The Formula
The Internal Tonic
The cornerstone of Hoxsey therapy is a liquid herbal preparation taken orally over extended periods—sometimes years. The formula contains at least ten ingredients suspended in a base of potassium iodide solution. According to Hoxsey's 1956 autobiography You Don't Have to Die, the tonic was designed to work as a "blood purifier" or "alterative"—nineteenth-century terms for medicines believed to gradually restore the body to health.
Potassium Iodide: The Base
Unlike the herbal components, potassium iodide (KI) is an inorganic salt that serves as the vehicle for the other ingredients. In nineteenth-century medicine, iodides were considered important "alteratives" and were used to treat everything from syphilis to goiter. The FDA, in its 1956 warning, claimed that potassium iodide could "actually accelerate the growth of tumors"—though this assertion has not been substantiated by modern research.
The Nine Primary Herbs
Each herb in the Hoxsey tonic has a documented history in traditional medicine, and several contain compounds that have attracted interest from cancer researchers. As USDA botanist James A. Duke noted in his 1988 analysis, all nine herbs have Native American traditions of use for cancer, some extending back over 3,000 years.
Red Clover
A common meadow plant, red clover has been used in folk medicine across cultures as a "blood cleanser." It contains isoflavones—particularly formononetin, biochanin A, genistein, and daidzein—that have demonstrated anticancer activity in laboratory studies. Genistein and daidzein can induce apoptosis in colon cancer cells and arrest the cell cycle at G1 or G2/M phases.
Safety concern: Red clover acts as an estrogen agonist in vitro and may stimulate ER-positive breast cancer cell proliferation. Memorial Sloan Kettering advises breast cancer patients to avoid it.
Licorice Root
One of the most widely used medicinal plants in history, licorice root contains 3-13% glycyrrhizin, along with its active metabolite 18-beta-glycyrrhetinic acid. Research has shown these compounds can inhibit NF-kappaB, protein kinase C, and Ras pathways. Over 400 cytotoxic derivatives have been prepared from licorice compounds, with 128 showing IC50 values below 30 microM against cancer cell lines.
Safety concern: Can cause hypertension, hypokalemia, and at high doses, neurotoxicity. Has caused deaths when used excessively.
Burdock Root
Burdock contains arctigenin, a lignan that has shown remarkable potency in laboratory studies. Against liver cancer cells, arctigenin demonstrated IC50 values as low as 4.74 nM (HepG2 cells)—exceptionally potent compared to many pharmaceutical compounds. A Phase I clinical trial (GBS-01) at Japan's National Cancer Center Hospital East tested arctigenin in 15 patients with gemcitabine-refractory pancreatic cancer at doses of 3-12g orally, achieving 1 partial response and 4 cases of stable disease with no dose-limiting toxicities.
Barberry Root
The active compound berberine is among the most researched of all Hoxsey ingredients. A landmark randomized controlled trial (the CBAR study, NCT02226185) involving 1,108 participants across 7 hospitals in China found that berberine significantly reduced colorectal adenoma recurrence: 36% in the berberine group versus 47% in placebo (RR 0.77, p=0.001). A 2024 six-year follow-up confirmed lasting benefits: 34.7% recurrence versus 52.1% in controls. The researchers concluded berberine "might be a crucial secondary chemopreventive agent."
Stillingia Root
Known as "Queen's Root," stillingia was used by Eclectic physicians as a lymphatic stimulant. It contains diterpene esters including prostatin and gnidilatidin. While in vitro antitumor activity has been observed, no human studies exist. The plant contains phorbol ester compounds that can act as tumor promoters, raising safety questions.
Poke Root
Pokeweed contains mitogenic compounds and pokeweed antiviral protein (PAP), which has been studied for antiviral and immunological effects. The root was traditionally used by Native Americans and Eclectic physicians for tumors and skin diseases.
Critical warning: All parts of pokeweed are toxic to humans. Ingestion causes severe nausea, vomiting, diarrhea, and abdominal cramps. Pokeweed has caused deaths in children. James A. Duke noted this was the only potentially toxic herb in the Hoxsey formula.
Cascara
A well-established laxative, cascara contains anthraquinone glycosides including cascarosides and emodin. The FDA withdrew over-the-counter approval in 2002 due to concerns about safety with long-term use, including electrolyte disturbances and potential liver injury. The bark must be aged to reduce its harsh purgative effects.
Prickly Ash Bark
Known as the "toothache tree" for its numbing properties, prickly ash contains alkaloids and furanocoumarins including psoralen and imperatorin. Research has demonstrated antifungal activity against 11 strains including Candida, and berry extracts have shown cytotoxicity to tumor cells. However, pharmacological research on cancer applications remains limited.
Buckthorn Bark
Like cascara, buckthorn is primarily a laxative containing anthraquinone glycosides (glucofrangulin, frangulin). The European Medicines Agency has approved it for short-term constipation relief (maximum 8-10 days). Fresh bark is violently purgative and must be aged before use.
The Philosophy Behind the Tonic
The Hoxsey tonic was conceived in the tradition of "alterative" medicine—the nineteenth-century belief that certain medicines could gradually correct imbalances in the body's humors or vital processes. According to this model, the tonic would:
- Detoxify the blood and tissues
- Stimulate the immune system's natural defenses
- Support lymphatic drainage and circulation
- Cleanse the liver and normalize elimination
- Restore proper mineral balance
While these concepts are not recognized in modern oncology, they represent a coherent system of thought that was mainstream medical theory well into the early twentieth century.
The External Paste
For skin cancers and accessible tumors, Hoxsey used topical preparations known as escharotics—caustic substances that destroy tissue on contact. The primary formulation, called the "red paste," bears a striking resemblance to a preparation that would later become the foundation of one of modern dermatology's most important innovations.
The Red Paste Formula
| Ingredient | Amount | Function |
|---|---|---|
| Zinc Chloride (ZnCl₂) | Saturated solution | Primary escharotic; tissue fixative |
| Antimony Trisulfide (Stibnite, Sb₂S₃) | 40g in Mohs formula | Paste binder; maintains zinc chloride suspension |
| Bloodroot (Sanguinaria canadensis) | 10g in Mohs formula | Secondary escharotic; antimicrobial |
The Mohs Surgery Connection
In 1933, Dr. Frederic Mohs of the University of Wisconsin developed his revolutionary technique of chemosurgery using a paste with a nearly identical formula:
Hoxsey's Red Paste
- Antimony trisulfide
- Zinc chloride
- Bloodroot
Original Mohs Paste
- 40.0 gm Stibnite (antimony trisulfide)
- 34.5 ml saturated zinc chloride
- 10.0 gm Sanguinaria canadensis
The critical difference lay not in the formulation but in the application. Mohs used the paste as a fixative for microscopic examination during staged surgical excision—applying it, letting it penetrate overnight, then shaving thin layers of tissue and examining each under a microscope until no cancer cells remained. This technique, known today as Mohs micrographic surgery, remains the gold standard for certain skin cancers, with cure rates exceeding 99% for basal cell carcinoma.
Hoxsey, in contrast, used the paste as a standalone treatment without microscopic verification of tumor margins. Dr. Mohs himself later "decried using escharotics alone because of the risk of disfigurement and unreliability of cure."
How Bloodroot Works—and Why It's Dangerous
Bloodroot contains sanguinarine, an alkaloid that kills cells by blocking the Na+/K+-ATPase enzyme. In laboratory studies, sanguinarine shows cytotoxicity against breast cancer, glioma, leukemia, oral squamous cell, and colon cancer cell lines—sometimes with greater potency than chemotherapy agents like etoposide and cisplatin.
Critical Dangers of Bloodroot
The Yellow Powder
A secondary preparation, less commonly used, containing even more toxic ingredients:
- Arsenic sulfide — a known carcinogen
- Sulfur — antimicrobial and keratolytic agent
- Talc — powder base and texture modifier
- "Yellow precipitate" — composition unspecified in historical records
Application Process
- Pre-wash the affected area with trichloroacetic acid
- Apply the red paste directly to the lesion
- Cover and leave in place for 24 hours or more
- Tissue necrotizes (dies) over days to weeks
- An eschar (black scab) forms and eventually separates
- Wound heals by secondary intention, often with significant scarring
The Dietary Protocol
The third component of Hoxsey therapy is a comprehensive dietary regimen that accompanied the herbal preparations. While some restrictions echo modern nutritional advice, others reflect the health beliefs of the early twentieth century.
Foods Prohibited
- Pork and pork products
- Tomatoes
- Vinegar
- Pickled foods
- Carbonated beverages
- Alcohol
- Refined white flour
- Sugar
- Excessive salt
Foods and Supplements Recommended
- Iron-rich foods
- Calcium-rich foods
- Vitamin C sources
- Yeast supplements
- Grape juice
- Liver and liver extracts
- Cactus preparations
Additional Treatment Components
The full Hoxsey protocol included numerous supporting preparations:
- Antiseptic douches and washes
- Laxative tablets
- Nutritional supplements
- "Tri-tabs" (taken before meals)
- After-meal tablets
- Yeast tablets
- Calcium capsules
- Procaine hydrochloride with vitamins
Evidence Summary
| Ingredient | In Vitro | Animal | Human Trials | Safety |
|---|---|---|---|---|
| Red Clover | Strong | Some | Limited | Estrogenic |
| Burdock/Arctigenin | Strong | Yes | Phase I | Low risk |
| Berberine | Strong | Yes | RCT | Mild GI |
| Licorice | Strong | Yes | None specific | Hypertension |
| Bloodroot | Moderate | Limited | None | Severe |
| Pokeweed | Limited | Limited | None | Deaths |
| Prickly Ash | Moderate | Limited | None | Low risk |
| Stillingia | Limited | Limited | None | Phorbol esters |