Inula racemosa

Inula racemosa Hook. f. (Pushkarmool / Indian Elecampane): A Comprehensive Reference

1. Identity, Nomenclature, and Botanical Description

Scientific name: Inula racemosa Hook. f. Inula racemosa, also known as Pushkarmool or Indian elecampane, is a perennial herbaceous plant indigenous to the Himalayan region and various parts of Central Asia, classified within the family Asteraceae, and characterised by its tall stature, prominent foliage, and clusters of yellow blossoms.

Synonyms and common names: The botanical synonym Inula royleana (C.B. Clarke) is recognised, and the plant belongs to the family Asteraceae. It is known variously as Pokharmul (Hindi), Pushkara Mulamu (Telugu), Indian elecampane or Elicampane (English), Pohkarmul (Gujarati), Puskaramul (Kannada), Poshkar (Kashmiri), Pushkarmul (Malayalam), and Puskaramulam (Tamil).

Plant morphology: I. racemosa is a stout herbaceous perennial plant up to 1.75 m tall, with basal leaves arranged in a racemose manner. The plant grows from 0.5 to 1.5 metres in height; the stem is grooved, rough, and very hairy, while the leaves are large, elliptical, 3–6 cm long and 2–3 cm in breadth, with long petioles. It features numerous stems arising from a fragrant rootstock and elliptic-lanceolate leaves with a dense hair covering on the underside.

Geographic distribution and habitat: The plant is common to Kashmir in India because it grows in temperate and alpine western Himalayas, ranging from 1,300 to 4,500 metres of elevation. Among several species of the genus Inula, I. racemosa is a perennial plant found between altitudes of 1,500–4,200 m above mean sea level in open temperate meadows and forest margins. It is mainly found in India's temperate and sub-alpine regions, particularly in Kashmir, Himachal Pradesh, and Uttarakhand. The plant also grows widely in the western Himalayas of Xinjiang (China), Afghanistan, and Nepal.

Conservation status: Inula racemosa, also known as mannu or pushkarmool, is a critically endangered perennial herb that belongs to the family Asteraceae. As an anti-inflammatory and anti-diarrhoeal drug, it is today a critically endangered plant (IUCN, 1993), with its population declining due to a lengthy cultivation cycle, prevalence of small land holdings, and continuously fluctuating market demand. The Indian Government, through the Ministry of AYUSH and the National Medicinal Plant Board, is actively promoting conservation, development, and sustainable management; however, despite these efforts, cultivation in its native cold arid habitat remains limited due to low yields and economic returns compared to other cash crops.

Plant parts used: The primary part of the plant used for medicinal purposes is the root. The dried roots are used to make decoctions, powders, or herbal formulations.

2. Traditional and Historical Use

2.1 Ayurveda (India)

Pushkarmool is one of the most important medicinal and ornamental plants mentioned in Ayurvedic scriptures. It is specifically mentioned in ancient texts including the Charaka Samhita and Sushruta Samhita, which are foundational texts of Ayurveda. In the Charaka Samhita, Pushkarmool is listed within the Shvasahara group of herbs useful in asthma and COPD. It has traditionally been a staple in Ayurvedic medicine due to its multifaceted therapeutic attributes, including expectorant, diuretic, and anti-inflammatory properties.

In Ayurvedic scriptures, pushkarmool is widely cited as one of the essential herbs used as thermogenic, anti-inflammatory, digestive, cardiotonic, acrid, expectorant, carminative, alexipharmic, anodyne, aphrodisiac, febrifuge, and tonic. Pushkarmool is one of the reputed medicinal plants used in the traditional system of Ayurveda for its potential benefits in cardiorespiratory and cardiovascular diseases, especially angina pectoris, and is a common ingredient of polyherbal formulations indicated for cardiovascular diseases.

2.2 Chinese Traditional Medicine and Other Asian Systems

I. racemosa is used in Indian Ayurvedic medicine, Chinese Traditional Medicine (CTM), Bhutanese Sowa Rigpa Medicine (BSM), and European homeopathy for treating various disorders including cough, dyspnoea, asthma, tuberculosis, pain, acute enteritis, dysentery, angina, hyperlipidaemia, hepatic ischaemia, and ischaemic heart diseases. In China, I. racemosa is also used by Kazakh and Uighur doctors living near the Himalayas, and by Mongolian and Tujia doctors living in other parts of China.

2.3 Tibetan Medicine

Pushkarmool has a significant presence in traditional Tibetan medicine, where it is known as "Dugpa" or "Shaluli." It is used to treat respiratory disorders including asthma, bronchitis, and coughs, and is also employed to alleviate digestive issues, promote appetite, and improve overall digestion.

2.4 Himalayan Ethnic Communities

The roots, including the rhizomes, were used in the treatment of various ailments like chest pain, liver dysfunction, dyspnoea, and cardiovascular diseases by the ethnic Himalayan residents. The roots and rhizomes are also used by local people as a cough remedy and as a tonic for animals. Different ethnic communities use this plant to treat asthma, respiratory illness, skin diseases, heart disorders, and other ailments.

2.5 Traditional Preparations

The dried roots of Pushkarmool are used to make decoctions, powders, or herbal formulations. Traditional preparations are used to support respiratory health, alleviate coughs and colds, treat asthma and bronchitis, improve digestion, and support overall well-being. It is also prepared with other plant extracts for treating angina, hyperlipidaemia, hepatic ischaemia, and ischaemic heart diseases.

3. Key Phytochemical Constituents

3.1 Primary Sesquiterpene Lactones

The main phytochemical compounds identified in different parts of the plant are the sesquiterpene lactones alantolactone and isoalantolactone. Alantolactone and isoalantolactone are two important sesquiterpene lactones of the eudesmanolide type, present in the essential oil of Inula racemosa in a ratio of approximately 4:6.

Inula racemosa yields large amounts of sesquiterpene lactones. Alantolactone (ALT), isoalantolactone (IALT), alloalantolactone, inunal, isoinunal, alantodiene, and isoalantodiene are sesquiterpene lactones isolated from the non-polar fractions of the root.

The major active constituents of the radix in this herb are sesquiterpene lactones, including alantolactone (AL), isoalantolactone (IAL), dihydroalantolactone, dihydroisoalantolactone, and alantolides, besides β-sitosterol and daucosterol.

3.2 Other Phytochemical Classes

The sesquiterpene lactones are accompanied by other constituents including glycosides, tannins, sterols, terpenoids, and saponins, providing a wide range of pharmacological properties. The roots contain inulin (10.1%) and roylene (3%); the root essential oil contains alantolactone.

The phytochemical studies of I. racemosa extract resulted in the isolation of 67 compounds, the majority of which belong to the chemical class of terpenoids. Earlier chemical studies identified the presence of several phytopharmaceutical constituents, such as flavanol glycosides, sesquiterpenoids, and sesquiterpene lactones in the roots. A novel dimeric sesquiterpene, "disesquicin," was also reported in the roots of I. racemosa, exhibiting cytotoxic activities towards human cancer cell lines.

3.3 Biosynthesis and Tissue Localisation

Root-specific expression of the germacrene-mediated alantolactone biosynthesis pathway — involving GAS, GAO, G8H, IPP, DMAP, and KAO — supports the finding that the root is the primary site of alantolactone biosynthesis, with phytochemical accumulation values of 726.08 μg/10 mg for alantolactones and 988.59 μg/10 mg for isoalantolactones. A significant interaction of leaf-specific carbohydrate metabolism with root-specific inulin biosynthesis indicates source (leaf) to sink (root) regulation of inulin.

4. Mechanisms of Action

4.1 Anti-inflammatory Mechanisms

An in vitro study in lipopolysaccharide (LPS)-stimulated RAW 264.7 cells demonstrated the anti-inflammatory effect of alantolactone through the inhibition of mRNA transcription, cyclooxygenase-2 (COX-2) protein, and inducible nitric oxide synthase (iNOS), as well as the subsequent products nitric oxide (NO), prostaglandin E2 (PGE2), and tumour necrosis factor (TNF-α). In peritoneal and RAW 264.7 macrophages stimulated by LPS, isoalantolactone was shown to decrease NF-κB activation, which in turn reduced the formation of nitric oxide, PGE2, and cytokines (IL-6, TNF-α).

4.2 Beta-adrenergic Blocking Activity

Inula racemosa root powder was investigated in patients with proven ischaemic heart disease. The powder prevented ST-segment depression and T-wave inversion as observed in the post-exercise electrocardiogram. The petroleum ether extract of roots lowered plasma insulin and glucose levels within 75 minutes of oral administration to albino rats and significantly counteracted adrenaline-induced hyperglycaemia in rats. The extract further showed negative inotropic and negative chronotropic effects on frog heart. All these findings indicate that one of the constituents of Inula racemosa may have adrenergic beta-blocking activity.

4.3 Anticancer Mechanisms

Studies indicate that alantolactone and isoalantolactone exhibit significant anticancer activities through various mechanisms. These include the induction of apoptosis, regulation of the cell cycle, inhibition of angiogenesis, and suppression of metastasis. The compounds have demonstrated efficacy in vitro and in vivo, affecting various cancer cell lines with minimal toxicity to normal cells. Studies on HL-60 cells treated with the n-hexane fraction of I. racemosa at 10, 25, and 50 μg/mL for 6 hours revealed that it induces apoptosis through both intrinsic and extrinsic pathways by generating reactive oxygen species (ROS) intermediates. Mitochondrial dysfunction prompted the release of cytochrome c, translocation of pro-apoptotic protein (Bax), activation of the caspase cascade, and cleavage of specific caspase-3 substrates such as PARP, ultimately leading to apoptosis.

4.4 Hypoglycaemic Mechanism

Alcoholic extract of the root of I. racemosa lowers blood glucose and enhances liver glycogen without increasing plasma insulin in rats, and there is no increase in the degree of degranulation of the beta cells of the pancreas. It appears that the hypoglycaemic response of I. racemosa is not due to enhanced secretion or synthesis of insulin; the action may be at the peripheral level by potentiating insulin sensitivity.

5. Scientific Evidence by Area of Use

5.1 Cardiovascular System: Angina Pectoris and Ischaemic Heart Disease

Several experimental and clinical studies have demonstrated the potential of I. racemosa in cardiovascular diseases including hypertension, coronary heart disease, atherosclerosis, thrombosis, and myocardial infarction.

A pivotal early clinical investigation (Tripathi YB, Tripathi P, Upadhyay BN, 1988, Journal of Ethnopharmacology) assessed the adrenergic beta-blocking activity of the plant directly in human subjects. In this study, Inula racemosa root powder was investigated in patients with proven ischaemic heart disease. The powder prevented ST-segment depression and T-wave inversion as observed in the post-exercise electrocardiogram. While these findings were significant, this study was preliminary in nature and limited in its methodology by current standards.

To evaluate the cardioprotective potential of Inula racemosa in myocardial ischaemic-reperfusion injury, Wistar male albino rats were randomly divided into four groups. Animals in groups III and IV received I. racemosa extract (100 mg/kg) for 30 days. On the 30th day, animals underwent 45 minutes of ligation of the left anterior descending coronary artery and were thereafter reperfused for 60 minutes. This animal model study (Ojha S, Nandave M, Kumari S, Arya DS, 2010, J Ethnopharmacol) demonstrated cardioprotective results in rats but does not constitute clinical evidence.

A more recent initiative registered a randomised controlled trial (RCT) to examine the role of Pushkarmool formulations in coronary artery disease (CAD) management. The secondary outcome measures include the change in the Canadian Cardiovascular Society grading scale of angina pectoris; the change in the exercise stress test; the change in lipid profile, IL-6, and serum pro-BNP levels; and changes in the need for standard care medications for CAD. Safety is being evaluated by recording the incidence of adverse events and changes in laboratory safety parameters. This RCT was prospectively registered with the Clinical Trial Registry of India (CTRI/2024/02/062553 dated February 12, 2024). Results from this trial are not yet available in the published literature; the evidence at this stage must be characterised as preliminary.

A polyherbal formulation called "Lipistat," comprising equal proportions of extracts of Terminalia arjuna, Inula racemosa Hook, and latex of Commiphora mukul, was found to be effective in the treatment and management of lipid disorders. This represents a combination product study, not an isolation of I. racemosa effects alone.

Evidence strength: The human evidence for cardiovascular benefit is preliminary. The most-cited clinical data (Tripathi 1988) was conducted in patients with ischaemic heart disease and showed objective ECG changes, but is limited by its age, small scale, and the standards of the era. Animal studies are more extensive. No large, rigorously controlled RCTs with I. racemosa as a monotherapy have been completed and published to date.

5.2 Respiratory System: Asthma, Bronchitis, and Expectorant Activity

The extract of Inula racemosa is used against cough, dyspnoea, asthma, tuberculosis, pains, acute enteritis, and dysentery, and as an expectorant. I. racemosa is commercially useful in pharmaceutical products mainly because of its expectorant, antispasmodic, hypotensive, anti-inflammatory, carminative, thermogenic, digestive, cardiotonic, acrid, alexipharmic, anodyne, aphrodisiac, febrifuge, and antiseptic properties.

Documented records reveal that the herb has the potential to treat stomach ulcers and respiratory tract infections including chronic obstructive pulmonary disease (COPD). Research on asthma models has been published (Vadnere GP et al., 2009, as cited in the Springer chapter on Pushkarmool's pharmacological activities), but available peer-reviewed literature does not yet include completed human clinical trials specifically assessing respiratory end-points as primary outcomes for I. racemosa as a monotherapy.

Evidence strength: Respiratory benefits are well-established as traditional claims across multiple medical traditions. Preclinical (animal model) and in vitro evidence exists. No completed, published clinical trials focusing specifically on respiratory outcomes have been identified.

5.3 Hepatoprotective Activity

Alantolactone, known as helenin and isolated from the petroleum ether extract of the roots of Inula racemosa, was screened for hepatoprotective activity in vitro against galactosamine and thioacetamide, and in vivo against carbon tetrachloride, paracetamol, and rifampicin-induced hepatotoxicities in albino rats. Alantolactone showed significant (p<0.01) anti-inflammatory and hepatoprotective activities similar to that of silymarin.

A study by Mangathayaru K et al. (2015) evaluated the hepatoprotective activity of isolated isoalantolactone against chloroform-induced liver injury in male Wistar rats at a dose of 100 mg/kg and compared the effect with standard drug silymarin (10 mg/kg), reporting that isoalantolactone significantly reduced the levels of serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, alkaline phosphatase, and bilirubin, similar to the silymarin-treated group.

In a 2021 PMC-indexed study assessing liver protection against diethylnitrosamine-induced hepatic damage in a murine model, a safe and effective maximum dose of Inula racemosa root extract was maintained at 500 mg/kg body weight for the evaluation of hepatoprotective activity in the experimental rats.

A study published in PMC (2017) examined the therapeutic impact of I. racemosa in hepatic ischaemia-reperfusion (I/R) injury in rats. Repercussions of oxidative stress and cardiac function against isoproterenol-based myocardial infarction are caused by flavonol glycosides found in high concentrations in Inula racemosa.

Evidence strength: All hepatoprotective evidence to date is from animal and in vitro models only. No human clinical trial data on liver-related outcomes have been identified. Evidence is preliminary and preclinical.

5.4 Anticancer Activity

Studies indicate that alantolactone and isoalantolactone exhibit significant anticancer activities through various mechanisms including the induction of apoptosis, regulation of the cell cycle, inhibition of angiogenesis, and suppression of metastasis. The compounds have demonstrated efficacy in vitro and in vivo, affecting various cancer cell lines with minimal toxicity to normal cells. Alantolactone and isoalantolactone from Inula racemosa show promising potential as anticancer agents.

The lowest IC50 value of the n-hexane fraction of I. racemosa was 10.25 μg/mL for Colo-205, a colon cancer cell line, while 17.86 μg/mL was the highest IC50 value observed against CNS cancer cell line SF-295. These results strongly support further research and development of bioactive constituents from Inula racemosa as potential anticancer agents with possible therapeutic implications.

The diverse mechanisms of action and reported minimal side effects in preclinical models position the compounds as candidates for further research and development. Future studies should focus on clinical trials to establish their efficacy and safety in humans.

Evidence strength: Entirely preclinical (in vitro and animal in vivo). No human data exist. All anticancer findings should be considered mechanistic and exploratory only.

5.5 Antidiabetic Activity

The petroleum ether extract of roots lowered plasma insulin and glucose levels within 75 minutes of oral administration to albino rats and significantly counteracted adrenaline-induced hyperglycaemia in rats. In a separate study, alcoholic extract of the root of I. racemosa lowered blood glucose and enhanced liver glycogen without increasing plasma insulin in rats; there was also no increase in the degree of degranulation of the beta cells of the pancreas. In similar conditions it did not show any effect on adrenal gland activity; however, the thyroid gland underwent activation at a later stage (delayed response). It appears that the hypoglycaemic response is not due to enhanced secretion or synthesis of insulin, and the action may be at the peripheral level by potentiating insulin sensitivity.

Evidence strength: Animal model data only. No human clinical trials have been identified. Preliminary.

5.6 Antimicrobial and Antifungal Activity

Alantolactone and its pyrazoline derivatives were screened in vitro for antifungal potential at various concentrations against Alternaria brassicae and Penicillium italicum using the spore germination inhibition technique and against Rhizoctonia solani by the poisoned food technique. All compounds exhibited fairly good fungitoxicity against the test fungi with ED50 values of less than 500 μg/mL.

Alantolactone (AL) and isoalantolactone (IAL) are described as the major active compounds conferring the strong antifungal and anti-inflammatory activity attributed to the whole plant.

Evidence strength: In vitro data only for antimicrobial/antifungal endpoints. No clinical data available.

5.7 Anti-allergic / Antihistaminic Activity

The plant I. racemosa was evaluated for anti-histamine, antiallergic effect, and mast cell-stabilising activity, among other activities. Evaluation of type I hypersensitivity in rats (Srivastava S et al., 1999, Indian Journal of Physiology and Pharmacology, PMID 10365318) documented antiallergic effects in animal models.

Evidence strength: Animal model data; no clinical evidence identified.

5.8 Antimutagenic and Antiapoptotic Activity

A study was performed as part of an attempt to authenticate the use of Inula racemosa root extract as a traditional medicine in India by investigating biological properties, including antimutagenic and antiapoptotic effects, in an in vivo mouse model.

Evidence strength: Preclinical, in vivo (mouse) data only.

6. Body Systems and Health Areas of Association

Based on a synthesis of documented pharmacological studies, I. racemosa has been investigated in connection with the following body systems and health areas:

• Cardiovascular system: The plant is well recognised for cardioprotective effects. Areas studied include angina pectoris, ischaemic heart disease, atherosclerosis, hypertension, thrombosis, and myocardial infarction.
• Respiratory system: It is traditionally used to alleviate symptoms associated with respiratory ailments such as cough, asthma, bronchitis, and congestion; the herb is believed to possess expectorant and bronchodilator properties.
• Hepatic system: Hepatoprotective activity is a recognised area of pharmacological investigation.
• Metabolic / Endocrine system: Antidiabetic and antihyperlipidaemic activities have been documented in animal studies.
• Immune system: Immunomodulatory effects are attributed to the sesquiterpene lactone and glycoside content.
• Gastrointestinal system: The plant extract and its active constituents show activity against abdominal pain, acute enteritis, and bacillary dysentery.
• Oncology (preclinical): Mechanisms documented include the induction of apoptosis, regulation of the cell cycle, inhibition of angiogenesis, and suppression of metastasis.
• Integument (skin): Root oil containing alantolactone is widely utilised as an antiseptic and as a home remedy for boils and skin infection.

7. Dosage Forms and Reported Dosages

Inula racemosa is prepared in the form of decoctions, powders, or herbal formulations from the dried roots. The following dosages have been reported in specific studies or sources:

• Animal study (cardioprotection, Ojha et al., 2010): I. racemosa extract was administered at 100 mg/kg orally for 30 days in a rat ischaemia-reperfusion model.
• Animal study (hepatoprotection): A dose of 500 mg/kg body weight was maintained as the safe and effective maximum dose for evaluation of hepatoprotective activity in experimental rats.
• Animal study (hepatoprotection, isoalantolactone isolated compound): Isoalantolactone was evaluated at a dose of 100 mg/kg in male Wistar rats and compared with the standard drug silymarin at 10 mg/kg.
• Animal study (hepatoprotection with root extract, paracetamol model): Oral administration of I. racemosa root extract (IRE) at 300 mg/kg prevented the paracetamol-induced hepatic changes.

No large-scale, peer-reviewed human clinical trials have established a consensus therapeutic dose for I. racemosa as a dietary supplement or pharmaceutical.

8. Safety Considerations and Known Interactions

8.1 Contact Dermatitis and Sesquiterpene Lactone Sensitisation

In the case of Inula spp., there is evidence that the presence of sesquiterpenoid lactones, such as alantolactone and isoalantolactone, are responsible for allergic contact dermatitis. Research showed isoalantolactone as a sensitiser that cross-reacts with alantolactone, though one murine study concluded that isoalantolactone did not show sensitising capacity in the specific model studied — a point of contradiction in the literature.

Sesquiterpene lactones are a large, diverse group of chemicals found in several plant families that cause allergic contact dermatitis. Patients with Compositae sensitisation are routinely warned against the ingestion of vegetables, spices, teas, and herbal remedies from this plant family. The evidence for systemic allergic dermatitis caused by sesquiterpene lactone-containing plants is mostly anecdotal and based on patient statements rather than systematic scientific data.

8.2 Cross-reactivity with Compositae / Asteraceae Family

Individuals with a contact allergy to the sesquiterpene lactone/compositae mix are allergic to plants in the daisy family, Asteraceae. The Compositae family includes many garden plants, wild flowers, vegetables, and herbs. Individuals with documented Compositae sensitivity are at greater risk of reaction from topical or oral exposure to I. racemosa.

8.3 Documented Safety Profile in Preclinical Studies

The safety of Inula racemosa roots was confirmed by Srivastava et al. in antiallergic studies. In preclinical studies where no adverse effects of the extract were found at tested doses, the maximum dose of I. racemosa root extract maintained as safe and effective was 500 mg/kg body weight in experimental rats. However, these animal findings cannot be directly extrapolated to human safety profiles without clinical data.

8.4 Potential for Contact Dermatitis Upon External Use

External use of preparations from the Inula genus is associated with the risk not only of contact dermatitis but also more widespread immunological responses such as erythema multiforme-like eruptions. This safety concern applies particularly to topical applications.

8.5 Recognised Knowledge Gaps

The association and role of particular phytoconstituents in specific biological properties still need to be validated. There are no reports on measures regarding its conservation and mechanism of toxicity research, which also need more attention. Comprehensive investigations are imperative to delineate its pharmacological mechanisms and potential adverse reactions.

9. Conservation, Trade, and Regulatory Status

Inula racemosa Hook. f. is a critically endangered perennial herb distributed throughout the Himalaya, commercially useful in pharmaceutical products mainly because of its expectorant, antispasmodic, hypotensive, anti-inflammatory, carminative, thermogenic, digestive, cardiotonic, acrid, alexipharmic, anodyne, aphrodisiac, febrifuge, and antiseptic properties. Its population is declining due to a lengthy cultivation cycle, prevalence of small land holdings, and continuously fluctuating market demands.

The Indian Government, through the Ministry of AYUSH and the National Medicinal Plant Board, is actively promoting the conservation, development, and sustainable management of medicinal plants. Despite these conservation efforts, cultivation in the plant's native cold arid habitat remains limited due to low yields and economic returns compared to other cash crops and poor market linkages.

10. Summary of Evidence Quality

Across all documented areas of biological activity, the evidence base for Inula racemosa is characterised as follows:

• Traditional use: Well-documented across multiple independent medical traditions (Ayurveda, TCM, Sowa Rigpa, Unani) spanning centuries, with consistent references in foundational classical texts.
• Phytochemistry: Robustly characterised; the dominant bioactive class (eudesmanolide sesquiterpene lactones, particularly alantolactone and isoalantolactone) is well-established through multiple analytical methods.
• Mechanisms of action: Multiple in vitro mechanisms have been identified for anti-inflammatory (COX-2/iNOS/NF-κB inhibition), anticancer (apoptosis induction), and cardiovascular (beta-adrenergic modulation) activities.
• Clinical / human evidence: Sparse. The most relevant human data comes from an older preliminary clinical investigation of beta-blocking activity and ECG changes in ischaemic patients (Tripathi, 1988). A formal RCT for CAD management was registered in India in 2024 but has not yet reported results. No randomised, placebo-controlled clinical trials have been completed and published for any indication.
• Overall evidence strength: The totality of evidence remains predominantly preclinical (in vitro and animal in vivo). The collective evidence from pharmacological investigations underscores the potential of Inula racemosa as a valuable natural remedy, signalling the need for further research and clinical validation to fully harness its health benefits.

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