The alterative herbs

The alterative herbs occupy an important position in traditional Western herbalism, although we have only a little information about how they work, many different and diverse traditional sources can attest to their medicinal efficiency. Overall, they are thought to work by acting as ‘cleansing’ agents, meaning they stimulate the activity of the excretory organs such as the liver and kidneys to remove unwanted materials from the body. Unfortunately, this is one of the least satisfying definitions we have of any herbal action and is regularly subject to scrutiny. However, what is clear is alteratives do work for certain kinds of problems and people, we just don’t know exactly how yet.

Alteratives appear to beneficially alter the course of chronic diseases with a specificity towards certain diseases that involve chronic inflammation or ‘damp heat’; such as psoriasis, acne, and rheumatoid arthritis. There is some preliminary scientific support for these ideas we will discuss later. As the definition is vague, it can be helpful to study some example definitions of an alterative from traditional herbalism text books. Of these examples, I find Maria Groves to provide the most clear and succinct definition.

David Hoffman: ‘Alteratives gradually alter and correct a ‘polluted’ condition of the blood stream and restore a healthier functioning. The way alteratives work is poorly understood, but they certainly work…(they are) perhaps the herbs most often used in the context of skin conditions, the roots of which lie deep within the metabolism of the individual. They cleanse the whole of the body, but their activity is focused in different areas, some in the kidneys, some in the liver… and they have to be chosen according to their specific indications’ (Hoffman, 1988).

Harvey Felter: ‘A drug which causes a favourable change or alteration in the processes of nutrition and repair, probably through some unknown way improving metabolism.’ (Felter, 1922).

John Scudder: ‘We suppose… They may change the condition of the blood by a direct influence exerted upon it… They may in some manner effect the removal of the worn-out tissues, and favour the process of nutrition… They may neutralize or change the character of decomposing or noxious agents that exist in the system as the result of some pathological process, or that have been introduced from without… They undoubtedly favor elimination by stimulating the excretory organs to increased activity.’ (Scudder, 1898)

Maria Groves: ‘Alteratives improve the body’s detoxification processes and efficient removal of metabolic wastes. They often encourage detoxification of the blood and interstitial fluid via the liver, lymphatic system, and the kidneys’ (Groves, 2016)

Alterative actions

Different alteratives have greater or lesser affinities for different excretory organs, but what is in common is they will stimulate activity of a particular organ to increase elimination. To explain further, Maria Groves subdivides alteratives to include those with the following actions (Groves, 2016):

Lymphagogues (lymph stimulants/ movers): Burdock root, red clover, sarsaparilla

Choleretics and cholagogues (liver stimulants/ movers): Dandelion, burdock root, yellow dock root

Diuretics (kidney stimulants/ movers): Dandelion, nettles, sarsaparilla

We will now turn to examine some of the classic alteratives from Western herbalism, considering both traditional knowledge and preliminary scientific data. One of the most well known and researched is sarsaparilla.



Sarsaparilla is a woody trailing perennial vine that may refer to one of a number of similar species scattered throughout the world (Kuhn and Winston, 2000). Sarsaparilla is cultivated in Mexico, Jamaica, China, and Central and Southern America. ‘Sarsaparilla’ as a name comes from Spanish words, prickly (zarsa), vine (parra), and small (illa). It is said sarsaparilla was used by the ancient Greeks as an antidote to poisons, however, it only became widely popular in Europe medicinally during the 16th century when Spanish explorers discovered the Caribbean species (Castleman, 2001). Native Americans and also Caribbean Indians used sarsaparilla to treat skin and urinary diseases. They saw sarasaparilla as a tonic herb for preserving youth and strength. Mexican sarsaparilla was transported to Spain around 1530 and then used as a treatment for syphilis and also as a ‘strengthening tonic’. It was used by Nicholas Culpeper, a famous 17th century English herbalist, for rheumatism and ‘many kinds of diseases’ (Culpeper, 1814).

In more modern times, David Hoffman in his text Holistic Herbal mentions sarsaparilla is a widely applicable alterative and that it may be used to aid proper functioning of the body as a whole (Hoffman, 1988). It is indicated for scaly skin conditions like psoriasis and also as part of a wider treatment for rheumatism, especially rheumatoid arthritis. For psoriasis, sarsaparilla is often combined with similar alteratives to increase medicinal power such as burdock root and yellow dock. Sarsaparilla roots contain a high relative abundance of steroidal saponins that are related to its medicinal properties (Challinor et al., 2012). Steroidal saponins display a range of bioactivities, including cytotoxic, hemolytic, anti-inflammatory, anti-fungal, and anti-bacterial properties.

Sarasaparilla is a relatively well studied alterative and preliminary studies give us insights into how alteratives may function physiologically. For example, gout is a disease associated with the accumulation of urate in the blood stream. In one study, the authors found an extract of sarsaparilla was effective in enhancing urate excretion via the kidneys of hyperuricemic mice (Wu et al., 2014). This supports the role of alteratives in the stimulation of the excretory organs that results in removal of unwanted compounds from the body. Another similar study investigated metabolic syndrome. Metabolic syndrome is a metabolic disorder associated with an increased risk of developing kidney failure, cardiovascular, and cerebrovascular diseases. In this study, using a mouse model of metabolic syndrome, the authors found sarsaparilla root extract was able to control weight gain and was able to decrease elevated levels of triglycerides (fatty molecules) by 60% (Amaro et al., 2014). This study supports the traditional role of alteratives as beneficial modulators of metabolism. While these studies were conducted in animal models, which are not as reliable, there is one human clinical trial of great interest.

In the 1940s when there was more interest in sarsaparilla, one study observed a greater improvement with sarsaparilla extract treatment in psoriasis patients opposed to those patients who received a placebo (Thurmon et al., 1942). 18% of those patients treated with the sarsaparilla extract experienced total remission, while only 6% on the placebo. This study was published in the New England Journal Of Medicine, a prestigious journal. However, in these early days experimental standards were less demanding and this clinical trial does not seem to have been blinded and statistical analysis was not performed. Regardless of this, I think this study shows great promise for the medicinal potential of sarsaparilla in humans. Perhaps in the future, as herbs become more popular again in Western culture as medicines, further studies will expand on the role of sarsaparilla extracts in treating psoriasis and other chronic inflammatory diseases.

Note: Alteratives are often rather drying to the constitution, so care must be taken not to dry some one out too much by using moistening herbs or avoiding the more drying alteratives. More moistening alteratives include red clover and burdock. They also have been known to be too much for older weak people to handle who may respond better to tonification (i.e. use of the adaptogens). It is best to generally proceed with caution with these herbs.


Amaro, Carol Arely Botello, et al. “Hypoglycemic and hypotensive activity of a root extract of Smilax aristolochiifolia, standardized on N-trans-feruloyl-tyramine.” Molecules 19.8 (2014): 11366-11384.

Challinor, Victoria L., et al. “Steroidal saponins from the roots of Smilax sp.: structure and bioactivity.” Steroids 77.5 (2012): 504-511.

Culpeper, Nicholas. Culpeper’s complete herbal. (1814).

Felter, Harvey. The Eclectic Materia Medica, Pharmacology, and Therapeutic (1922)

Groves, Maria. Body into Balance. Storey Publishing. (2016).

Hoffman, David. Holistic herbal. Element Books. (1988).

Kuhn, Merrily A., and David Winston. Herbal therapy and supplements: a scientific and traditional approach. Lippincott Williams & Wilkins, 2000.

Scudder, John. The American Eclectic Materia Medica and Therapeutics (1898)

Thurmon, Francis M. “The treatment of psoriasis with a sarsaparilla compound.” New England Journal of Medicine 227.4 (1942): 128-133.

Wu, Xiao-Hui, et al. “Smilax riparia reduces hyperuricemia in mice as a potential treatment of gout.” The American journal of Chinese medicine 42.01 (2014): 257-259.