the spiny central disk. They are [[herbaceous]], drought-tolerant [[perennial plant]]s growing to 1 or 2 m in height. The [[leaf|leaves]] are lanceolate to elliptic, 10–20 cm long and 1.5–10 cm broad. Like all Asteraceae, the [[flower]]s are a composite [[inflorescence]], with purple (rarely yellow or white) florets arranged in a prominent, somewhat cone-shaped [[head (botany)|head]]; "cone-shaped" because the petals of the outer ray florets tend to point downward (are reflexed) once the flower head opens, thus forming a cone.<br clear = left>


==Species==
== Description ==
[[Image:Yellow Coneflower Echinacea paradoxa Closeup Bee 3008px.jpg|thumb|right|A [[Bee]] on an ''Echinacea paradoxa'' flower]]
[[Image:Echinacea 3.jpg|thumb|right|The spiny center of the head showing the paleae, from which the name derives]][[Image:Yellow Coneflower Echinacea paradoxa Closeup Bee 3008px.jpg|thumb|right|A bee on an ''Echinacea paradoxa'' head ([[inflorescence]])]]
[[Image:Bee pollinating a flower at the National Zoo.jpg|thumb|right|A bee on an ''[[Echinacea purpurea]]'' head]]
The species of ''Echinacea'' are:
[[File:Fasciation on an Echinacea purpurea.jpg|thumb|[[Fasciation]] on an ''Echinacea purpurea'']]
*''[[Echinacea angustifolia]]'' - Narrow-leaf Coneflower
''Echinacea'' species are [[Herbaceous plant|herbaceous]], [[drought]]-tolerant [[perennial plant]]s growing up to {{convert|140|cm|ftin|abbr=on}} in height. They grow from [[taproot]]s, except ''[[Echinacea purpurea|E. purpurea]]'', which grows from a short [[caudex]] with fibrous roots. They have erect stems that in most species are unbranched. Both the [[Basal leaf|basal]] and cauline (stem) leaves are arranged [[Alternate leaf|alternately]]. The leaves are normally hairy with a rough texture, having [[uniseriate]] [[trichome]]s (1–4 rings of cells), but sometimes they lack hairs. The basal leaves and the lower stem leaves have [[petiole (botany)|petiole]]s, and as the leaves progress up the stem the [[petiole (botany)|petiole]]s often decrease in length. The leaf blades in different species may have one, three, or five nerves. Some species have linear to [[Leaf shape|lanceolate]] leaves, and others have [[Leaf shape|elliptic- to ovate-shaped leaves]]; often the leaves decrease in size as they progress up the stems. Leaf bases gradually increase in width away from the [[petiole (botany)|petiole]]s or the bases are [[Leaf shape|rounded to heart shaped]]. Most species have [[leaf margins]] that are [[Leaf shape|entire]], but sometimes they are [[Leaf shape|dentate or serrate]].
*''[[Echinacea atrorubens]]'' - Topeka Purple Coneflower
*''[[Echinacea laevigata]]'' - Smooth Coneflower, Smooth Purple Coneflower
*''[[Echinacea pallida]]'' - Pale Purple Coneflower
*''[[Echinacea paradoxa]]'' - Yellow Coneflower, Bush's Purple Coneflower
*''[[Echinacea purpurea]]'' - Purple Coneflower, Eastern Purple Coneflower
*''[[Echinacea sanguinea]]'' - Sanguine purple coneflower
*''[[Echinacea simulata]]'' - Wavyleaf Purple Coneflower
*''[[Echinacea tennesseensis]]'' - Tennessee Coneflower


The flowers are collected together into single rounded [[Flower heads|heads]] at the ends of long [[Peduncle (botany)|peduncles]]. The [[inflorescence]]s have crateriform to [[wikt:hemisphere|hemispheric]] shaped involucres which are {{convert|12|-|40|mm|in|abbr=on}} wide. The [[phyllary|phyllaries]], or [[bract]]s below the flower head, are persistent and number 15–50. The phyllaries are produced in a 2–4 series. The receptacles are hemispheric to [[conic]]. The [[palea (botany)|paleae]] ([[chaff]]s on the receptacles of many [[Asteraceae]]) have orange to reddish purple ends, and are longer than the disc corollas. The paleae bases partially surrounding the [[cypselae]], and are keeled with the [[apical meristem|apices]] abruptly constricted to [[Leaf shape|awn-like]] tips. The [[ray florets]] number 8–21 and the [[Petal|corollas]] are dark purple to pale pink, white, or yellow. The tubes of the [[Corolla (flower)|corolla]] are hairless or sparsely hairy, and the [[Leaf|laminae]] are spreading, reflexed, or drooping in habit and [[Leaf shape|linear to elliptic or obovate in shape]]. The [[abaxial]] faces of the [[Leaf|laminae]] are [[Glossary of botanical terms#glabrous|glabrous]] or moderately hairy. The [[flower heads]] have typically 200–300 fertile, bisexual [[disc floret]]s but some have more. The [[Petal|corollas]] are pinkish, greenish, reddish-purple or yellow and have tubes shorter than the throats. The [[pollen]] is normally yellow in most species, but usually white in ''[[Echinacea pallida|E. pallida]]''. The three or four-angled [[fruit]]s ([[cypselae]]), are tan or bicolored with a dark brown band distally. The [[pappi]] are persistent and variously crown-shaped with 0 to 4 or more prominent teeth. x = 11.{{sfn|Urbatsch et al|2006}}
[[Image:Echinacea 3.jpg|thumb|right|The spiny flower center from which the name derives]]


Like all [[Asteraceae|members of the sunflower family]], the flowering structure is a composite [[inflorescence]], with rose-colored (rarely yellow or white) [[flower|florets]] arranged in a prominent, somewhat cone-shaped [[head (botany)|head]] – "cone-shaped" because the petals of the outer ray florets tend to point downward (are reflexed) once the [[flower head]] opens, thus forming a cone. Plants are generally long lived, with distinctive flowers. The common name "coneflower" comes from the characteristic center "cone" at the center of the flower head.
==Medicinal Effects==
A controlled [[double-blind study]] from the University of Virginia School of Medicine and documented in the New England Journal of Medicine<ref name='NEJM_Turner'> {{cite journal|title=An Evaluation of Echinacea angustifolia in Experimental Rhinovirus Infections|journal=The New England Journal of Medicine|date=2005-07-28|first=Ronald B.|last=Turner|coauthors=Rudolf Bauer, Karin Woelkart, Thomas C. Hulsey, and J. David Gangemi|volume=353|issue=|pages=341-348|id=PMID 16049208 |url=http://content.nejm.org/cgi/content/abstract/353/4/341|format=|accessdate=2008-03-24 }}</ref> stated that ''Echinacea'' extracts had "no clinically significant effects" on rates of infection or duration or intensity of symptoms. The effects held when the herb was taken immediately following infectious exposure and when taken as a [[prophylaxis]] starting a week prior to exposure.


== Taxonomy ==
An earlier University of Maryland review based on 13 European studies concluded that ''Echinacea'', when taken at first sign of a cold, reduced cold symptoms or shortened their duration.<ref>Paul Bergner. "Healing Power of Echinacea and Goldenseal and Other Immune System Herbs" (The Healing Power)1997</ref> The review also found that three of four published studies concluded that taking ''Echinacea'' to prevent a cold was ineffective.


The first ''Echinacea'' species were discovered by European explorers in forests of southeastern North America during the 18th century.{{sfn|Binns et al|2004}} The [[genus]] ''Echinacea'' was then formally described by [[Linnaeus]] in 1753, and this specimen as one of five species of ''[[Rudbeckia]]'', ''[[Rudbeckia purpurea]]''.{{sfn|Linnaeus|1753}}{{sfn|Binns et al|2001}} [[Conrad Moench]] subsequently reclassified it in 1794 as the separate but related genus, ''Echinacea'', with the single species ''Echinacea purpurea'',{{sfn|Moench|1794}}{{sfn|Kindscher|Wittenberg|2006|p=9}} so that the [[botanical authority]] is given as (L.) Moench.{{sfn|Tropicos|2021}} In 1818, [[Thomas Nuttall|Nuttall]], using the original name, described a variety of ''Rudbeckia purpurea'', which he named ''Rudbeckia purpurea'' var ''serotina''.{{sfn|Nuttall|1818|p=2:178}} In 1836, [[De Candolle]] elevated this variety to a species in its own right, as ''[[Echinacea serotina]]'' (Nutt.) DC, by which time four species of the genus ''Echinacea'' were recognised.{{sfn|de Candolle|1824–1873|p=5:&nbsp;554}}{{sfn|Binns et al|2004}}
As with any herbal preparation, individual doses may vary significantly in active chemical composition. In addition to poor process control which may affect inter- and intra-batch homogeneity, species, plant part, extraction method, and contamination or adulteration with other products all lead to variability between products.<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16437427&query_hl=4&itool=pubmed_docsum Linde K, ''et al''. ''Echinacea'' for preventing and treating the common cold. ''Cochrane Database Syst Rev''. 2006 Jan 25;(1):CD000530]</ref><ref name=consumerlab>{{cite web | url = http://www.consumerlab.com/results/echinacea.asp | title = Product Review: Echinacea | accessdate = 2007-08-02 | date = [[2004-03-18]] | publisher = ConsumerLab.com, LLC }}</ref>


Historically, there has been much confusion over the taxonomic treatment of the genus, largely due to the ease with which the taxa [[Hybrid (biology)|hybridize]] with [[introgression]] where species ranges overlap, and high morphological variation.{{sfn|McGregor|1968}}{{sfn|Kindscher|Wittenberg|2016|p=38}} Furthermore it was discovered that the [[type specimen]] for ''Echinacea purpurea'' (L) Moench was not the one originally described by Linnaeus, but rather that described by De Candolle as ''Echinacea serotina'' (Nutt.) DC.{{sfn|Binns et al|2004}}
[[European Medicines Agency]] (EMEA) assessed the body of evidence and approved the use of expressed juice and dried expressed juice from fresh flowering aerial parts of [[Echinacea purpurea]], for the short term prevention and treatment of common cold. According to their recommendations: "it should not be used for more than 10 days. The use in children below 1 year of age is contraindicated, because of theoretically possible undesirable effect on immature immune system. The use in children between 1 and 12 years of age is not recommended, because efficacy has not been sufficiently documented although specific risks are not documented. In the absence of sufficient data, the use in pregnancy and lactation is not recommended." <ref>EMEA Monograph on Echinacea purpurea[http://www.emea.europa.eu/pdfs/human/hmpc/echinaceae_purpureae_herba/10494506enfin.pdf] </ref>
Assesment report is also published <ref>[http://www.emea.europa.eu/htms/human/hmpc/monograph/echinaceae_purpureae_herba.htm]</ref>


=== Subdivision ===
===Popular Belief and Traditional Use===
Echinacea is popularly believed to be an [[immunostimulator]], stimulating the body's non-specific [[immune system]] and warding off [[infection]]s. A common reference source for believers is a 2007 [[meta-analysis]] in The Lancet Infectious Diseases;<ref>Shah SA, Sander S, White CM, Rinaldi M, Coleman CI. Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis.Lancet Infect Dis. 2007 Jul;7(7):473-80. [http://www.thelancet.com/journals/laninf/article/PIIS1473309907701603/abstract] </ref> however, this study fails to indicate important confounding factors that could drive the reported conclusion. The studies pooled in the meta-analysis used different types of ''Echinacea'', different parts of the plant, and various dosages. This review cannot inform recommendations on the efficacy of any particular type of ''Echinacea'', dosage, or treatment regimen. The safety of ''Echinacea'' under long-term use is also unknown.<ref>{{cite journal |author=Caruso TJ, Gwaltney JM |title=Treatment of the common cold with echinacea: a structured review |journal=Clin. Infect. Dis. |volume=40 |issue=6 |pages=807-10 |year=2005 |pmid=15736012 |doi=10.1086/428061}}</ref>


Many taxonomic treatments of the genus ''Echinacea'' have recorded varying numbers of subordinate [[taxa]], ranging between 2 and 11.{{sfn|Binns et al|2004}} One of the most widely adopted schemes was that of McGregor (1968),{{sfn|McGregor|1968}} which included nine species, of which two, ''E. angustifolia'' DC and ''E. paradoxa'' (Norton) Britton, were further divided into two [[cultivar|varietals]].{{sfn|Kindscher|Wittenberg|2006|p=9}} Treatments that include ten species, differ by the addition of ''E. serotina'' (Nutt.) DC.{{sfn|Flagel et al|2008}} Alternative classification include with four species and eight subspecies, and two subgenera with four species, has been proposed, based on [[Plant morphology|morphology]] alone, but has proved controversial.{{sfn|Kindscher|Wittenberg|2016|p=38}} This recognised [[subgenus]] ''Echinacea'', with the single species ''E. purpurea'', and subgenus ''Pallida'', with three species, ''E. atrorubens'', ''E. laevigata'' and ''E. pallida''. In this scheme, other taxa are reduced to [[variety (botany)|variety]] rank, e.g. ''E. atrorubens'' var. ''neglecta''.{{sfn|Binns et al|2001}}{{sfn|Binns et al|2002}} Subsequently, McGregor's classification was preserved in the [[Flora of North America]] (2006).{{sfn|Urbatsch et al|2006}}
===History===
''Echinacea angustifolia'' rhizome was used by North American [[Plains Indians]], perhaps more than most other plants, for various herbal remedies. Echinacea was one of the basic antimicrobial herbs of [[Eclectic medicine]] in the mid 1800s through the early 1900s, and its use was documented for snakebite and anthrax. In the 1930s "Echinacea" became popular in both Europe and America as an herbal medicine.


[[DNA analysis]] has been applied to determine the number of ''Echinacea'' species, allowing clear distinctions among species based on chemical differences in root [[metabolite]]s. The research concluded that of the 40 genetically diverse populations of ''Echinacea'' studied, there were nine to ten distinct species.{{sfn|Perry|2010}}
===Active substances===
Like most [[crude drug]]s from plant or animal origin, the constituent base for ''Echinacea'' is complex, consisting of a wide variety of chemicals of variable effect and potency. Some chemicals may be directly antimicrobial, while others may work at stimulating or modulating different parts of the immune system. All species have chemical compounds called [[phenols]], which are common to many other plants. Both the phenol compounds [[Cichoric acid|Cichoric]] and [[caftaric acid|caftaric]] are present in ''E. purpurea'', other phenols include [[echinacoside]], which is found in greater levels within ''E. angustifolia'' and ''E. pallida'' roots than in other species. When making herbal remedies, these phenols can serve as markers for the quantity of raw ''Echinacea'' in the product. Other chemical constituents that may be important in ''Echinacea'' health effects include [[alkylamides]] and [[polysaccharide]]s.


====Root or whole plant====
==== Species ====
[[Plants of the World Online]] gives nine accepted species,{{sfn|POWO|2021}} and [[World Flora Online]] gives ten:{{sfn|WFO|2021}}
As with any plant, the chemical make up of ''Echinacea'' is not consistent throughout the organism. In particular, the root has been promoted as containing a more efficacious mixture of active chemicals. A 2003 study in the Journal of the American Medical Association (Taylor ''et al.'' 2003<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14657066&dopt=Abstract "Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial", Taylor, J. A., et al. 2003., ''Journal of the American Medical Association'' 2003 Dec 3;290(21):2824-30]</ref>) found that when ''Echinacea'' products made from the entire plant were taken after the second cold symptom appeared they provided no measurable beneficial effect for children in treating the severity or duration of symptoms caused by the common cold virus. The study has been criticized for using whole-plant extracts instead of root extracts, and the dosages studied were lower than those recommended by herbalists.{{Fact|date=March 2008}} A 2005 study in the New England Journal of Medicine (Turner, 2005<ref name='NEJM_Turner' />) focused on several root extracts, but still found no statistically significant effects on duration, intensity, or prevention of symptoms.
*''[[Echinacea angustifolia]]'' <small></small> &ndash; Narrow-leaf coneflower
*''[[Echinacea atrorubens]]'' <small></small> &ndash; Topeka purple coneflower
*''[[Echinacea laevigata]]'' <small></small> &ndash; Smooth coneflower, smooth purple coneflower
*''[[Echinacea pallida]]'' <small></small> &ndash; Pale purple coneflower
*''[[Echinacea paradoxa]]'' <small></small> &ndash; Yellow coneflower, Bush's purple coneflower
*''[[Echinacea purpurea]]'' <small></small> &ndash; Purple coneflower, eastern purple coneflower
*''[[Echinacea sanguinea]]'' <small></small> &ndash; Sanguine purple coneflower
*''[[Echinacea serotina]]'' <small></small> &ndash; Narrow-leaved purple coneflower
*''[[Echinacea simulata]]'' <small></small> &ndash; Wavyleaf purple coneflower
*''[[Echinacea tennesseensis]]'' <small></small> &ndash; Tennessee coneflower
These two databases differ in their treatment of ''E. serotina'' <small>(Nutt.) DC. </small>, the former considering this as a synonym of ''E. purpurea'' and the latter as a distinct species.


=== Former classification ===
====Frequency of administration====
Proponents of ''Echinacea'' assert that it is not a "one-dose" treatment, and that in order to work effectively, a dose should be taken at the very first sign of a cold symptom. Subsequent doses are called for every two to four hours after the first dose, including during the overnight sleeping period, until the cold symptoms have disappeared.


* ''[[Rudbeckia]]''
====Species====
* ''[[Brauneria]]'' (1790){{sfn|Kindscher|Wittenberg|2016|p=38}}
The several species of ''Echinacea'' differ in their precise chemical constitution, and may provide variable dosages of any active ingredients.


=== Etymology ===
===Side effects and contraindications===
Reported adverse effects of ''Echinacea'' include [[nausea]], [[dizziness]], [[dyspnea]], [[rash]], [[dermatitis]], [[pruritis]], and [[hepatotoxicity]]. These tend to be infrequent, mild, and transient.<ref>{{cite web | last = Cheeseman | first = Mark | title = Echinacea | work = Complementary Medicines Summary | publisher = UK Medicines Information, [[National Health Service]] | date = [[2002-12-13]] | url = http://www.ukmi.nhs.uk/Med_info/documents/EchinaceaCMS.pdf | type = pdf | accessdate = 2007-07-07}}</ref><ref name=MayoSE>{{cite web | url = http://www.mayoclinic.com/health/echinacea/NS_patient-echinacea | title = Echinacea (E. angustifolia DC, E. pallida, E. purpurea) | accessdate = 2007-12-18 | author = [[Mayo Clinic]]}}</ref> ''Echinacea'' should not be taken by persons with progressive systemic and auto-immune disorders, connective tissue disorders, or related diseases. It should not be used with [[immunosuppressants]] or [[hepatotoxicity|hepatotoxic drugs]],<ref name=MayoSE/><ref name="pmid9818800">{{cite journal | author = Miller LG | title = Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions | journal = Arch. Intern. Med. | volume = 158 | issue = 20 | pages = 2200-11 | year = 1998 | pmid = 9818800 | url = http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=9818800 }}</ref>, and has the potential to interfere with anesthesia.<ref name='ACS'> {{cite web|url=http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Echinacea.asp? |title=Echinacea |accessdate=2008-03-24 |date=2007-06-26 |publisher=American Cancer Society }}</ref>


Moench named the genus ''Echinacea'', from the Greek word {{lang|grc|[[wikt:ἐχῖνος|ἐχῖνος]]}} (''{{transliteration|grc|ekhinos}}'') for [[hedgehog]] or [[sea-urchin]], in recognition that in the seed stage, the cone has spiny projections.{{sfn|Kindscher|Wittenberg|2006|p=9}}{{sfn|Plowden|1972|loc=[https://drugs.org/details/manualofplantnam0000plow/page/47 p.&nbsp;7]}}
In one investigation by an independent consumer testing laboratory, 5 of 11 selected retail ''Echinacea'' products failed quality testing. Four of the failing products contained measured levels of phenols believed to be related to potency below the levels stated on the labels. One failing product was contaminated with lead.<ref name=consumerlab />


== Distribution and habitat ==
==Other uses==
Some species of ''Echinacea'', notably ''E. purpurea'', ''E. angustifolia'', and ''E. pallida'', are grown as [[ornamental plant]]s in gardens<ref>[http://www.ars.usda.gov/SP2UserFiles/Place/36251200/Posters/Echinacea_poster2.pdf "A Comprehensive Echinacea Germplasm Collection Located at the North Central Regional Plant Introduction Station"], USDA</ref> They tolerate a wide variety of conditions, maintain attractive foliage throughout the season, and multiply rapidly. Appropriate species are used in [[prairie]] restorations.


''Echinacea'' is restricted to North America, east of the Rocky Mountains, and in the Atlantic drainage area, predominantly the Great Plains and central United States and adjacent areas of Canada.{{sfn|Binns et al|2002}}{{sfn|Binns et al|2004}}{{sfn|Kindscher|2021}} The genus range is from [[Saskatchewan]] in the north to almost the [[Gulf of Mexico]] in Louisiana and Texas in the south, and from the Ohio [[oak savanna]]s, [[Calcareous glade|glades of Tennessee]] and the Carolinas in the east, to the [[Rocky Mountains|Rocky Mountain]] foothills in the west.{{sfn|Flagel et al|2008}}
==References==

{{reflist}}
== Conservation ==

Natural populations of ''Echinacea'' are threatened by over-harvesting of wild specimens for the herbal product trade and modification of their habitats by humans.{{sfn|Kindscher|2021}} Major reductions in the size of populations of ''E. laevigata'' and ''E. tennesseensis'' have led to their classification as [[endangered species]].{{sfn|Binns et al|2002}}{{sfn|Kindscher|2006}} ''E. tennesseensis'' had recovered sufficiently by 2011 that it was removed from the list.{{sfn|Fish and Wildlife Service|2011}}

== Cultivation ==

Many species of ''Echinacea'' are cultivated for commercial use,{{sfn|Binns et al|2002}} while others, notably ''[[Echinacea purpurea|E. purpurea]]'', ''[[Echinacea angustifolia|E. angustifolia]]'', and ''[[Echinacea pallida|E. pallida]]'', are grown as [[ornamental plant]]s in gardens.{{sfn|McCoy et al|2005}} Many cultivars exist, and many of them are asexually propagated to keep them true to type.

== Uses ==

''Echinacea'' has long been used as a [[traditional medicine]].{{sfn|Binns et al|2002}}

=== History ===

''[[Echinacea angustifolia]]'' was widely used by the [[Indigenous peoples of the Americas|North American Indigenous peoples]] as [[traditional medicine|folk medicine]], with archaeological evidence dating back to the 18th century. Traditional use included external application (insect bites, burns, wounds), chewing of roots (throat and tooth infections) and internal use (cough, pain, snake bites, stomach cramps).{{sfn|Hostettmann |2003}}{{sfn|Kindscher|2007|p=156}} Some [[Plains tribes]] used ''Echinacea'' for cold symptoms. The [[Kiowa]] used it for coughs and sore throats, the [[Cheyenne]] for sore throats, the [[Pawnee people|Pawnee]] for headaches, and many tribes, including the [[Lakota people|Lakota]], used it as a [[analgesic|pain medication]].{{sfn|Moerman|1998|p=205}} Early European settlers noticed this and began to develop their own uses. According to [[Wallace Sampson]], its modern use for the [[common cold]] began when a Swiss [[herbal supplement]] maker was told that ''Echinacea'' was used for cold prevention by [[Native American tribes]] who lived in the area of [[South Dakota]].{{sfn|Chang|2007}} The first preparation was Meyers Blood Purifier ({{Circa|1880}}), which was promoted for [[neuralgia]], rattlesnake bites and [[rheumatism]]. By the start of the 20th century it was the most common herbal remedy in America.{{citation needed|date=November 2021}} Commercial cultivation began in Germany in the late 1930s, and in Switzerland in 1950, by A. Vogel. Soon chemists and pharmacologists began the task of identifying potentially active ingredients and their properties. These included [[wikt:alyklamide|alyklamides]], [[cichoric acid]], [[echinacoside]], [[wikt:ketoalkene|ketoalkenes]] and [[polysaccharides]]. Extracts appeared to exhibit [[immunostimulant]] properties and were mainly promoted for the prevention and treatment of [[colds]], [[influenza]] and [[sepsis]]. Despite many different preparations and hundreds of publications, no exact identification of a truly active ingredient has been identified.{{sfn|Hostettmann |2003}}

=== Infectious diseases ===

''Echinacea'' is of no benefit as a treatment for the common cold.{{sfn|Karsch-Volk et al|2014}} A 2016 [[meta-analysis]] found tentative evidence that use of ''Echinacea'' [[extract]]s reduced the risk of repeated [[respiratory infection]]s.{{sfn|Schapowal et al|2015}}

=== Side effects ===

When taken by mouth, ''Echinacea'' does not usually cause [[side effects]],{{sfn|NCCIH|2020}} but may have undesirable interactions with various [[drug]]s prescribed for diseases, such as [[heart disease]], [[bleeding]], and [[autoimmune disease]]s, such as [[rheumatoid arthritis]], [[Systemic lupus erythematosus|lupus]], or [[psoriasis]].{{sfn|Natural Standard Research Collaboration|2013}}{{sfn|Drugsite|2021}} Although there are no specific case reports of [[drug interactions]] with ''Echinacea'',{{sfn|Izzo|Ernst|2009}} safety about taking ''Echinacea'' supplements is not well understood, with possibilities that it may cause side effects, such as [[nausea]], stomach upset or [[diarrhea]], and that it may have [[adverse reaction]]s with other medications.{{sfn|Natural Standard Research Collaboration|2013}} One of the most extensive and systematic studies to review the safety of ''Echinacea'' products concluded that overall, "adverse events are rare, mild and reversible," with the most common symptoms being "[[gastrointestinal]] and skin-related."{{sfn|Huntley et al|2005}} Such side effects include [[nausea]], [[abdominal pain]], [[diarrhea]], [[itch]], and [[rash]].{{sfn|Drugsite|2021}} ''Echinacea'' has also been linked to [[allergic reactions]], including [[asthma]], [[shortness of breath]], and one case of [[anaphylaxis]].{{sfn|Huntley et al|2005}}{{sfn|Mullins|1998}}{{sfn|Ang-Lee et al|2001}} Muscle and joint pain has been associated with ''Echinacea'', but it may have been caused by cold or [[flu]] symptoms for which the ''Echinacea'' products were administered.{{sfn|Huntley et al|2005}} There are isolated case reports of rare and [[Idiosyncratic drug reaction|idiosyncratic reactions]] including [[thrombocytopenic purpura]], [[leucopenia]], [[hepatitis]], [[kidney failure]], and [[atrial fibrillation]], although it is not clear that these were due to ''Echinacea'' itself.{{sfn|Natural Standard Research Collaboration|2013}} Up to 58 drugs or supplements may interact with ''Echinacea''.{{sfn|Drugsite|2021}}

As a matter of manufacturing safety, one investigation by an independent-consumer testing laboratory found that five of eleven selected retail ''Echinacea'' products failed quality testing. Four of the failing products contained levels of phenols below the potency level stated on the labels. One failing product was contaminated with lead.{{sfn|Cooperman|2021}}

==== Children under 12 years old ====

The European Herbal Medicinal Products Committee (HMPC) and the UK Herbal Medicines Advisory Committee (HMAC) recommended against the use of ''Echinacea''-containing products in children under the age of 12. Manufacturers re-labelled all oral ''Echinacea'' products that had product licenses for children with a warning that they should not be given to children under 12 as a precautionary measure.{{sfn|MHRA|2014}}

==== Pregnancy ====

Although research has not found increased risk of [[birth defects]] associated with use of ''Echinacea'' during the [[first trimester]], it is recommended that [[pregnant women]] should avoid ''Echinacea'' products until stronger safety supporting evidence becomes available.{{sfn|Natural Standard Research Collaboration|2013}}

==== Lactation ====

It is recommended that women [[breastfeeding]] should use caution with ''Echinacea'' products due to insufficient safety information available.{{sfn|Natural Standard Research Collaboration|2013}}

==== General precaution ====

The U.S. [[Food and Drug Administration]] recommends precaution about using [[dietary supplements]] because some products may not be risk free under certain circumstances or may interact with [[Prescription drug|prescription]] and [[over-the-counter]] medicines.{{sfn|FDA|2017}}

As with any herbal preparation, individual doses of ''Echinacea'' may vary significantly in chemical composition.{{sfn|NCCIH|2020}} Inconsistent process control in manufactured echinacea products may involve poor inter- and intra-batch [[homogeneity]], species or plant part differences, variable extraction methods, and [[contamination]] or [[adulteration]] with other products, leading to potential for substantial product variability.{{sfn|Karsch-Volk et al|2014}}{{sfn|Cooperman|2021}}

=== Research ===

''Echinacea'' products vary widely in composition.{{sfn|NCCIH|2020a}} They contain different species (''[[Echinacea purpurea|E. purpurea]]'', ''[[Echinacea angustifolia|E. angustifolia]]'', ''[[Echinacea pallida|E. pallida]]''), different plant segments (roots, flowers, [[extracts]]), different preparations ([[extracts]] and expressed juice), and different chemical compositions which complicate understanding of a potential effect.{{sfn|Barnes et al|2005}}{{sfn|Hart|Dey|2009}}
Well-controlled [[clinical trial]]s{{sfn|Turner et al|2005}} are limited and low in quality, with little [[evidence-based medicine|scientific evidence]] that ''Echinacea'' [[dietary supplement|supplement products]] are useful for treating any disease.{{sfn|Drugsite|2021}}{{sfn|Hart|Dey|2009}}{{sfn|Karsch-Volk et al|2014}}

According to [[Cancer Research UK]], "There is no scientific evidence to show that echinacea can help treat, prevent or cure cancer in any way. Some therapists have claimed that echinacea can help relieve side effects from cancer treatments such as [[chemotherapy]] and [[radiotherapy]], but this has not been proven either."{{sfn|Cancer Research UK|2019}}

Although there are multiple [[scientific review]]s and [[meta-analysis|meta-analyses]]{{sfn|Shah et al |2007}} published on the supposed [[immunology|immunological]] effects of ''Echinacea'', there is significant variability of products used among studies, leading to low-quality or no evidence for efficacy and safety, leading to considerable controversy.{{sfn|Chang|2007}} Consequently, regulatory authorities, such as the United States [[Food and Drug Administration]], have not approved ''Echinacea'' products as safe and effective for any health or therapeutic purpose.{{sfn|NCCIH|2020}}{{sfn|Drugsite|2021}}{{sfn|Hart|Dey|2009}}

== See also ==
* [[List of ineffective cancer treatments]]

== References ==
{{Reflist|20em}}

== Bibliography ==
{{Refbegin|30em}}
=== Books and documents ===

* {{cite web|last=European Union|author-link=European Union|title=European Union herbal monograph on ''Echinacea purpurea'' (L.) Moench, herba recens|url=http://www.ema.europa.eu/docs/en_GB/document_library/Herbal_-_Community_herbal_monograph/2015/04/WC500185437.pdf|publisher=Committee on Herbal Medicinal Products, [[European Medicines Agency]]|date=24 November 2015|access-date=16 March 2018|archive-date=19 June 2018|archive-url=https://web.archive.org/web/20180619002157/http://www.ema.europa.eu/docs/en_GB/document_library/Herbal_-_Community_herbal_monograph/2015/04/WC500185437.pdf|url-status=dead}}
* {{cite book|editor-last1=Kindscher|editor-first1=Kelly|title=The Conservation Status of Echinacea Species|url=http://www.fs.usda.gov/Internet/FSE_DOCUMENTS/fsm91_054353.pdf|publisher=[[USDA]]|date=30 September 2006}}
* {{cite book |editor1-last=Kindscher |editor1-first=Kelly |title=Echinacea: Herbal Medicine with a Wild History |date=2016 |publisher=[[Springer Nature]] |isbn=978-3-319-18155-4 |url=https://books.google.com/books?id=pQBkDAAAQBAJ }}{{link note|note=additional excerpts [https://www.springer.com/gp/book/9783319181554 here]}}
* {{cite book |last=McKeown |first=K A |editor-last1=Janick |editor-first1=Jules |title=Perspectives on New Crops and New Uses |date=1999 |publisher=[[ASHS Press]] |isbn=978-0-9615027-0-6 |url=https://books.google.com/books?id=NR1IAAAAYAAJ |chapter=A Review of the Taxonomy of the Genus Echinacea |pages=482–489 |chapter-url=https://hort.purdue.edu/newcrop/proceedings1999/v4-482.html }}
* {{cite book |editor-last1=Miller |editor-first1=Sandra Carol |editor-last2=Yu |editor-first2=He-ci |title=Echinacea: The genus Echinacea |series=Medicinal and Aromatic Plants - Industrial Profiles |date=2004 |publisher=[[CRC Press]] |isbn=978-0-203-02269-6 |url=https://books.google.com/books?id=WT48zTwLa9AC }}
* {{cite book |last1=Moerman |first1=Daniel E. |title=Native American Ethnobotany |date=1998 |publisher=[[Timber Press]] |isbn=978-0-88192-453-4 |url=https://books.google.com/books?id=UXaQat5icHUC }}
* {{cite book|last=Mowrey|first=Daniel|name-list-style=vanc|title=Echinacea|publisher=McGraw-Hill Professional|year=1998|isbn=978-0-87983-610-8|url=https://books.google.com/books?id=WlRXleQhLeQC}}
* {{cite book |last1=Plowden |first1=C. Chicheley |title=A Manual of Plant Names |date=1972 |edition=3rd |origyear=1968 |publisher=[[Allen & Unwin]] |isbn=978-0-04-580007-0 |url=https://books.google.com/books?id=N6sgAQAAIAAJ }}{{link note|note=Available [https://archive.org/details/manualofplantnam0000plow/page/n3/mode/2up here] at [[Internet Archive]]}}

;Historical sources
* {{cite book |last1=de Candolle |first1=A. P. |author-link=Augustin Pyramus de Candolle |title=Prodromus systematis naturalis regni vegetabilis, sive, Enumeratio contracta ordinum generum specierumque plantarum huc usque cognitarium, juxta methodi naturalis, normas digesta 17 vols. |date=1824–1873 |publisher=Treuttel et Würtz |location=Paris |url=https://www.biodiversitylibrary.org/bibliography/286#/summary }}
* {{cite book|last=Linnaeus|first=Carl|author-link=Linnaeus|title=Species Plantarum: exhibentes plantas rite cognitas, ad genera relatas, cum differentiis specificis, nominibus trivialibus, synonymis selectis, locis natalibus, secundum systema sexuale digestas. 2 vols.|url=https://www.biodiversitylibrary.org/bibliography/669#/summary|year=1753|volume=2|chapter=Rudbeckia|chapter-url=https://www.biodiversitylibrary.org/item/13830#page/349/mode/1up|page=907|publisher=Impensis Laurentii Salvii|location=Stockholm}}, ''see also'' [[Species Plantarum]]
* {{cite book |last1=Moench |first1=Conrad |author-link=Conrad Moench |title=Methodus plantas horti botanici et agri Marburgensis: a staminum situ describendi |date=1794 |publisher=Marburgi cattorum: in officina nova libraria academiae |location=[[Marburg]] |url=https://www.biodiversitylibrary.org/bibliography/304 |language=latin |chapter=Echinacea |page=591 |chapter-url=https://www.biodiversitylibrary.org/page/449222#page/224/mode/1up }}
* {{cite book |last1=Nuttall |first1=Thomas |author-link=Thomas Nuttall |title=The Genera of North American Plants: And a Catalogue of the Species, to the Year 1817. 2 vols. |date=1818 |publisher=Nuttall |location=Philadelphia |url=https://books.google.com/books?id=WYZIAAAAYAAJ |volume=1 |isbn=9780608408859 }}{{link note|note=[https://books.google.com/books?id=Pk8-AAAAcAAJ Volume 2], both volumes also available [https://www.biodiversitylibrary.org/bibliography/290 here] at [[Biodiversity Heritage Library|BHL]]}}

=== Chapters ===

* {{cite encyclopedia |editor1-link=David J. Wishart |editor-last1=Wishart |editor-first1=David J. |title=Encyclopedia of the Great Plains Indians |date=2007 |publisher=[[University of Nebraska Press]] |isbn=978-0-8032-9862-0 |url=https://books.google.com/books?id=646oX4hA8EkC |last=Kindscher |first=Kelly |chapter=Plant Lore |page=166 }}{{link note|note=Excerpted and expanded from {{cite encyclopedia |url=https://books.google.com/books?id=rtRFyFO4hpEC |title=Encyclopedia of the Great Plains |date=2004 |isbn=978-0-8032-4787-1 |page=309 |last1=Wishart |first1=David J. |publisher=U of Nebraska Press }}, also searchable at Internet Archive, [https://archive.org/details/encyclopediagrea00wish_849/page/n166 here]}}
* {{cite book |last1=Kindscher |first1=Kelly |last2=Wittenberg |first2=Rebecca |title=The naming and classification of Echinacea species |date=2006|pages=8–31}}, in {{harvtxt|Kindscher|2006}}
* {{cite book |last1=Kindscher |first1=Kelly |last2=Wittenberg |first2=Rebecca |title=The naming and classification of Echinacea species |date=2016|pages=37–45}}, in {{harvtxt|Kindscher|2016}}
* {{cite book |last1=Binns |first1=S. E. |last2=Arnason |first2=J. T. |last3=Baum |first3=B. R. |title=Taxonomic history and revision of the genus Echinacea |date=2004 |pages=3–11|ref={{harvid|Binns et al|2004}}}}, in {{harvtxt|Miller|Yu|2004}}
* {{cite book|last=Panero|first=J L|editor-last=Kadereit|editor-first=Joachim W.|editor2-last=Jeffrey|editor2-first=Charles|editor3-last=Kubitzki|editor3-first=Klaus|editor-link3=Klaus Kubitzki|title=The families and genera of vascular plants v.&nbsp;8 Flowering Plants. Eudicots: Asterales|url=https://books.google.com/books?id=VhUZnM8S47IC|year=2007|isbn=978-3-540-31051-8|publisher=[[Springer Science & Business Media]]|chapter=Heliantheae|pages=440–477}}

=== Articles ===

* {{cite journal |last1=Barnes |first1=Joanne |last2=Anderson |first2=Linda A |last3=Gibbons |first3=Simon |last4=Phillipson |first4=J David |title=Echinacea species (Echinacea angustifolia (DC.) Hell., Echinacea pallida (Nutt.) Nutt., Echinacea purpurea (L.) Moench): a review of their chemistry, pharmacology and clinical properties |journal=[[Journal of Pharmacy and Pharmacology]]|date=August 2005 |volume=57 |issue=8 |pages=929–954 |doi=10.1211/0022357056127|pmid = 16102249 | s2cid = 25151912 | doi-access = free |ref={{harvid|Barnes et al|2005}}}}
* {{cite journal |last1=Hobbs |first1=Christopher |title=Echinacea: A Literature Review: Botany, History, Chemistry, Pharmacology, Toxicology, and Clinical Uses |journal=HerbalGram |date=Winter 1994 |issue=30 |pages=33–48 |url=https://www.herbalgram.org/resources/herbalgram/issues/30/table-of-contents/article702/ }}
* {{cite journal |last1=Hostettmann |first1=K. |title=Geschichte einer Pflanze am Beispiel von Echinacea |trans-title=History of a plant: the example of Echinacea|journal=[[Complementary Medicine Research]] |date=2003 |volume=10 |issue=1 |pages=9–12 |doi=10.1159/000071678|pmid=12808356 |s2cid=72348436 |language=de}}
* {{cite journal |last1=Perry |first1=Ann |title=No Easy Answers to Echinacea's Evolution |journal=Agricultural Research |date=March 2010 |volume=58 |issue=3 |page=22 |url=https://agresearchmag.ars.usda.gov/AR/archive/2010/Mar/March2010.pdf }}

;Taxonomy and phylogeny
* {{cite journal |last1=Binns |first1=Shannon E. |last2=Baum |first2=Bernard R. |last3=Arnason |first3=John T. |title=Typification of Echinacea purpurea (L.) Moench (Heliantheae: Asteraceae) and its implications for the correct naming of two Echinacea taxa |journal=[[Taxon (journal)|Taxon]]|date=2001 |volume=50 |issue=4 |pages=1169–1175 |doi=10.2307/1224737|jstor=1224737|ref={{harvid|Binns et al|2001}}}}
* {{cite journal |last1=Binns |first1=Shannon E. |last2=Baum |first2=Bernard R. |last3=Arnason |first3=John Thor |title=A Taxonomic Revision of Echinacea (Asteraceae: Heliantheae) |journal=Systematic Botany |date=2002 |volume=27 |issue=3 |pages=610–632 |jstor=3093966 |ref={{harvid|Binns et al|2002}}}}
* {{cite journal |last1=Flagel |first1=L. E. |last2=Rapp |first2=R. A. |last3=Grover |first3=C. E. |last4=Widrlechner |first4=M. P. |last5=Hawkins |first5=J. |last6=Grafenberg |first6=J. L. |last7=Alvarez |first7=I. |last8=Chung |first8=G. Y. |last9=Wendel |first9=J. F. |title=Phylogenetic, morphological, and chemotaxonomic incongruence in the North American endemic genus Echinacea |url=https://core.ac.uk/download/pdf/38934956.pdf |journal=[[American Journal of Botany]] |date=1 June 2008 |volume=95 |issue=6 |pages=756–765 |doi=10.3732/ajb.0800049 |pmid=21632401 |ref={{harvid|Flagel et al|2008}} }}
* {{cite journal |last1=McGregor |first1=Ronald L |title=The taxonomy of the genus Echinacea (Compositae) |journal=University of Kansas Science Bulletin |date=1968 |volume=48 |pages=113–142 |url=https://archive.org/details/cbarchive_52471_thetaxonomyofthegenusechinacea1902 }}
* {{cite journal |last1=Urbatsch |first1=Lowell E. |last2=Baldwin |first2=Bruce G. |last3=Donoghue |first3=Michael J. |title=Phylogeny of the Coneflowers and Relatives (Heliantheae: Asteraceae) Based on Nuclear rDNA Internal Transcribed Spacer (ITS) Sequences and Chlorplast DNA Restriction Site Data |journal=[[Systematic Botany]] |date=July 2000 |volume=25 |issue=3 |pages=539 |doi=10.2307/2666695|jstor=2666695 |s2cid=28581817 |ref={{harvid|Urbatch et al 2000}}}}
* {{cite journal |last1=Zhang |first1=N |last2=Erickson |first2=DL |last3=Ramachandran |first3=P |last4=Ottesen |first4=AR |last5=Timme |first5=RE |last6=Funk |first6=VA |last7=Luo |first7=Y |last8=Handy |first8=SM |title=An analysis of Echinacea chloroplast genomes: Implications for future botanical identification. |journal=[[Scientific Reports]] |date=16 March 2017 |volume=7 |issue=1 |pages=216 |doi=10.1038/s41598-017-00321-6 |pmid=28303008|pmc=5428300 |bibcode=2017NatSR...7..216Z }}

;Traditional medicine

* {{cite journal |last1=Ang-Lee |first1=Michael K. |last2=Moss|first2=Jonathan |last3=Yuan |first3=Chun-Su|title=Herbal Medicines and Perioperative Care |journal=[[JAMA]] |date=11 July 2001 |volume=286 |issue=2 |pages=208–216 |doi=10.1001/jama.286.2.208| pmid = 11448284|ref={{harvid|Ang-Lee et al|2001}} }}
* {{cite journal |last1=Canlas |first1=Judith |last2=Hudson |first2=James B |last3=Sharma |first3=Manju |last4=Nandan |first4=Devki |title=Echinacea and trypanasomatid parasite interactions: Growth-inhibitory and anti-inflammatory effects of Echinacea |journal=[[Pharmaceutical Biology]] |date=September 2010 |volume=48 |issue=9 |pages=1047–1052 |doi=10.3109/13880200903483468| doi-access = free | pmid = 20731557|ref={{harvid|Canlas et al|2010}}}}
* {{cite journal |last1=Hart |first1=Anna |last2=Dey |first2=Paola |title=Echinacea for prevention of the common cold: An illustrative overview of how information from different systematic reviews is summarised on the internet |journal=[[Preventive Medicine]] |date=August 2009 |volume=49 |issue=2–3 |pages=78–82 |doi=10.1016/j.ypmed.2009.04.006| pmid = 19389422}}
* {{cite journal |last1=Huntley |first1=Alyson L |last2=Thompson Coon |first2=Joanna |last3=Ernst |first3=Edzard |title=The Safety of Herbal Medicinal Products Derived from Echinacea Species: A Systematic Review |journal=[[Drug Safety]] |date=2005 |volume=28 |issue=5 |pages=387–400 |doi=10.2165/00002018-200528050-00003
| pmid = 15853441| s2cid = 25239464|ref={{harvid|Huntley et al|2005}}}}
* {{cite journal |last1=Izzo |first1=Angelo A. |last2=Ernst |first2=Edzard |title=Interactions Between Herbal Medicines and Prescribed Drugs: An Updated Systematic Review |journal=[[Drugs (journal)|Drugs]] |date=September 2009 |volume=69 |issue=13 |pages=1777–1798 |doi=10.2165/11317010-000000000-00000| pmid = 19719333| s2cid = 25720882}}
* {{cite journal |last1=Karsch-Völk |first1=Marlies |last2=Barrett |first2=Bruce |last3=Kiefer |first3=David |last4=Bauer |first4=Rudolf |last5=Ardjomand-Woelkart |first5=Karin |last6=Linde |first6=Klaus |title=Echinacea for preventing and treating the common cold |journal=[[Cochrane Database of Systematic Reviews]] |date=20 February 2014 | volume = 2 | issue = 2 | pages = CD000530 |doi=10.1002/14651858.CD000530.pub3| pmid = 24554461 | pmc = 4068831|ref={{harvid|Karsch-Volk et al|2014}}}}
* {{cite journal |last1=Mullins |first1=Raymond J |title=Echinacea-associated anaphylaxis |journal=[[Medical Journal of Australia]] |date=February 1998 |volume=168 |issue=4 |pages=170–171 |doi=10.5694/j.1326-5377.1998.tb126773.x |pmid = 9507713 | s2cid = 11837168}}
* {{cite journal |last1=Schapowal |first1=A |last2=Klein |first2=P |last3=Johnston |first3=SL |title=Echinacea reduces the risk of recurrent respiratory tract infections and complications: a meta-analysis of randomized controlled trials. |journal=[[Advances in Therapy]] |date=March 2015 |volume=32 |issue=3 |pages=187–200 |doi=10.1007/s12325-015-0194-4 |pmid=25784510|s2cid = 1294616|ref={{harvid|Schapowal et al|2015}}}}
* {{cite journal |last1=Shah |first1=Sachin A |last2=Sander |first2=Stephen |last3=White |first3=C Michael |last4=Rinaldi |first4=Mike |last5=Coleman |first5=Craig I |title=Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis |journal=[[The Lancet Infectious Diseases]] |date=July 2007 |volume=7 |issue=7 |pages=473–480 |doi=10.1016/S1473-3099(07)70160-3|pmid=17597571 |pmc=7106401 |ref={{harvid|Shah et al |2007}}}}
* {{cite journal |last1=Turner |first1=Ronald B. |last2=Bauer |first2=Rudolf |last3=Woelkart |first3=Karin |last4=Hulsey |first4=Thomas C. |last5=Gangemi |first5=J. David |title=An Evaluation of Echinacea angustifolia in Experimental Rhinovirus Infections |journal=[[New England Journal of Medicine]] |date=28 July 2005 |volume=353 |issue=4 |pages=341–348 |doi=10.1056/NEJMoa044441|pmid=16049208 |ref={{harvid|Turner et al|2005}}|doi-access=free }}

=== Websites ===

* {{cite web |last1=Chang |first1=Louise |title=Study: Echinacea Cuts Colds by Half. Skeptic Remains Unconvinced by New Analysis |url=https://www.webmd.com/cold-and-flu/news/20070626/study-echinacea-cuts-colds-by-half |website=[[WebMD]] |access-date=12 October 2021 |date=26 June 2007 }}
* {{cite web |last1=Cooperman |first1=Tod |title=Echinacea Supplements Review |url=https://www.consumerlab.com/reviews/echinacea-review/echinacea/ |website=Product reviews |publisher=[[ConsumerLab]] |access-date=9 October 2021 |date=17 July 2021 }}* {{cite web |last1=Kindscher |first1=Kelly |title=Conservation planning for Echinacea species |url=https://kindscher.ku.edu/research/medicinal-plants/echinacea/conservation-planning-for-echinacea-species |website=Kansas Biological Survey: Research - medicinal plants |publisher=[[University of Kansas]] |access-date=30 September 2021 |date=2021 }}
* {{cite web |last1=Fish and Wildlife Service |author-link=United States Fish and Wildlife Service |title=Endangered and Threatened Wildlife and Plants; Removal of Echinacea tennesseensis (Tennessee Purple Coneflower) From the Federal List of Endangered and Threatened Plants |url=https://www.federalregister.gov/documents/2011/08/03/2011-19674/endangered-and-threatened-wildlife-and-plants-removal-of-echinacea-tennesseensis-tennessee-purple |website=Federal Register |publisher=[[Department of the Interior]] |access-date=21 September 2021 |date=3 August 2011 }}
* {{cite web|last=NCCIH|author-link=National Center for Complementary and Integrative Health|title=Echinacea|url=http://nccih.nih.gov/health/echinacea/ataglance.htm|publisher=[[US National Institutes of Health]]|date=July 2020|access-date=17 September 2021}}
* {{cite web|last=NCCIH|author-link=National Center for Complementary and Integrative Health|title=The Common Cold and Complementary Health Approaches: What the Science Says|url=https://www.nccih.nih.gov/health/providers/digest/the-common-cold-and-complementary-health-approaches-science|publisher=[[US National Institutes of Health]]|date=December 2020a|access-date=25 September 2021}}
* {{cite web|last=Drugsite|author-link=Drugs.com|title=Echinacea Uses, Benefits & Dosage - Drugs.com Herbal Database|url=https://www.drugs.com/npp/echinacea.html|website=Drugs.com|publisher=Drugsite Trust|location=New Zealand|access-date=29 September 2021|date=8 April 2021}}
* {{cite web|last=Cancer Research UK|author-link=Cancer Research UK|title=Echinacea|url=https://about-cancer.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/complementary-alternative-therapies/individual-therapies/echinacea|website=Complementary and alternative therapies|access-date=4 October 2021|date=18 January 2019}}
* {{cite web |last1=Natural Standard Research Collaboration |author-link=Natural Standard Research Collaboration |title=Echinacea (Echinacea angustifolia, Echinacea pallida, Echinacea purpurea) |url=http://www.mayoclinic.org/drugs-supplements/echinacea/safety/HRB-20059246 |website=Drugs and supplements |publisher=[[Mayo Clinic]] |access-date=4 October 2021 |archive-url=https://web.archive.org/web/20170708015252/http://www.mayoclinic.org/drugs-supplements/echinacea/safety/HRB-20059246 |archive-date=8 July 2017 |date=1 November 2013 }}
* {{cite web |last1=MHRA |author-link=Medicines and Healthcare products Regulatory Agency |title=Echinacea herbal products should not be used in children under 12 years old |url=https://webarchive.nationalarchives.gov.uk/ukgwa/20141206003656/http://www.mhra.gov.uk/NewsCentre/Pressreleases/CON180627 |website=[[The National Archives (United Kingdom)|The National Archives]] |type=Press release |access-date=9 October 2021 |date=20 August 2014 }}
* {{cite web |last1=FDA |author-link=FDA |title=What You Need to Know about Dietary Supplements |url=https://www.fda.gov/food/buy-store-serve-safe-food/what-you-need-know-about-dietary-supplements |website=Food: Consumers |access-date=9 October 2021 |date=29 November 2017 }}

;Databases and floras
* {{cite web |last1=McCoy |first1=Ann |last2=Widrlechner |first2=Mark |last3=Carstens |first3=Jeff |title=A Comprehensive Echinacea Germplasm Collection Located at the North Central Regional Plant Introduction Station |url=https://www.ars.usda.gov/ARSUserFiles/50301000/Posters/Echinacea_poster2.pdf |website=Iowa Botanical Supplement Research Center |publisher=[[Agricultural Research Service|USDA/ARS]], [[Iowa State University, Ames]] |access-date=10 October 2021 |date=October 2005 |type=Conference poster |ref={{harvid|McCoy et al|2005}} }}{{link note|note=[https://lib.dr.iastate.edu/ncrpis_conf/29/ Fifty-Fifth Annual Meeting of the Eastern Region of the International Plant Propagators' Society]}}
* {{cite web |last1=Urbatsch |first1=Lowell E. |last2=Neubig |first2=Kurt M. |last3=Cox |first3=Patricia B. |title=Echinacea Moench, Methodus. 591. 1794. |url=http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=111203 |access-date=23 September 2021 |work=[[Flora of North America]] |year=2006 |volume=21 |page=88 |publisher=[[Oxford University Press]] |location=New York |ref={{harvid|Urbatsch et al|2006}} }}
* {{cite web|title=''Echinacea purpurea'' (L.) Moench|website=[[Tropicos]]|url=https://www.tropicos.org/name/2710007|publisher=[[Missouri Botanical Garden]]|access-date=14 September 2021|date=2021|ref={{harvid|Tropicos|2021}}}}
* {{cite web|last=POWO|author-link=Plants of the World Online|title=Echinacea Moench|url=https://powo.science.kew.org/taxon/urn:lsid:ipni.org:names:30035795-2|website=Plants of the World Online|publisher=[[Royal Botanic Gardens, Kew]]|date=2021|access-date=19 September 2021}}
* {{cite web|last=WFO|author-link=World Flora Online|title=Echinacea|url=http://www.worldfloraonline.org/taxon/wfo-4000012904|access-date=15 September 2021|date=2021}}
{{Refend}}


==External links==
==External links==
*{{Commons category-inline}}
*[http://www.heronswood.com/Echinacea-culture/ Echinacea- Their Care and Culture] (Heronswood Nursery)
*{{Wikispecies-inline|Echinacea (Asteraceae)|''Echinacea''}}
* [http://web.mac.com/david.vernon/iWeb/The%20Canberra%20Journal/The%20Scribbles/AFFFC40F-7112-4236-9D24-A6173FD8FD91.html Echinacea - the wonder herb (reprinted from ''The Skeptic'' Winter 2007)]
* [http://content.herbalgram.org/abc/herbalgram/search.asp?p=1&s=echinacea&m=all American Botanical Council Web site] Echinacea information from The American Botanical Council


{{Taxonbar|from=Q1642983}}
[[Category:Asteraceae]]
{{Authority control}}
[[Category:Medicinal plants]]


[[Category:Echinacea| ]]
[[bg:Ехинацея]]
[[Category:Plants used in traditional Native American medicine]]
[[ca:Equinàcia]]
[[Category:Asteraceae genera]]
[[da:Purpursolhat]]
[[Category:Flora of Northern America]]
[[de:Sonnenhüte (Echinacea)]]
[[Category:Taxa named by Conrad Moench]]
[[es:Echinacea]]
[[fr:Echinacea]]
[[it:Echinacea (botanica)]]
[[lt:Ežiuolė]]
[[nl:Echinacea]]
[[pl:Jeżówka (roślina)]]
[[pt:Echinacea]]
[[ru:Эхинацея]]
[[tr:Kirpi otu]]
[[uk:Ехінацея]]

Latest revision as of 06:58, 25 May 2024

Echinacea
Echinacea purpurea 'Maxima'
Scientific classification Edit this classification
Kingdom: Plantae
Clade: Tracheophytes
Clade: Angiosperms
Clade: Eudicots
Clade: Asterids
Order: Asterales
Family: Asteraceae
Subfamily: Asteroideae
Tribe: Heliantheae
Subtribe: Zinniinae
Genus: Echinacea
Moench, 1794
Synonyms

Brauneria Necker ex T.C.Porter & Britton
Helichroa Raf.

Echinacea /ˌɛkɪˈnsiə, ˌɛkɪˈnʃiə/[1] is a genus of herbaceous flowering plants in the daisy family. It has ten species, which are commonly called coneflowers. They are native only in eastern and central North America, where they grow in moist to dry prairies and open wooded areas. They have large, showy heads of composite flowers, blooming in summer. The generic name is derived from the Greek word ἐχῖνος (ekhinos), meaning "hedgehog", due to the spiny central disk. These flowering plants and their parts have different uses. Some species are cultivated in gardens for their showy flowers. Two of the species, E. tennesseensis and E. laevigata, were formerly listed in the United States as endangered species; E. tennesseensis has been delisted due to recovery[2] and E. laevigata is now listed as threatened.[3]

Echinacea purpurea is used in traditional medicine. Although commonly sold as a dietary supplement, there is insufficient scientific evidence that Echinacea products are effective or safe for improving health or treating any disease.

Description[edit]

The spiny center of the head showing the paleae, from which the name derives
A bee on an Echinacea paradoxa head (inflorescence)
A bee on an Echinacea purpurea head
Fasciation on an Echinacea purpurea

Echinacea species are herbaceous, drought-tolerant perennial plants growing up to 140 cm (4 ft 7 in) in height. They grow from taproots, except E. purpurea, which grows from a short caudex with fibrous roots. They have erect stems that in most species are unbranched. Both the basal and cauline (stem) leaves are arranged alternately. The leaves are normally hairy with a rough texture, having uniseriate trichomes (1–4 rings of cells), but sometimes they lack hairs. The basal leaves and the lower stem leaves have petioles, and as the leaves progress up the stem the petioles often decrease in length. The leaf blades in different species may have one, three, or five nerves. Some species have linear to lanceolate leaves, and others have elliptic- to ovate-shaped leaves; often the leaves decrease in size as they progress up the stems. Leaf bases gradually increase in width away from the petioles or the bases are rounded to heart shaped. Most species have leaf margins that are entire, but sometimes they are dentate or serrate.

The flowers are collected together into single rounded heads at the ends of long peduncles. The inflorescences have crateriform to hemispheric shaped involucres which are 12–40 mm (0.47–1.57 in) wide. The phyllaries, or bracts below the flower head, are persistent and number 15–50. The phyllaries are produced in a 2–4 series. The receptacles are hemispheric to conic. The paleae (chaffs on the receptacles of many Asteraceae) have orange to reddish purple ends, and are longer than the disc corollas. The paleae bases partially surrounding the cypselae, and are keeled with the apices abruptly constricted to awn-like tips. The ray florets number 8–21 and the corollas are dark purple to pale pink, white, or yellow. The tubes of the corolla are hairless or sparsely hairy, and the laminae are spreading, reflexed, or drooping in habit and linear to elliptic or obovate in shape. The abaxial faces of the laminae are glabrous or moderately hairy. The flower heads have typically 200–300 fertile, bisexual disc florets but some have more. The corollas are pinkish, greenish, reddish-purple or yellow and have tubes shorter than the throats. The pollen is normally yellow in most species, but usually white in E. pallida. The three or four-angled fruits (cypselae), are tan or bicolored with a dark brown band distally. The pappi are persistent and variously crown-shaped with 0 to 4 or more prominent teeth. x = 11.[4]

Like all members of the sunflower family, the flowering structure is a composite inflorescence, with rose-colored (rarely yellow or white) florets arranged in a prominent, somewhat cone-shaped head – "cone-shaped" because the petals of the outer ray florets tend to point downward (are reflexed) once the flower head opens, thus forming a cone. Plants are generally long lived, with distinctive flowers. The common name "coneflower" comes from the characteristic center "cone" at the center of the flower head.

Taxonomy[edit]

The first Echinacea species were discovered by European explorers in forests of southeastern North America during the 18th century.[5] The genus Echinacea was then formally described by Linnaeus in 1753, and this specimen as one of five species of Rudbeckia, Rudbeckia purpurea.[6][7] Conrad Moench subsequently reclassified it in 1794 as the separate but related genus, Echinacea, with the single species Echinacea purpurea,[8][9] so that the botanical authority is given as (L.) Moench.[10] In 1818, Nuttall, using the original name, described a variety of Rudbeckia purpurea, which he named Rudbeckia purpurea var serotina.[11] In 1836, De Candolle elevated this variety to a species in its own right, as Echinacea serotina (Nutt.) DC, by which time four species of the genus Echinacea were recognised.[12][5]

Historically, there has been much confusion over the taxonomic treatment of the genus, largely due to the ease with which the taxa hybridize with introgression where species ranges overlap, and high morphological variation.[13][14] Furthermore it was discovered that the type specimen for Echinacea purpurea (L) Moench was not the one originally described by Linnaeus, but rather that described by De Candolle as Echinacea serotina (Nutt.) DC.[5]

Subdivision[edit]

Many taxonomic treatments of the genus Echinacea have recorded varying numbers of subordinate taxa, ranging between 2 and 11.[5] One of the most widely adopted schemes was that of McGregor (1968),[13] which included nine species, of which two, E. angustifolia DC and E. paradoxa (Norton) Britton, were further divided into two varietals.[9] Treatments that include ten species, differ by the addition of E. serotina (Nutt.) DC.[15] Alternative classification include with four species and eight subspecies, and two subgenera with four species, has been proposed, based on morphology alone, but has proved controversial.[14] This recognised subgenus Echinacea, with the single species E. purpurea, and subgenus Pallida, with three species, E. atrorubens, E. laevigata and E. pallida. In this scheme, other taxa are reduced to variety rank, e.g. E. atrorubens var. neglecta.[7][16] Subsequently, McGregor's classification was preserved in the Flora of North America (2006).[4]

DNA analysis has been applied to determine the number of Echinacea species, allowing clear distinctions among species based on chemical differences in root metabolites. The research concluded that of the 40 genetically diverse populations of Echinacea studied, there were nine to ten distinct species.[17]

Species[edit]

Plants of the World Online gives nine accepted species,[18] and World Flora Online gives ten:[19]

These two databases differ in their treatment of E. serotina (Nutt.) DC. , the former considering this as a synonym of E. purpurea and the latter as a distinct species.

Former classification[edit]

Etymology[edit]

Moench named the genus Echinacea, from the Greek word ἐχῖνος (ekhinos) for hedgehog or sea-urchin, in recognition that in the seed stage, the cone has spiny projections.[9][20]

Distribution and habitat[edit]

Echinacea is restricted to North America, east of the Rocky Mountains, and in the Atlantic drainage area, predominantly the Great Plains and central United States and adjacent areas of Canada.[16][5][21] The genus range is from Saskatchewan in the north to almost the Gulf of Mexico in Louisiana and Texas in the south, and from the Ohio oak savannas, glades of Tennessee and the Carolinas in the east, to the Rocky Mountain foothills in the west.[15]

Conservation[edit]

Natural populations of Echinacea are threatened by over-harvesting of wild specimens for the herbal product trade and modification of their habitats by humans.[21] Major reductions in the size of populations of E. laevigata and E. tennesseensis have led to their classification as endangered species.[16][22] E. tennesseensis had recovered sufficiently by 2011 that it was removed from the list.[23]

Cultivation[edit]

Many species of Echinacea are cultivated for commercial use,[16] while others, notably E. purpurea, E. angustifolia, and E. pallida, are grown as ornamental plants in gardens.[24] Many cultivars exist, and many of them are asexually propagated to keep them true to type.

Uses[edit]

Echinacea has long been used as a traditional medicine.[16]

History[edit]

Echinacea angustifolia was widely used by the North American Indigenous peoples as folk medicine, with archaeological evidence dating back to the 18th century. Traditional use included external application (insect bites, burns, wounds), chewing of roots (throat and tooth infections) and internal use (cough, pain, snake bites, stomach cramps).[25][26] Some Plains tribes used Echinacea for cold symptoms. The Kiowa used it for coughs and sore throats, the Cheyenne for sore throats, the Pawnee for headaches, and many tribes, including the Lakota, used it as a pain medication.[27] Early European settlers noticed this and began to develop their own uses. According to Wallace Sampson, its modern use for the common cold began when a Swiss herbal supplement maker was told that Echinacea was used for cold prevention by Native American tribes who lived in the area of South Dakota.[28] The first preparation was Meyers Blood Purifier (c. 1880), which was promoted for neuralgia, rattlesnake bites and rheumatism. By the start of the 20th century it was the most common herbal remedy in America.[citation needed] Commercial cultivation began in Germany in the late 1930s, and in Switzerland in 1950, by A. Vogel. Soon chemists and pharmacologists began the task of identifying potentially active ingredients and their properties. These included alyklamides, cichoric acid, echinacoside, ketoalkenes and polysaccharides. Extracts appeared to exhibit immunostimulant properties and were mainly promoted for the prevention and treatment of colds, influenza and sepsis. Despite many different preparations and hundreds of publications, no exact identification of a truly active ingredient has been identified.[25]

Infectious diseases[edit]

Echinacea is of no benefit as a treatment for the common cold.[29] A 2016 meta-analysis found tentative evidence that use of Echinacea extracts reduced the risk of repeated respiratory infections.[30]

Side effects[edit]

When taken by mouth, Echinacea does not usually cause side effects,[31] but may have undesirable interactions with various drugs prescribed for diseases, such as heart disease, bleeding, and autoimmune diseases, such as rheumatoid arthritis, lupus, or psoriasis.[32][33] Although there are no specific case reports of drug interactions with Echinacea,[34] safety about taking Echinacea supplements is not well understood, with possibilities that it may cause side effects, such as nausea, stomach upset or diarrhea, and that it may have adverse reactions with other medications.[32] One of the most extensive and systematic studies to review the safety of Echinacea products concluded that overall, "adverse events are rare, mild and reversible," with the most common symptoms being "gastrointestinal and skin-related."[35] Such side effects include nausea, abdominal pain, diarrhea, itch, and rash.[33] Echinacea has also been linked to allergic reactions, including asthma, shortness of breath, and one case of anaphylaxis.[35][36][37] Muscle and joint pain has been associated with Echinacea, but it may have been caused by cold or flu symptoms for which the Echinacea products were administered.[35] There are isolated case reports of rare and idiosyncratic reactions including thrombocytopenic purpura, leucopenia, hepatitis, kidney failure, and atrial fibrillation, although it is not clear that these were due to Echinacea itself.[32] Up to 58 drugs or supplements may interact with Echinacea.[33]

As a matter of manufacturing safety, one investigation by an independent-consumer testing laboratory found that five of eleven selected retail Echinacea products failed quality testing. Four of the failing products contained levels of phenols below the potency level stated on the labels. One failing product was contaminated with lead.[38]

Children under 12 years old[edit]

The European Herbal Medicinal Products Committee (HMPC) and the UK Herbal Medicines Advisory Committee (HMAC) recommended against the use of Echinacea-containing products in children under the age of 12. Manufacturers re-labelled all oral Echinacea products that had product licenses for children with a warning that they should not be given to children under 12 as a precautionary measure.[39]

Pregnancy[edit]

Although research has not found increased risk of birth defects associated with use of Echinacea during the first trimester, it is recommended that pregnant women should avoid Echinacea products until stronger safety supporting evidence becomes available.[32]

Lactation[edit]

It is recommended that women breastfeeding should use caution with Echinacea products due to insufficient safety information available.[32]

General precaution[edit]

The U.S. Food and Drug Administration recommends precaution about using dietary supplements because some products may not be risk free under certain circumstances or may interact with prescription and over-the-counter medicines.[40]

As with any herbal preparation, individual doses of Echinacea may vary significantly in chemical composition.[31] Inconsistent process control in manufactured echinacea products may involve poor inter- and intra-batch homogeneity, species or plant part differences, variable extraction methods, and contamination or adulteration with other products, leading to potential for substantial product variability.[29][38]

Research[edit]

Echinacea products vary widely in composition.[41] They contain different species (E. purpurea, E. angustifolia, E. pallida), different plant segments (roots, flowers, extracts), different preparations (extracts and expressed juice), and different chemical compositions which complicate understanding of a potential effect.[42][43] Well-controlled clinical trials[44] are limited and low in quality, with little scientific evidence that Echinacea supplement products are useful for treating any disease.[33][43][29]

According to Cancer Research UK, "There is no scientific evidence to show that echinacea can help treat, prevent or cure cancer in any way. Some therapists have claimed that echinacea can help relieve side effects from cancer treatments such as chemotherapy and radiotherapy, but this has not been proven either."[45]

Although there are multiple scientific reviews and meta-analyses[46] published on the supposed immunological effects of Echinacea, there is significant variability of products used among studies, leading to low-quality or no evidence for efficacy and safety, leading to considerable controversy.[28] Consequently, regulatory authorities, such as the United States Food and Drug Administration, have not approved Echinacea products as safe and effective for any health or therapeutic purpose.[31][33][43]

See also[edit]

References[edit]

  1. ^ https://www.merriam-webster.com/dictionary/echinacea
  2. ^ "Tennessee purple coneflower (Echinacea tennesseensis)". Environmental Conservation Online System. U.S. Fish & Wildlife Service. Retrieved 19 June 2023.
  3. ^ "Smooth coneflower (Echinacea laevigata)". Environmental Conservation Online System. U.S. Fish & Wildlife Service. Retrieved 19 June 2023.
  4. ^ a b Urbatsch et al 2006.
  5. ^ a b c d e Binns et al 2004.
  6. ^ Linnaeus 1753.
  7. ^ a b Binns et al 2001.
  8. ^ Moench 1794.
  9. ^ a b c Kindscher & Wittenberg 2006, p. 9.
  10. ^ Tropicos 2021.
  11. ^ Nuttall 1818, p. 2:178.
  12. ^ de Candolle 1824–1873, p. 5: 554.
  13. ^ a b McGregor 1968.
  14. ^ a b c Kindscher & Wittenberg 2016, p. 38.
  15. ^ a b Flagel et al 2008.
  16. ^ a b c d e Binns et al 2002.
  17. ^ Perry 2010.
  18. ^ POWO 2021.
  19. ^ WFO 2021.
  20. ^ Plowden 1972, p. 7.
  21. ^ a b Kindscher 2021.
  22. ^ Kindscher 2006.
  23. ^ Fish and Wildlife Service 2011.
  24. ^ McCoy et al 2005.
  25. ^ a b Hostettmann 2003.
  26. ^ Kindscher 2007, p. 156.
  27. ^ Moerman 1998, p. 205.
  28. ^ a b Chang 2007.
  29. ^ a b c Karsch-Volk et al 2014.
  30. ^ Schapowal et al 2015.
  31. ^ a b c NCCIH 2020.
  32. ^ a b c d e Natural Standard Research Collaboration 2013.
  33. ^ a b c d e Drugsite 2021.
  34. ^ Izzo & Ernst 2009.
  35. ^ a b c Huntley et al 2005.
  36. ^ Mullins 1998.
  37. ^ Ang-Lee et al 2001.
  38. ^ a b Cooperman 2021.
  39. ^ MHRA 2014.
  40. ^ FDA 2017.
  41. ^ NCCIH 2020a.
  42. ^ Barnes et al 2005.
  43. ^ a b c Hart & Dey 2009.
  44. ^ Turner et al 2005.
  45. ^ Cancer Research UK 2019.
  46. ^ Shah et al 2007.

Bibliography[edit]

Books and documents[edit]

Historical sources

Chapters[edit]

Articles[edit]

Taxonomy and phylogeny
Traditional medicine

Websites[edit]

Databases and floras

External links[edit]