IngredientsDicentra formosa (western, wild, or Pacific bleeding heart) is a species of flowering plant in the poppy family, Papaveraceae (subfamily: Fumarioideae), native to the Pacific Northwest of North America, with fern-like foliage and an inflorescence of drooping pink, purple, yellow, or cream "hearts." The species is also commonly called Oregon bleeding heart and western bleeding heart. The epithet formosa is derived from the Latin word meaning "beautiful" or "well-formed."
The genus name Dicentra is derived from the Greek dis, meaning "twice," and centron, meaning "spur" — referring to the characteristic twice-spurred shape of its flowers. The genus Dicentra was established by Johann Jacob Bernhardi in 1833, with its species initially classified within the family Fumariaceae.
Historical synonyms used in Eclectic medical literature include Corydalis formosa (an incorrect but frequently applied name in the 19th century), and Fumaria formosa. The Eclectics sometimes referred to D. formosa as Corydalis formosa, though Corydalis and Dicentra are distinct genera that should not be confused or considered interchangeable.
There are two subspecies: Dicentra formosa subsp. formosa and Dicentra formosa subsp. oregana. Subsp. formosa grows in the majority of the plant's range, from Vancouver Island and southern British Columbia south through Washington and Oregon to central California in the Coast Ranges and Cascades, and on the western slope of the Sierra Nevada. Subsp. oregana grows in a small area of southern Oregon and northern California in serpentine soils in the Siskiyou Mountains.
Pacific bleeding heart is a hairless, soft perennial from slender, brittle rhizomes with upright, leafless flowering stems that grows in moist woods. It bears drooping clusters of pink, heart-shaped flowers flushed with lavender on leafless stems; pink, heart-shaped flowers hang in small, branched clusters above soft, fern-like, bluish-green leaves at the base. The airy, fern-like foliage occurs on separate stalks, and the plant grows from 6–18 inches in height.
The Pacific bleeding heart subspecies formosa was first noted by Europeans when the Scottish surgeon and naturalist Archibald Menzies encountered it on the Vancouver Expedition; Menzies collected seed in 1792 in Nootka Sound and gave it to the Royal Botanic Gardens at Kew in 1795.
The Pacific bleeding heart is frequently confused with the fringed bleeding heart (Dicentra eximia) and sold under that name. The fringed bleeding heart, an Appalachian-area plant, has narrower flowers and longer, more curved outer petal tips. The popular related plant, Lamprocapnos spectabilis, also called "bleeding heart" and native to Asia, was formerly placed in the same genus.
The plant parts used medicinally have been the fresh or dried rhizome, as well as dried aerial parts. Fluid extracts, compound syrups, and tinctures were made from the deep yellow, pea-like tubers of the plant. Contemporary preparations include:
Dicentra formosa, commonly known as Pacific Bleeding Heart, has a rich history of medicinal use particularly among Indigenous peoples of the Pacific Northwest. Traditionally, various parts of the plant — especially the roots — were used as remedies for a range of ailments. Native American tribes such as the Coast Salish and the Makah employed decoctions and infusions of Dicentra formosa roots to alleviate pain, particularly in the back and chest.
According to Moerman (1998), Pacific bleeding heart was used as an anthelmintic, topical analgesic (for toothache), and to make hair grow by the Native American Skagit people living in the state of Washington. It was also used by the Thompson River Indians in southern British Columbia, though the exact nature of the use was not recorded.
It was used externally to treat skin sores and as a poultice for bruises and swelling due to its believed anti-inflammatory properties. The roots were sometimes chewed or brewed into a tea to serve as a mild sedative or to ease nervous conditions. The root was considered the strongest part, and a tincture of the root was used for sore teeth, lost fillings, or mouth trauma. Any part of the plant could be applied locally to painful sprains, bruises, or contusions. Internally, a tincture was used to calm down from shaky nervousness or uncontrollable anger following physical violence or an accident.
The Skagit people used it as an anthelmintic, making a worm medicine with a decoction of pounded roots.
Among the Eclectics, Dicentra was a leading alterative and tonic for many health conditions, although it has fallen out of favor among many contemporary practitioners. The Eclectics used it primarily as an alterative, diuretic, and tonic with properties similar to those of the bitter tonics Gentiana or Berberis.
Its tonic properties were extolled by Eclectic physicians including Finley Ellingwood, MD; William Cook, MD; Harvey Wickes Felter, MD; and others, who found it beneficial in the treatment of syphilitic conditions, blood dyscrasias, and "glandular derangements" of the system. Dicentra was also used for amenorrhea, dysmenorrhea, and chronic skin disorders.
A century ago, bleeding heart tonic was used to strengthen people with long-standing syphilis. The tonic was described as increasing appetite, stimulating liver metabolism, and generally helping anabolic functions in people who had been sick for long periods of time.
Eli Jones, MD, an Eclectic doctor with a large cancer practice, considered Dicentra particularly indicated when the patient had cachexia (1911), and he recommended a dose of 10 drops of tincture three times per day. Petersen (1905) wrote of its use for "nodular swelling" and "enlarged glands," both of which could encompass at least some cancer patients.
An Eclectic medical formula still in use in some naturopathic circles is Scudder's Alterative Compound, an herbal tincture formula long used in the treatment of patients with lymphatic and other cancers.
The alkaloids of Dicentra formosa that have been documented include, in addition to the previously known compounds protopine and dicentrine, glaucine and corytuberine, as well as an alkaloid also obtained from D. eximia. The full alkaloid profile as established by successive phytochemical investigations includes:
Aggarwal (2009) noted that a large number of physiologically active isoquinoline alkaloids isolated from the tubers of many Dicentra species are classified according to their structures as aporphines, protoberberines, protopines, and cularines alkaloids.
All parts of Dicentra species contain isoquinoline alkaloids such as protopine, bulbocapnine, and corydine, which are responsible for the plant's toxicity and primarily exert neuromuscular effects by antagonizing GABA receptors.
Dicentrine is an aporphine-type isoquinoline alkaloid isolated from several medicinal plants, some of which are used in traditional medicine to treat cancer and other diseases. Dicentrine has been shown to exert cytotoxic activity toward cancer cells by unwinding DNA and inhibiting the catalytic activity of DNA topoisomerases.
Dicentrine, as an aporphinic alkaloid, exerts anti-inflammatory and anticancer activities. It displays activity against many types of cancer by regulating cell cycles, inhibiting topoisomerase II, and inducing apoptosis.
In in vitro research on A549 lung adenocarcinoma cells, dicentrine was shown to effectively sensitize TNF-α-induced apoptosis, and increases caspase-8, -9, -3, and poly (ADP-ribose) polymerase (PARP) activities by upregulating the death-inducing signaling complex and by inhibiting the expression of antiapoptotic proteins including cIAP2, cFLIP, and Bcl-XL.
Dicentrine's effectiveness in medicine has been found to be mainly attributable to its antiplatelet, alpha-1-adrenoceptor, epidermal growth factor, antiprotozoal, larvicidal, antimicrobial, topoisomerase II, and acetylcholinesterase inhibitory potential.
Among simple aporphinoids, dicentrine has been reviewed for its cytotoxic properties; its mechanisms of action are not well known, but DNA-manipulating enzymes such as polymerases and topoisomerases are among the most frequently cited targets for these benzylisoquinoline compounds.
Bulbocapnine is an alkaloid found in Corydalis (notably the European species C. cava) and Dicentra. It has been shown to act as an acetylcholinesterase inhibitor and inhibits biosynthesis of dopamine via inhibition of the enzyme tyrosine hydroxylase. Like apomorphine, it is reported to be an inhibitor of amyloid beta protein (Aβ) fiber formation, whose presence is a hallmark of Alzheimer's disease (AD), making it a potential therapeutic under the amyloid hypothesis.
The formation of a covalent bond between benzylisoquinoline components creates aporphine alkaloids that bind to dopaminergic receptors. Bulbocapnine is classified as a dopamine receptor antagonist at subtypes D1/D2, owing to the alpha configuration of its C6a hydrogen.
According to the Dorland's Medical Dictionary, bulbocapnine "inhibits the reflex and motor activities of striated muscle."
Protopine exhibits anti-thrombotic and anti-inflammatory activities, antispasmodic and relaxant activity, antifungal effect, hepato-protective activity, neuro-protective activity, anticholinesterase and antiamnesic effects, anti-cancer effect, antidepressant-like effect, and analgesic effect.
The pharmacological activities of protopine are associated with its ability to inhibit K+(ATP) channel subunits or Ca2+ channels, activate GABAA receptors, exert antioxidant effects, inhibit NF-κB activity, and depress phosphorylation of MAPK.
Protopine is an isoquinoline alkaloid with diverse biological activities including anti-arrhythmia, cardiovascular protection, and anti-hypertensive effects. Research demonstrated that protopine could prevent aconitine-induced arrhythmia and chloroform-induced ventricular fibrillation through inhibiting ICa-L in a concentration-dependent manner, and it has been employed as a multiple ion channel blocker for the prevention of arrhythmia through inhibiting IKr and INa.
Evidence grade: Preliminary — in vitro and animal studies only; no human clinical trials.
Dicentra contains several isoquinoline alkaloids of interest including protopine, corydine, isocorydine, bulbocapnine, and dicentrine, and several of these have shown cytotoxic and chemoprotective abilities in laboratory studies (Choi et al., 2007; Cui et al., 2006).
Other compounds from Dicentra related to cardiac glycosides have been shown in laboratory research to induce apoptosis in human tumor cell lines (McNulty et al., 2007).
D. canadensis has been reported to contain the aporphine alkaloids bulbocapnine and dicentrine (Stern, 2008), and both of these compounds inhibit topoisomerase II in vitro, an action associated with inhibiting cancer cells (Woo et al., 1999).
In a 2023 screening study published in the International Journal of Molecular Sciences, five natural compounds including dicentrine were investigated as G-quadruplex ligands as anticancer candidates. Among the compounds investigated, dicentrine proved to be the most effective ligand of telomeric and oncogenic G-quadruplexes, also showing good G-quadruplex vs. duplex selectivity. In-depth studies in solution demonstrated the ability of dicentrine to thermally stabilize telomeric and oncogenic G-quadruplexes without affecting control duplex DNA.
In a review of topoisomerase-targeting anticancer drugs, dicentrinone and dicentrine, two alkaloids related to those in Dicentra formosa, were noted to show selective activities on topoisomerase I.
It must be emphasized that no controlled human clinical trials of Dicentra formosa or its isolated alkaloids for cancer treatment or prevention have been published in the peer-reviewed literature accessible through PubMed. Further study is needed to identify the chemoprotective and cytotoxic effects of its constituents so that they may be better understood and applied in the prevention and treatment of cancer.
Evidence grade: Traditional use only; no controlled human clinical studies exist for D. formosa specifically.
The use of Dicentra formosa for pain — including toothache, back pain, chest pain, sprain, and bruise pain — rests on ethnobotanical records rather than clinical trials. It has been used as a narcotic-analgesic for pain and central nervous system disorders. The root is the strongest part, and a tincture of the root has been used for sore teeth, lost fillings, or mouth trauma. The analgesic rationale is pharmacologically plausible given the alkaloid profile: protopine, one of its principal alkaloids, has demonstrated analgesic effects in preclinical research. All evidence for analgesia, however, is either traditional or derived from in vitro and animal studies of isolated alkaloids, not clinical trials of the whole plant.
Evidence grade: Preclinical (in vitro and animal); no human trials.
In animal studies, protopine (at 50–100 mg/kg) inhibited carrageenan-induced rat paw oedema with a potency approximately threefold that of aspirin. These results suggest protopine acts as a potent inhibitor of thromboxane synthesis and platelet-activating factor (PAF) with anti-inflammatory properties.
In vitro studies investigating protopine's anti-inflammatory activity in LPS-stimulated BV2 cells found that treatment with protopine (at 5, 10, and 20 μM) significantly suppressed the secretion of NO and PGE2 in a concentration-dependent manner without affecting cell viability, by downregulating iNOS and COX-2 expression.
These findings apply to isolated protopine from various plant sources and have not been replicated in human trials, nor has the whole extract of Dicentra formosa been evaluated clinically for anti-inflammatory endpoints.
Evidence grade: Preclinical; no human clinical data for D. formosa.
Bulbocapnine, a principal alkaloid of Dicentra, has been shown in laboratory studies to act as an acetylcholinesterase inhibitor, to inhibit dopamine biosynthesis via tyrosine hydroxylase inhibition, and to inhibit amyloid beta protein (Aβ) fiber formation, whose presence is a hallmark of Alzheimer's disease, making it a compound of theoretical interest under the amyloid hypothesis.
Bulbocapnine acts as a dopamine receptor antagonist at D1/D2 subtypes by virtue of its aporphine alkaloid structure. This mechanism underpins its experimental use in models of catalepsy and vestibular dysfunction, though no approved clinical application exists for bulbocapnine in isolation.
The traditional use of root tincture to "calm shaky nervousness" (internally, a tincture was used to calm down from shaky nervousness, or uncontrollable anger as an aftermath of physical violence, an accident, etc.) aligns conceptually with CNS depressant alkaloid mechanisms but has not been evaluated in clinical trials.
Evidence grade: Ethnobotanical only; no clinical trial data.
Anthelmintic use — specifically worm medicine prepared from a decoction of pounded roots — was documented among the Skagit people of Washington State. No controlled studies exist to confirm or quantify an anthelmintic effect for whole-plant preparations of D. formosa.
Evidence grade: Preclinical only.
Protopine from related Fumariaceae plants has demonstrated antiarrhythmic, cardiovascular-protective, and antihypertensive effects in preclinical models. Research showed that protopine prevents aconitine-induced arrhythmia and chloroform-induced ventricular fibrillation through inhibiting ICa-L in a concentration-dependent manner, and functions as a multiple ion channel blocker through inhibiting IKr and INa.
No cardiovascular clinical trials of Dicentra formosa preparations have been conducted.
Evidence grade: Preclinical only.
In a study examining the alkaloids of related Tibetan medicine plants in the genus Corydalis, compounds including bulbocapnine and isocorydine — alkaloids also present in D. formosa — were found to exhibit improvement effects on carbon tetrachloride (CCl4)-induced acute liver injury in mice. These are heterologous findings that cannot be extrapolated directly to D. formosa preparations.
There are no controlled human clinical trials establishing pharmacologically validated dosages for Dicentra formosa. All dosage information below reflects historical and naturopathic literature reports, not evidence-based clinical guidance.
All parts of the plant are considered poisonous, though toxic effects in humans are reported only in large quantities. Contact with cell sap can cause minor skin irritation lasting only a few minutes, and repeated contact may produce more persistent skin irritation. Reported symptoms of toxicity include trembling, staggering, vomiting, diarrhea, convulsions, and labored breathing. The toxic principle is identified as several isoquinoline alkaloids.
All parts of Dicentra plants are poisonous; poisoning generally only occurs after ingesting large amounts of the plant, and skin irritation caused by the plant is minor and quick to fade.
D. formosa contains isoquinoline alkaloids known to be fatal to cattle. The poisonous principles have been identified as several isoquinoline alkaloids including cularine and its derivatives. All parts of the plant — particularly the tubers — are hazardous. Cattle are primarily affected; sheep are more resistant. Symptoms include trembling, staggering, salivation and frothing at the mouth, convulsions, vomiting, diarrhea, and labored breathing; decrease in milk production is also reported. Rapid recovery occurs in most cases; death is rare.
The alkaloids bulbocapnine and protopine — both present in D. formosa — are mechanism-based inactivators of CYP2C19, the first methylenedioxyphenyl compounds shown to exhibit quasi-irreversible inactivation of this enzyme. CYP2C19 activity was not significantly restored by dialysis when it had been inactivated by the alkaloids in the presence of a NADPH-regenerating system. This study demonstrated time-dependent inhibition by these alkaloids and confirmed its quasi-irreversible nature.
The CYP2C19 enzyme plays an important role in the metabolism of many commonly used drugs; relatively little is known about CYP2C19 inhibitors from natural origin, which could inhibit CYP2C19 potentially causing clinically relevant metabolism-based drug interactions.
In a series of 49 structurally related plant isoquinoline alkaloids evaluated for interactions with CYP2C19, the previously identified mechanism-based inactivators bulbocapnine and protopine were examined. The IC50 values of the alkaloids ranged from 0.11 to 210 µM, and 42 of the 49 alkaloids were confirmed to be time-dependent inhibitors of CYP2C19.
Among compounds studied computationally, bulbocapnine was predicted to have the potential to inhibit all five major CYP isoforms (CYP1A2, CYP2C19, CYP2C9, CYP2D6, and CYP3A4), especially the CYP2C19 and CYP2C9 isoforms. Because many widely prescribed drugs (including proton pump inhibitors, antiplatelet agents such as clopidogrel, and certain antidepressants) are CYP2C19 substrates, co-administration with D. formosa preparations containing these alkaloids carries a theoretical but unquantified risk of herb-drug interactions. These findings are currently limited to in vitro and in silico studies; no human pharmacokinetic interaction studies have been conducted with D. formosa preparations.
All parts of Dicentra species contain isoquinoline alkaloids that primarily exert neuromuscular effects by antagonizing GABA receptors. This is relevant to any use alongside benzodiazepines, barbiturates, or other GABAergic drugs, where theoretical pharmacodynamic antagonism may occur. No clinical studies have evaluated this interaction.
Dicentra formosa causes minor skin irritation when touched, lasting only a few minutes, and skin irritation after repeated contact with the cell sap has also been reported.
The Pacific bleeding heart is frequently confused with the fringed bleeding heart (Dicentra eximia) and sold under that name. The fringed bleeding heart, an Appalachian-area plant, has narrower flowers and longer, more curved outer petal tips. Botanical misidentification in preparations or wild-crafted material could result in inadvertent substitution, as the alkaloid profiles of the two species differ.
The historical use of Dicentra formosa has contributed to its inclusion as an ingredient in modern nutritional products, although scientific validation of its benefits remains in early stages. Its scientific validation of benefits remains in early stages.
As of the current literature review, there are no published randomized controlled trials, observational human studies, or systematic reviews specifically evaluating whole-plant preparations of Dicentra formosa for any health indication. The available scientific literature is confined to:
Further study is needed to identify the chemoprotective and cytotoxic effects of its constituents so that they may be better understood and applied in the prevention and treatment of cancer, for which it holds research interest.
Health conditions that Dicentra formosa may help support.
Body systems that Dicentra formosa may help support.
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