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QUININE BARK
Family: Rubiaceae
Genus: Cinchona
Species: officinalis, ledgeriana, succirubra, calisaya
Common names: Quinine Bark, Quina, Quinine, Kinakina, China Bark, Cinchona Bark, Yellow Cinchona, Red Cinchona, Peruvian Bark, Jesuit's Bark, Quina-quina, Calisaya bark, Fever Tree
Part Used: Bark, Wood
DESCRIPTION
Properties/Actions:
 Analgesic, Anesthetic, Antiarrhythmic, Antibacterial, Antimalarial, Anti-microbial, Anti-parasitic, Antipyretic, Antiviral, Antiseptic, Astringent, Bactericide, Fungicide, Febrifuge, Insecticide, Nervine, Stomachic, Tonic
Phytochemicals:
 (-)-epicatechin, Alkaloids, Alkaloids, Aricine, Caffeic-acid, Cinchofulvic-acid, Cincholic-acid-beta-d-quinovoside, Cinchonain-IA, Cinchonain-IB, Cinchonain-IC, Cinchonain-ID, Cinchonain-IIA, Cinchonain-IIB, Cinchonidine, Cinchonine, Cinchophyllamine, Cinchotannic-acid, Cinchotine, Conquinamine, Cuscamidine, Cuscamine, Cusconidine, Cusconine, Dicinchonine, Diconquinine, Dihydroquinidine, Epiquinamine, Epiquinidine, Epiquinine, Homocinchonine, Hydrocinchonidine, Hydroquinidine, Hydroquinine, Isocinchophyllamine, Javanine, Paricine, Proanthocyanidin-A-2, Procyanidin-B-5, Procyanidin-C-1, Quinacimine, Quinamine, Quinic-acid, Quinicine, Quinine, Quininidine, Quinovic-acid-beta-d-quinovoside, Quinovin, Resin, Starch, Sucirubine
Traditional Remedy:
 One-half cup bark decoction 1-3 times daily or 1-2 ml of a 4:1 tincture twice daily. 1 to 2 grams of powdered bark in tablets or capsules can be substituted if desired. SeeTraditional Herbal Remedies Preparation Methods page if necessary for definitions.

ETHNOBOTANY: WORLDWIDE USES
Brazil
 Anemia, Appetite Stimulant, Debility, Dyspepsia, Fatigue, Febrifuge, Fevers, Gastrointestinal Disorders, Malaria, Stomachic, Tonic
Elsewhere
 Adenopathy, Amebiasis, Anesthetic, Bactericide, Carditis, Cold, Contraceptive, Dandruff, Diarrhea, Dysentery, Dyspepsia, Fever, Flu, Hangover, Insecticide, Lumbago, Malaria, Neuralgia, Neuritis, Pertussis, Pile, Pinworms, Pneumonia, Repellant(insect), Schizonticide, Sciatica, Septicemia, Sore Throat, Stomatitis, Stimulant, Stomachic, Tonic, Tumor(glands), Typhoid, Uterotonic, Varicosity
Europe
 Alcoholism, Anemia, Anti-cramp, Anti-protozoal, Antimalarial, Antiseptic, Appetite Stimulant, Arrhythmia, Bitter, Debility, Diarrhea, Enlarged Spleen, Febrifuge, Fevers, Flatulence, Gallbladder Disorders, Hairloss, Leg Cramps, Liver Disorders, Polymyalgia, Tonic
Mexico
 Antiseptic, Astringent, Malaria, Tonic
Turkey
 Antiseptic, Astringent, Fever, Malaria, Tonic
US
 Anesthetic, Antimalarial, Antipyretic, Antiviral, Appetite, Astringent, Bactericidal, Cardiotonic, Colds, Digestive Disorders, Dyspepsia, Flu, Headaches, Heart Palpitations, Hemorrhoids, Leg Cramps, Tonic, Varicose Veins
Venezuela
 Cancer, Malaria
The genus Cinchona comprises about forty species of trees reaching 15 to 20 meters in height and producing white, pink or yellow flowers. All Cinchonas are indigenous to the eastern slopes of the Amazonian area of the Andes where they grow between 1,500 to 3,000 meters in elevation on either side of the equator (from Columbia to Bolivia). They can also be found in the northern part of the Andes, on the eastern slopes of the central and western ranges. They are now widely cultivated in many tropical countries for their commercial value although they are not indigenous to those area..
Cinchona, or "Quinine Bark" is one of the rainforest's most famous plants and most important discoveries. Legends say that the name cinchona comes from the Countess of Chinchon, the wife of a viceroy of Peru, who was cured in 1638 of a malarial type of fever by using the bark of the Cinchona tree. It was supposedly introduced to European medicine in 1640 by the Countess Chinchon but the plant producing it was not known to botanists until 1737, who supposedly named it after the Countess almost a hundred years later for her contribution. (1) Quinine bark was used by the Jesuits very early in its history, first advertized for sale in England in 1658 and was made official in the London Pharmacopoeia in 1677. (2) Several years after "Countess's powder" arrived in England, it arrived in Spain where the virtues of these bark were rapidly recognized, from this "tree of fever of the region of Loxa". Rapidly and due to the influence of the Company of Jesus, the "jesuits' powder" became known all over Europe. Physicians gave credit to the drug, and because of the specificity of its action on malaria, it was recognized officially even while the identity of the producing species remained unknown.(3)
Throughout the 1600's to mid 1800's Quinine Bark was the most used treatment for malaria, evidencing remarkable results, as well as being used for fever, indigestion, mouth and throat diseases, and cancer.(1) In 1820, two scientists, Pelletier and Caventou, isolated a quinoline alkaloid in the bark which provided the highest anti-malarial effect and named it Quinine. Once discovered, methods were developed to extract the quinine from the natural bark to sell as a antimalarial drug. The South American rainforests benefitted from the income generated by harvesting this resource discovered in their territory up until the end of the 19th century. But in the middle of the 19th century, seeds of Cinchona calisaya and Cinchona pubescens were smuggled out by the British and the Dutch. The calisaya species was planted and cultivated in Java by the Dutch and the pubescens species in India and Ceylon by the British. However, the quinine content of these species was too low for high grade production of quinine cost effectively. Then the Dutch smuggled seeds of Cinchona ledgeriana out of Bolivia and established extensive plantations of high grade Cinchona trees in Java, soon dominating world production of cinchona and Quinine.(10) By 1918, the production of quinine was under the total control of the Dutch "kina burea" in Amsterdam. Huge profits were reaped, but Bolivia and Peru, from where the resource originated saw none of it. Then the upheavals of the second world war led to changes in the market which still remain in effect today. When Java was occupied by the Japanese in 1942, a severe shortage of quinine on the side of the Allies ensued, and the South American sources of cinchona trees were once again in demand and new African plantations were planted. This shortage of quinine also fueled the research for developing and producing synthetic antimalarials.

In 1944 scientists were able to synthesize the quinine alkaloid in the laboratory. This led to various synthesized quinine drugs to treat malaria and the use of the common bark and the natural quinine extracted from the bark and sold as antimalarial drugs fell out use. Again, huge profits were reaped by the pharmaceutical companies which sold these synthetic antimalarial drugs which were only possible by discovering this unique alkaloid in the bark of a South American rainforest tree. Yet the South American countries providing the discovery saw none of these profits. Today, Indonesia and India still cultivates cinchonas, but Zaire has become the top supplier of a world market which is also supplied by other African countries (Burundi, Cameroon, Kenya), and much lower on the list of producers are the South American countries of Peru, Bolivia and Ecuador.

Although all cinchona species are good sources of quinine, C. succirubra and C. ledgeriana are the species with the highest amount of quinine alkaloids, which is why they are the species of choice for cultivation today. Early on, the cardiac effect of cinchona bark were noted with its use in academic medicine at the end of the 17th century and quinine bark was used sporadically through the first half of the 18th century for cardiac problems and arrhythmia with purified quinine becoming a standard component of cardiac therapy in the 2nd half of the 19th century.(5) Another chemical called Quinidine was discovered to be responsible for this beneficial cardiac effect. Quinidine, a compound essentially produced by semisythesis from quinine is still used in rhythmology today and is sold as a prescription drug. It is reported of be an Antiarrhythmic which interferes directly with the electrolphysiological properties of the cardiac cells, inhibits rapid sodium influx, and decreases the atrial and intraventricular conduction velocity. It is sales demand for quinidine that still generates and leads the market demand for harvesting cinchona bark today since scientists have been unsuccessful in synthesizing this chemical without the utilizing the natural quinine found in cinchona bark.
Table: Alkaloid Content Comparison by Cinchona species (1, 3)
Species Total Alkaloids (%) Quinine Content (%)
C. calisaya 3 - 7 0 - 4
C. pubescens 4.5 - 8.5 1 - 3
C. officinalis 5 - 8 2 - 7.5
C. ledgeriana 5 -14

 3 - 13
C. succirubra 6 - 16 4 - 14
Quinine bark is harvested today much as it has been for hundreds of years and most all commercial sources of cinchona come from plantations established during World War II. The tree trunks are beaten and the peeling bark is removed. The bark partially regenerates on the tree and after a few years and several cycles of removing the bark and letting it grow back, the trees are uprooted and new ones planted. The cinchona and quinine market is difficult to calculate. It is thought that 300 to 500 metric tons of quinine are extracted annually from 5,000 to 10,000 metric tons of bark annually.(3) Nearly half of the cinchona harvest is directed to the food industry for the production of quinine water, tonic water, and as a bitter additive, and 30 to 50% is thought to be converted to quinidine, a prescription cardiac drug.(3) Quinine is very bitter tasting and commercially sold tonic waters which use quinine as it's bitter ingredient/component usually contain around 100 to 300 parts per million quinine(1) and up to a maximum concentration of 70 milligrams of quinine per liter of tonic water.(3)
Despite the pharmaceutical drugs replacing the use of natural Quinine barks for malaria, the use of the natural bark is still employed in herbal medicine around the world. In Brazil, cinchona bark is considered tonic, stomachic, and febrifuge being employed for anemia, debility, dyspepsia and gastrointestinal disorders, as an appetite stimulant, for general fatigue, malaria, fevers, and as a reconstituent in other serious maladies.(6, 7) Dr. James Duke reports other folk remedies for cinchona bark as a natural remedy for cancer (breast, glands, liver, mesentery, spleen), cancinomata and tumors, adenopathy, amebiasis, cardidtis, cold, diarrhea, dysentery, dyspepsia, fever, flu, hangover, lumbago, malaria, neuralgia, neuritis, pertussis, piles, pinworms, pneumonia, sciatica, septicemia, sore throat, stomatitis, typhoid and varicose veins as well as used as a prophylactic (preventative) for the flu.(8) In European herbal medicine cinchona bark is considered anti-protozoal, anti-cramp, antimalarial, bitter, febrifuge and tonic which is used as a natural for remedy hairloss, appetite stimulant, alcoholism, enlarged spleen, liver and gallbladder disorders, flatulence, polymyalgia, arrhythmia, anemia, debility, diarrhea, leg cramps, and fevers of all kinds.(9) In the US, natural cinchona bark is used for a tonic, digestive aid, reducing heart palpitations and normalizing heart functions, hemorrhoids, varicose veins, headaches, leg cramps, colds and flu, to stimulate digestion and appetite, dyspepsia and for its astringent, bactericidal and anesthetic effects in various other conditions. (1, 11-15)

Interestingly enough, natural quinine extracted from Cinchona bark as well as the use of the natural bark tea and/or bark extracts are making a come-back in the management and treatment of malaria. As with any living and evolving organism, malaria has evolved over the years to develop a resistance and defense mechanism against our standard synthesized antimalarial drugs. It was shown early on that an effective dose of natural Cinchona bark extract elicited the same antimalarial activity as an effective dose of the quinine drug.(16) Scientists are now finding that strains of drug resistant malaria can still be treated effectively with natural quinine and/or Cinchona bark extracts. Daniel Mowrey states, "Cinchona, the primary source for quinine until the drug was synthetically produced, possesses the same antiviral, antimalarial, antipyretic properties as the drug. This equivalency may surprise those who believe that patented, commercialized drugs are superior to natural medicines, but it has been proven."(12) He references the 1969 study where rats injected with malaria were either injected with quinine or fed a cinchona extract and the same antimalarial activity was evidenced for both.(16)

With our wide spread evolving pathogens, bacteria and virus developing resistence to our standard antibiotics, antivirals and antimalarial drugs, its of little wonder that the use of the natural medicine of Cinchona bark is being revisited, even by giants like the World Health Organization. The natural remedy usually calls for a cup of boiling water to be poured over approximately 1 gram of the ground natural bark and allowed to steep for ten minutes. A cupful of this infusion is drunk about half-an-hour before meals to stimulate the appetite, or after meals to treat digestive disorders.(14) The use of pure quinine at large dosages can be toxic. The reported therapeutic oral dose for adults has generally ranged from 167 to 333 milligrams three times per day.(11) Reportedly, a single dose of 2 to 8 grams orally of pure quinine alkaloids may be fatal to an adult.(1, 15) Yet with an quinine alkaloid content of the natural bark being approximately 5-6 percent on average, natural bark teas and extracts prepared in the traditional manner have a long history of use without toxic effects since the actual quinine content is much much lower than 2 grams (a cup of cinchona tea would provide approximately 5-6 milligrams of quinine alkaloids).

The history of the Cinchona tree provides a perfect example of how a natural product can go from folklore or indigenous use into world trade and then the drug market. It's also a perfect example of how indigenous people and countries with important resources are too often pirated and left out of the profit loop by industrialized nations and rich multinational profit driven organizations. Despite the fact that quinine and quinidine drugs were patented and capitalized on, Peru and Bolivia, from whence the discovery was made and the resources extracted from, did not share in the patents or resulting profits. Their natural resources were spirited away, smuggled out of their countries and world markets were created from them which only put them in the bottom of the pack for competing in the world market from resources indigenous to their country. While governments are making inroads and new laws to correct this situation, we still have a long way to go in doing the right thing. Hopefully, if Cinchona bark makes a come-back in the growing natural products industry, or new drugs are developed for these drug resistant strain of pathogens, new laws will protect the natural resources of these developing nations.
Footnotes:
  1. Monograph: Quinine Aug 1993, The Lawrence Review of Natural Products, Facts and Comparisons, Inc.: St. Louis, MO

  2. Grieve, Mrs. M. 1971. A MODERN HERBAL, Dover Publications: New York, NY

  3. Bruneton, Jean, Pharmacognosy, Phytochemistry, Medicinal Plants., Intercept Ltd, 1995, Hampshire England

  4. Evans, WC., Trease and Evan's Pharmacognosy, ed. 13, Philadelphia, PA: W.B. Saunders, 1989

  5. Prinz, A., Discovery of the cardiac effectiveness of cinchona bark and its alkaloids., Wien Klin Wochenschr, 102: 24, 1990 Dec 21, 721-3

  6. Cruz, G.L. 1995. Dicionario Das Plantas Uteis Do Brasil, 5th ed., Bertrand: Rio de Janeiro, Brazil

  7. Coimbra, Raul, 1994. Manual de Fitoterapia 2nd Ed., Editora Cejup: Belem, Brazil.

  8. Duke, JA, CRC Handbook of Medicinal Herbs 1985. Ed. CRC Press Boca Raton, FL

  9. Bartram, Thomas. 1995. Encyclopedia of Herbal Medicine. Grace Publishers: Dorset, England.

  10. Samuelsson, Gunnar. 1992. Drugs of Natural Origin, Swedish Pharmaceutical Press: Stockholm, Sweden.

  11. Heinerman, John, 1996. Heinerman's Encyclopedia of Healing Herbs & Spices. Parker Publishing: West Nyack, NY.

  12. Mowrey, Daniel, 1986. The Scientific Validation of Herbal Medicine. Keats Publishing: New Canaan, CT.

  13. Hoffman, D. 1991. The New Holistic Herbal, Element Books, Inc.: Rockport, MA.

  14. Wichtl, M. 1994. Herbal Drugs and Phytopharmaceuticals, CRC Press: Boca Roton, FL

  15. Lung. A. and Foster, S. 1996. Encyclopedia of Common Natural Ingredients, Wiley & Sons: New York, NY.

  16. Aviado, D.M., et al., Antimalarial and antiarrhythmic activity of plant extracts. Medicina Experimentalis - International Journal of Experimental Medicine 19(20, 79-94, 1969
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