Herbs in History: Hellebore


Helleborus spp.


By Alain Touwaide & Emanuela Appetiti | April 2024

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Treating madness?


Illustration 1: Helleborus

The Hare and The Tortoise in a Hungary postmark

Illustration 2: The Hare and The Tortoise in a Hungary postmark

Hellebore (Helleborus spp.) (Illustration 1) has a long history of use for the treatment of states of consciousness considered to be madness. The most famous example of this treatment is perhaps the fable The Hare and the Tortoise by the 17th-century French writer of the classical period, Jean de la Fontaine (1621-1695) (Illustration 2).

A grain or two of hellebore
According to its first two verses, the fable is about timeliness (Book VI, Fable 10):

To win a race, the swiftness of a dart
Availeth not without a timely start.

And here is the story in the English translation by Elizur Wright (1804–1885):

Said tortoise to the swiftest thing that is,
"I'll bet that you'll not reach, so soon as I
The tree on yonder hill we spy."
"So soon! Why, madam, are you frantic?"

And here comes also the hellebore that the Hare recommends to the Tortoise to stop her foolishness: would the tortoise, known for its slowness, be capable to run quicker than a hare, famous for its ability to run?

Replied the creature, with an antic;
"Pray take, your senses to restore,
A grain or two of hellebore."

Although La Fontaine’s Fable is probably the best known version of this tale in world literature, it certainly is not the first. La Fontaine’s Fables go back to the Arabic World and fables originated in India and translated into Arabic, and also to the collection of fables by the Greek author Aesop who might have lived in the 6th century BCE.

Further back in time

When La Fontaine’s fable is compared with its equivalent by Aesop, it appears to have added hellebore. This was not an invention, however, as hellebore already appeared in the ancient Greek culture well before Aesop, as far back as the mythological times.

Native distribution of Helleborus orientalis subsp. orientalis

Illustration 3: Native distribution of Helleborus orientalis subsp. orientalis

Native distribution of Helleborus cyclophyllus (A.Braun) Boiss

Illustration 4: Native distribution of Helleborus cyclophyllus (A.Braun) Boiss

Native distribution of Helleborus odorus Waldst. & Kit. ex Willd

Illustration 5: Native distribution of Helleborus odorus Waldst. & Kit. ex Willd

Native distribution of Helleborus niger L.

Illustration 6: Native distribution of Helleborus niger L.

Native distribution of Helleborus viridis L.

Illustration 7: Native distribution of Helleborus viridis L.

Hellebore was part of the natural environment of the ancient Greek World, with several species native to an area that encompassed the current country of Greece, Asia Minor (current Turkey), a large fraction of the Balkans, the regions overlooking the Black Sea, the Western Mediterranean, and also the islands from Cyprus and Crete to Sicily, with mostly the following 5 species:

  • H. orientalis Lam., particularly the subsp. orientalis, typical of current Greece, Asia Minor, Caucasus and Transcaucasus (Illustration 3);

  • H. cyclophyllus (A.Braun) Boiss., in Greece, the Balkans, Albania, Bulgaria and further North (former Yugoslavia) (Illustration 4);

  • H. odorus Waldst. & Kit. ex Willd., from the Balkans to the North, with Albania, Bulgaria, Romania (Illustration 5);

  • H. niger L., in the former Yugoslavia, Italy, Switzerland, Austria, and Germany, in Italy and Northern Europe (Illustration 6);

  • H. viridis L., in the West from Italy to Spain, and from France and Switzerland to Germany (Illustration 7).

In the ancient Greek culture, hellebore was known through the tale of Melampous and the daughters of Proetus, the king of Tiryns, in the Argolid.
Melampous was a blind seer supposedly with a black foot (hence his name, which means literally: the black-footed). As the story goes, the daughters of Proetus, the Proetids, insulted either Hera, the Mother Goddess and Zeus’ wife, or Dionysios. As a punishment, they were driven mad and behaved in irrational way, including by taking themselves for cows. From Tiryns, they were roaming through the Peloponnesus to the greatest desperation of their father who thought they had been struck by madness. This is where Melampous entered the story. Because of his abilities, he was called by Proetus to possibly heal his daughters. After a long negotiation about the recompense for his intervention, Melampous accepted the challenge. He followed Proetus’ daughters and noticed that they regularly went to drink the water of one river. He then threw hellebore in the river and brought the Proetids back to reason. This is where the reputation of hellebore as an agent to cure madness came. And this is what La Fontaine was alluding to in his remake of Aesop’s fable staging The Hare and The Tortoise. Being a purgative as we shall see, hellebore was supposed to eliminate the physiological fluids that invaded the brain, obscuring mental acuity and capability to clearly think.

From legend to medicine

The Proetids’ story is in fact a foundational tale, which goes way beyond the narrative and its literary nature. It is a device not only to recount in a concrete, historicized way the abstract property of a natural substance, but also—if not above all—to explore the mechanisms allowing for the discovery of the therapeutic action of plants by observing the animal world and transferring their behaviour to humans. From this viewpoint, it is a powerful instrument that brings us to the source of ancient medicine in the undefined time of mythology and the making of the Greek Culture.
Returning to historical times, hellebore is abundantly prescribed in the many treatises attributed to, but not by Hippocrates (460-between 375 and 350 BCE) that make up the Hippocratic Collection. There, both the black and the white hellebore were confused, although they are distinct genera and were distinguished in Antiquity, but possibly at a later time than the Hippocratic epoch. White hellebore, which has sometimes been identified as a species of the genus Helleborus (H. albus (L.) Gueldenst.), is in fact Veratrum album L. (Illustration 8), with a native distribution that is interesting as it does not include Greece (Illustration 9).

White Hellebore, Veratrum album L.

Illustration 8: White Hellebore, Veratrum album L.

Native distribution of Veratrum album L.

Illustration 9: Native distribution of Veratrum album L.

In the Hippocratic Collection both species total the highest number of mentions of all the plants used medicinally in the entire Collection. They have no major difference in the range of pathologies they treat, except some skin conditions (white spots and lichen) for which black hellebore was indicated in external use. Both hellebores were characterized as cathartic and were used for a great many conditions that needed elimination of a pathogenic matter—particularly one of the four real or supposed physiological liquids present in the human body, blood, phlegm, yellow bile and black bile. The conditions requiring administration in internal use were mostly gynaecological, from emmenagogue to abortifacient, particularly the evacuation of any physiological substance in the uterus and on the cervix that might have been a source of infection. This action explains why hellebore was supposed to be a mean increasing the possibility of conception: by eliminating possible source of infections, it created ideal physiological conditions in the uterus.

In the 1st century CE and the vast, all-embracing encyclopaedia on medicinal plants and natural substances compiled by Dioscorides (De materia medica), black and white hellebore are clearly distinguished in both their description and their medicinal uses. In their description, Dioscorides specifies, indeed, that one has a black root while the other has a white one.
About the medicinal uses, the black hellebore (De materia medica IV.162) is recommended for the treatment of the same medical conditions as in the Hippocratic Collection, including the skin pathologies. For its administration in internal use, Dioscorides suggests adding it to a dish of lentils in an interesting practical recommendation.

For white hellebore (IV.148), Dioscorides credits it with a cathartic action similar to that of the black hellebore, although he provides a more limited range of medical conditions, adding, however, an ophthalmological use. And, just as he included some concrete information about the way of administering black hellebore, he also discussed the dosage of white hellebore,:

The administration and dietary use have been worked on by those who wrote about its dosage. And we very much agree with the Sicilian Philonides from Enna.
In a treatise on materia medica, it is important to determine therapeutic dosages.
Some give it (= white hellebore) with an abundant porridge, or with a large quantity of juice, or they administer it after a little meal, particularly to the patients for whom the physician may suspect that they will choke or have a weak physical condition.
The purgation will be safer for the patients who take it that way, because the medicine is not introduced into their body in a pure form.

Back to madness

At approximately Dioscorides’ time, the Hippocratic Collection was accrued by a set of clearly inauthentic letters supposedly exchanged between Hippocrates himself and the philosopher Democritus (born ca. 460 BCE).
As the exchange goes, the citizens of the city of Abdera, in northern Greece where Democritus was living, called Hippocrates to cure the philosopher who was laughing at everything and nothing according to them; hence his nickname the laughing philosopher. The Abderians were imploring Hippocrates to bring him back to reason, namely by administering a potent remedy as hellebore, just as Melampous did with the Proetids.
After some discussion with the Abderians, Hippocrates accepted to travel to Abdera and visited Democritus with whom he had a long conversation. At its conclusion, he left Abdera without administering any medicine to Democritus—and hellebore less than any other—, leaving the Abderians surprised and frustrated. Asked to explain why he did not prescribe hellebore, Hippocrates wisely replied that Democritus was laughing at the madness of the world and Democritus’ co-citizens in Abdera, and at the vanity of humans spending—and ruining—their life running after worthless mundane things, instead of dedicating themselves to philosophical meditation and spiritual enrichment.
The fascination for hellebore and the belief in its power to bring humans to reason from the Proetids in the mythological epoch to the Abderians in historical times was so strong that it generated superstitions that even entered Dioscorides’ treatise. In the form attested by manuscripts, the chapter on hellebore ends with an interesting phytosociological belief about the transmission of therapeutic properties across plants species:

Planted with grapevines, near the roots, hellebore makes their wine purgative.

This note, which might have been added in some copy of De materia medica, is followed by the description of magical rituals clearly resulting from annotations successively made one after the other that were further added to one or more copies of the work and were subsequently introduced into the text:

People even sprinkle hellebore around their houses, convinced that it purifies.

Wherefore, even when digging it up, they stand facing east, praying to Apollo and Aesculapius, and watching out for an eagle.

They say that the eagle that flies overhead is fraught with danger.

This bird brings death if it should witness the digging of hellebore.

One must dig it fast because its extraction from the earth provokes headaches.

For this reason, diggers eat garlic and drink wine before harvesting it, to be invulnerable.

In fact, these apparently magical beliefs and prescriptions might have aimed to discourage uninformed or unaware individuals from using such a potent cathartic drug as hellebore, and acted as a useful preventative measure.

Li S., et al. (2024). Genus Helleborus: a comprehensive review of phytochemistry, pharmacology and clinical applications. Natural Product Research 19 February 2024, pp. 1–17.
Advance online publication. https://doi.org/10.1080/14786419.2024.2317880
Walkden M. (2022). “That They May Vomit Out Their Folly”: The Gut-Mind Axis and Hellebore in Early Modern England. Journal of British Studies 61 (2022), pp. 535–562.
Tsiftsoglou O. S. et al. (2022). Chemical constituents isolated from the aerial parts of Helleborus cyclophyllus (A. Braun) Boiss. (Ranunculaceae), evaluation of their antioxidant and anti-inflammatory activity in vitro and virtual screening of molecular properties and bioactivity score. Natural Product Research, 2022, 36 (23), pp. 6031–6038. https://doi.org/10.1080/14786419.2022.2041009
Balázs V.L. et al. (2020). Ethnobotanical, historical and histological evaluation of Helleborus L. genetic resources used in veterinary and human ethnomedicine. Genetic Resources and Crop Evolution 67 (2020), pp. 781–797.
Brillatz T., et al. (2020). Antiseizure potential of the ancient Greek medicinal plant Helleborus odorus subsp. cyclophyllus and identification of its main active principle. Journal of Ethnopharmacology 259 (2020), 112954.
Maieron M.A. (2018). On the hellebore trail: an anthropological research into
Madness. Medicina Historica  2(1) (2018), pp. 5-18.
Tsiftsoglou O.S., M.K. Stefanakis, D.M. Lazari (2018). Chemical constituents isolated from the rhizomes of Helleborus odorus subsp. cyclophyllus (Ranunculaceae). Biochemical Systematics and Ecology 79 (2018), pp. 8-11.
Olivieri M. F., et al. (2017). Pharmacology and psychiatry at the origins of Greek medicine: The myth of Melampus and the madness of the Proetides. Journal of the History of the Neurosciences 26(2) (2017), pp. 193–215.
Brillatz T. et al. (2016). Bioguided isolation of anticonvulsant principles from Helleborus cyclophyllus using the zebrafish epilepsy model. Planta Medica 82(S 01) (2016): S1-S381.
Barroso M. (2015). The Hellebore, the Plant beloved by the Greeks: the Reasons behind a Myth. Vesalius: Acta Internationales Historiae Medicinae 21(1) (2015), pp. 30–37.
Pieroni A. et al. (2014). Local knowledge on plants and domestic remedies in the mountain villages of Peshkopia (Eastern Albania). Journal of Mountain Science 11(1) (2014), pp. 180-194.
Maior M., C. Dobrotă (2013). Natural compounds with important medical potential found in Helleborus sp. Open Life Sciences 8(3) (2013), pp. 272-285. 
Fornaro M., N. Clementi, P. Fornaro (2009). Medicine and psychiatry in Western culture: Ancient Greek myths and modern prejudices, Annals of General Psychiatry 8 (2009), 21. https://doi.org/10.1186/1744-859X-8-21
Iatrou G., E. Kokkalou (1997). Rarity, conservation, importance and ethnopharmacological knowledge of the Greek flora, in V.H. Heywood, M. Skoula M. (eds), Identification of wild food and non-food plants of the Mediterranean region (Cahiers Options Méditerranéennes, 23). Chania: CIHEAM, 1997, pp. 65-75.
Philianos S. (1967). Pharmacognosy of the hellebores (Helleborus cyclophyllus),
Archeia tes Pharmakeutikes, 23 (5–6), 1967, pp. 65-187.
Lawrendiadis G. (1961). Contribution to the knowledge of the medicinal plants of Greece, Planta Medica 1961, pp. 164-169.

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