Pau d'Arco: Benefits, Bark Tea, Dosage & Side Effects

Open a bag of pau d'arco and you'll find thin, rust-colored shreds of bark. It's the inner bark of Handroanthus impetiginosus, a canopy tree of the Amazon rainforest and other parts of South America, and people across the continent have simmered it into a healing tea for generations.1

I use pau d'arco for yeast overgrowth, and its mild taste, gentler than most cleansing herbs, makes it easy to take as a tea.38

Its two best-known compounds, lapachol and beta-lapachone, have been studied for decades against yeast, inflammation and stomach ulcers.1

Did you know?

• The tree's species name, impetiginosus, comes from impetigo, a contagious skin infection, because people believed the tree could treat it.2

• Its flowers give it two more common names: the pink trumpet tree and the purple trumpet tree.2

• In lab tests, two compounds from the inner bark held back a Clostridium gut bacterium while leaving beneficial bifidobacteria and lactobacilli untouched, even at high amounts.9

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What is pau d'arco bark?

The tree is best known from the Amazon, and it grows wild from Mexico and Central America south to Argentina.2 Botanists have given it many scientific names over the years, so older studies and many labels call it Tabebuia impetiginosa or Tabebuia avellanedae.21

The bark's two main active compounds are lapachol and beta-lapachone, both members of a family called naphthoquinones, and the inner bark also carries anthraquinones, a related family of plant compounds.112 Most of the research on this page tests either the bark or one of those compounds, and each study below names which one it used.

A short history of pau d'arco

Long before any lab studied it, people across South America took the inner bark as a decoction, a tea made by simmering bark or roots, for bacterial and fungal infections, fever, malaria, and stomach and bladder disorders.1 The Callawaya people brew a concentrated inner-bark tea for inflamed skin, Brazilians have used the tree against pain, inflammation and snake venom, and a 2020 review traces its use for pain and arthritis back to the Inca civilization.2 In northeast Brazil the inner bark is still used as a painkiller, an anti-inflammatory and a diuretic,10 and in Paraguay it's one of the traditional plants for skin diseases.13

Medical reports on pau d'arco go back to at least 1873. In 1967, stories in the Brazilian press brought it back to wide attention, and in the same decade the U.S. National Cancer Institute studied the tree in detail.1

Here's pau d'arco's profile in the warming-and-cooling terms of traditional Chinese medicine:783

What is pau d'arco good for?

Pau d'arco benefits

Two benefits lead the list: pain relief, which has a first study in people, and support against yeast overgrowth, its use in my Candida Cleanse Protocol.63 Here are its benefits in order:

Does pau d'arco help period pain?

Period cramps that aren't caused by another condition, called primary dysmenorrhea, affect 41% to 90% of women of reproductive age. They're driven by inflammatory messengers called prostaglandins, especially prostaglandin E2, which is made by an enzyme called COX-2; these messengers make the uterus contract hard and cut its blood flow.6

That pathway is why researchers at the National University of Natural Medicine in Portland, Oregon, chose pau d'arco. In lab and animal studies, the bark and its compounds lowered prostaglandin E2 and COX-2 and eased pain and swelling, which suggests it may work much like the common anti-inflammatory pain relievers, without the stomach harm those drugs can cause.6

Twelve healthy women, ages 18 to 45, took three capsules a day with food for 8 weeks. Each capsule held 350 mg of pau d'arco and 25 mg of rutin, a flavonoid found in many common foods, for 1,050 mg of pau d'arco a day, and the women knew what they were taking.6 Each woman's pain was compared with her own starting score. Average pain fell from 74.17 before the study to 41.33 four hours after the first dose, taken on the first day of her next period, and it stayed lower at 49.45 at week 4 and 43.88 at week 8. Eleven of the 12 women had less pain on that first day, as did 10 of the 11 still reporting at week 4 and all 8 who reported at week 8.6

Pain interference, anxiety, depression, fatigue, sleep and sexual function all moved in the right direction, and hs-CRP, a blood marker of inflammation, fell by 1.16 mg/L, though none of those changes was statistically significant, and physical function scores slipped slightly.6 Five of the women also used other pain aids, such as anti-inflammatory drugs or ginger, at some point during the 8 weeks.6 The researchers noted that relief within 4 hours is about the timing you'd expect from an anti-inflammatory pain reliever.6

Our guide to natural painkillers covers more natural ways to ease the pain, and if you take a blood thinner, read the safety section first.

How pau d'arco may ease cramp pain

Researchers propose that pau d'arco eases cramps by calming the same inflammatory messengers that drive them. Here's the evidence, step by step:

Our guide to anti-inflammatory herbs covers other plants that work on these same messengers.

Pau d'arco for candida and yeast overgrowth

Candida yeast feeds on sugar, and sugar is also a signal for it to switch from harmless yeast into invasive threads called hyphae.3 That's why my protocol works in order: starve the yeast with the candida diet, open your body's drainage pathways, kill, then rebuild. Skip the starve phase and the herbs hit a colony that's still being fed; skip drainage and dead yeast becomes a toxin you reabsorb.3

The kill phase runs from about day 14 to day 28, after two weeks of the candida diet and a week of drainage support. Here's how pau d'arco fits into it:3

1. Open the biofilm. Yeast shelters inside biofilms, so my protocol starts each antifungal dose with NAC and serrapeptase, taken on an empty stomach half an hour to an hour ahead.
2. Week one: caprylic acid and oregano oil.
3. Week two: berberine and pau d'arco, 500 to 1,000 mg of pau d'arco twice a day with food. My protocol rotates antifungals every 7 days so the yeast can't adapt; pau d'arco is gentle enough that it can also run the full 14 days.
4. Start gently if you're sensitive, at half the dose for the first 3 days.
5. Cook with antifungal foods: raw garlic, coconut oil, Ceylon cinnamon and cloves with your meals, and bone broth every day.
6. Drink the tea: 1 to 2 cups of pau d'arco tea a day during the cleanse.
7. Rebuild with probiotics, the protocol's fourth phase.

If symptoms are still strong at day 28, my protocol runs a second 14-day kill after two weeks of rebuilding.3 As yeast dies off, a mild headache, tiredness and achiness are common on days 2 to 5 of the kill phase; drop to half the antifungal dose if you need to, and see candida die-off for what's normal.3

The lab research explains why pau d'arco earned its place. Beta-lapachone completely stopped the growth of a fluconazole-resistant Candida albicans strain taken from a patient's mouth, blocked 92% of its switch into hyphae and cut its biofilm formation by 84%.5 Against Candida auris, a yeast species that quickly picks up resistance to antifungal drugs, 100 µg/ml of beta-lapachone stopped 92.7% of growth, blocked 84.9% of biofilm formation and cut the activity of biofilms that had already formed by 87.1%, damaging the yeast's cell wall and its mitochondria along the way.4 It was also active against other azole-resistant Candida strains, both free-floating and in mature biofilms.21 And in a screen of 14 Paraguayan plants used traditionally for skin diseases, pau d'arco's bark extracts were among the most active against 11 fungi, yeasts included.13

Practitioners already reach for it: in a 2026 national survey of 223 Australian health professionals, pau d'arco was among the herbal medicines most often recommended for recurrent vaginal yeast infection, alongside garlic and horopito.22 It's taken by mouth, as tea or capsules, and the safety section lists the yeast symptoms that need a doctor's visit.

Other pau d'arco benefits under study

Beyond yeast and period pain, pau d'arco's research reaches into the stomach, the skin and cancer care.

Stomach lining and ulcers

Stomach complaints are one of pau d'arco's traditional uses, and in rats it protected the stomach lining.118 An alcohol-based extract of the bark, given by mouth, guarded the stomach against damage from alcohol and from ibuprofen, raised protective mucus and lowered stomach acid.18 In rats with chronic ulcers, the extract taken twice a day for 7 days shrank the ulcers by 44% at 100 mg/kg and by 36% at 300 mg/kg, with more mucus and faster renewal of the stomach lining.11

In lab tests, three compounds from the inner bark held back Helicobacter pylori, a stomach bacterium, at lower concentrations than the drug metronidazole, though the antibiotics amoxicillin and tetracycline worked at lower concentrations still.12 In mice with colitis, a water extract taken by mouth eased weight loss and gut inflammation by shifting immune cells toward calmer types.20

Facial redness

Lapachol has been tested on the skin, too. In 25 adults with mild to moderate facial redness from acne, rosacea or sun damage, a moisturizer containing lapachol, applied twice a day for 8 weeks, cut redness by 44% in the dermatologist's ratings and 40% in the participants' own. A skin-color meter measured 26% less redness at week 4 and 31% less at week 8, and a second instrument measured 29% less at week 8. All 25 finished without tolerability problems. The study had no comparison group and was funded by a skincare company.15 Our guide to rosacea covers more natural steps for a red, reactive face.

Pau d'arco and cancer

Pau d'arco's reputation as a cancer remedy comes from South America, where traditional healers in Brazil have prescribed it for tumors.2 The 1967 Brazilian press stories described cancer patients in a hospital who were treated with it, and the National Cancer Institute's study of the tree was part of a worldwide search of plants for anticancer compounds.1 In the early 1970s, the Institute gave lapachol, one of pau d'arco's compounds, by mouth to people with cancer. It slowed blood clotting the way the drug warfarin does, and with anemia and poor absorption also reported, the work was stopped early.232425

Researchers have kept studying the tree's compounds in the lab. A 2022 systematic review of 78 studies on pau d'arco and its close relatives found that their extracts were toxic to 15 lines of tumor cells grown in lab dishes, from breast, colon, liver, lung, cervical and ovarian cancers and leukemia, among others.26

The most practical human finding is support during treatment. In 40 adults having radiation for head and neck cancer, with no comparison group, people took a swallowable lapacho-based blend three times a day from the first day of radiation to the last, and the results were encouraging: 11 people (27.5%) developed moderate sores, 4 (10%) developed severe ones, no one developed the most severe grade, and no one had to stop radiation because of mouth sores. Nearly everyone took it through to the end of treatment without interruption.14 The blend contained more than lapacho, so the result belongs to the blend.

During chemotherapy or radiation, take supplements only with your cancer team's approval, as my Cancer Support Protocol advises, and pau d'arco's effect on blood clotting is one more reason to clear it with them first.2724

Pau d'arco tea: benefits and how to make it

Tea is a water extract of the inner bark, the same kind of extract tested in the anti-inflammatory research: in the lab it lowered prostaglandin E2 in immune cells, and in mice it eased pain, swelling and colitis.161020

Here's how to make it:

1. Measure the bark. Use the amount of dried, shredded inner bark your package directs for each cup of water.

2. Simmer it. Bark and roots are made into a decoction, simmered longer than you'd steep leaves or flowers.7

3. Strain and blend. Strain out the bark, then mix the tea with a chai tea, or simmer it with cinnamon, ginger and clove.8

4. Drink 1 to 2 cups a day during a candida cleanse.3

Why the spices? In those warming-and-cooling terms, cooling herbs suit people who run hot, with inflammation, irritability or flushing, while warming herbs suit people who run cold, with chills, slow digestion or fatigue.7 Pau d'arco is a cooling herb, so I have patients pair it with warming spices such as ginger or cinnamon.828 Cinnamon and cloves are already on the menu in my protocol's kill phase, so the blend fits right in.3

During the cleanse, drink the tea unsweetened, since the protocol takes all sugar, honey, syrups and sweeteners off the table while you starve the yeast; after the cleanse, most people can bring back occasional honey.3 For a creamy chai, use coconut milk, since the protocol leaves out conventional dairy.3 Our guide to herbal teas covers more to brew.

How much pau d'arco should you take?

Pau d'arco comes in several forms. Here's how each one is used:

The longest study of pau d'arco capsules in people ran 8 weeks.6 If you plan to take it longer than the 14-day kill phase and the cleanse, see the safety section on blood tests.3

How to choose a pau d'arco supplement

Quality varies widely in the pau d'arco sold around the world, so check the label for these:1

• The Latin name and the plant part. Look for Handroanthus impetiginosus, or the older Tabebuia impetiginosa or Tabebuia avellanedae, and inner bark.72

• Third-party testing for heavy metals, identity and purity.7

• Milligrams per capsule, so you can count your way to 500 to 1,000 mg a dose.3

• Bovine or fish gelatin, or a plant-based capsule shell.

• Fresh stock. Keep dried herbs cool, dark and tightly closed, and use them within about a year; tinctures keep 3 to 5 years.7

Pau d'arco side effects and who should skip it

In the period pain study, 9 of the 12 women reported a side effect at some point, almost all mild: a few had loose stools, nausea or dizziness, one had nosebleeds, and 2 stopped early, citing loose stools in one case and muscle spasms in the other.6 Blood tests stayed mostly normal, and none reached the study's stopping limits, though 5 women had mild changes in liver enzymes, potassium, urea or signs of anemia; only the anemia signs showed up in more than one woman, so the researchers suggest watching for it. If you take pau d'arco for longer than a cleanse, ask your practitioner for a complete blood count.6

Skip pau d'arco during pregnancy and while breastfeeding; my protocol skips all the antifungal herbs then.3 In pregnant rats, lapachol given by mouth caused fetal deaths and slowed fetal growth.3031 If you're pregnant or nursing, the candida diet, probiotics, coconut oil, garlic and bone broth are safe and often enough.3

The bottom line

Pau d'arco: frequently asked questions

References

1. Gómez Castellanos JR, Prieto JM, Heinrich M. Red Lapacho (Tabebuia impetiginosa)--a global ethnopharmacological commodity? J Ethnopharmacol. 2009;121(1):1-13. doi:10.1016/j.jep.2008.10.004
2. Zhang J, Hunto ST, Yang Y, et al. Tabebuia impetiginosa: A Comprehensive Review on Traditional Uses, Phytochemistry, and Immunopharmacological Properties. Molecules. 2020;25(18):4294. doi:10.3390/molecules25184294
3. Axe J. The Candida Cleanse Protocol: The 30-Day Healing Protocol. DrAxe.com protocol; 2026 (Phase 1 Starve: avoid all sugar, honey, syrups and sweeteners, and conventional dairy; p. 12, occasional honey after the cleanse; p. 15, why the phases run in order; p. 18, Phase 3 Kill: pau d'arco 500–1,000 mg twice daily, week two with berberine, half dose for 3 days if sensitive, pregnancy and breastfeeding skip the herbs; p. 20, Top 8 antifungals, #4 pau d'arco; 7-day meal plan and daily drinks, pau d'arco tea 1–2 cups; p. 26, die-off and when to stop).
4. de Moraes DC, Rollin-Pinheiro R, Pinto MDCFR, et al. Antifungal activity of β-lapachone against a fluconazole-resistant Candida auris strain. Braz J Microbiol. 2024;55(3):2593-2601. doi:10.1007/s42770-024-01375-1
5. Moraes DC, Curvelo JAR, Anjos CA, et al. β-lapachone and α-nor-lapachone modulate Candida albicans viability and virulence factors. J Mycol Med. 2018;28(2):314-319. doi:10.1016/j.mycmed.2018.03.004
6. McClure C, Bollen M, Buttolph L, et al. Safety and tolerability of Pau d' Arco (Tabebuia avellanedae) for primary dysmenorrhea: A single-arm, open-label trial on adults ages 18-45. Adv Integr Med. 2022;9(3):159-166. doi:10.1016/j.aimed.2022.04.003
7. Axe J. Top 50 Healing Herbs & Essential Oils. DrAxe.com protocol; 2026 ("Reading Each Page": warming and cooling herbs, and the forms you will see, including decoction and tincture; "How to Buy Quality Herbs" and storage; "Safety & Interactions": blood thinners and surgery).
8. Axe J, Rogers K. Signs That You Have a PARASITE (How to Cleanse Naturally) | The Worm Queen. The Dr. Josh Axe Show. 2025 (pau d'arco as a tea, less bitter than most cleansing herbs, blended with chai spices because it is very cooling, 26:18–26:52).
9. Park BS, Kim JR, Lee SE, et al. Selective growth-inhibiting effects of compounds identified in Tabebuia impetiginosa inner bark on human intestinal bacteria. J Agric Food Chem. 2005;53(4):1152-7. doi:10.1021/jf0486038
10. de Miranda FG, Vilar JC, Alves IA, et al. Antinociceptive and antiedematogenic properties and acute toxicity of Tabebuia avellanedae Lor. ex Griseb. inner bark aqueous extract. BMC Pharmacol. 2001;1:6. doi:10.1186/1471-2210-1-6
11. Pereira IT, Burci LM, da Silva LM, et al. Antiulcer effect of bark extract of Tabebuia avellanedae: activation of cell proliferation in gastric mucosa during the healing process. Phytother Res. 2013;27(7):1067-73. doi:10.1002/ptr.4835
12. Park BS, Lee HK, Lee SE, et al. Antibacterial activity of Tabebuia impetiginosa Martius ex DC (Taheebo) against Helicobacter pylori. J Ethnopharmacol. 2006;105(1-2):255-62. doi:10.1016/j.jep.2005.11.005
13. Portillo A, Vila R, Freixa B, et al. Antifungal activity of Paraguayan plants used in traditional medicine. J Ethnopharmacol. 2001;76(1):93-8. doi:10.1016/s0378-8741(01)00214-8
14. Giacomelli I, Scartoni D, Fiammetta M, et al. Oral Lapacho-Based Medication: An Easy, Safe, and Feasible Support to Prevent and/or Reduce Oral Mucositis During Radiotherapy for Head and Neck Cancer. Nutr Cancer. 2015;67(8):1247-53. doi:10.1080/01635581.2015.1082114
15. Draelos ZD. The Clinical Efficacy of Lapachol in Facial Redness Reduction. J Cosmet Dermatol. 2024;23(11):3662-3666. doi:10.1111/jocd.16602
16. Byeon SE, Chung JY, Lee YG, et al. In vitro and in vivo anti-inflammatory effects of taheebo, a water extract from the inner bark of Tabebuia avellanedae. J Ethnopharmacol. 2008;119(1):145-52. doi:10.1016/j.jep.2008.06.016
17. Rigamonti G, Veronesi F, Chiaradia E, et al. Selective activity of Tabebuia avellanedae against Giardia duodenalis infecting organoid-derived human gastrointestinal epithelia. Int J Parasitol Drugs Drug Resist. 2025;27:100583. doi:10.1016/j.ijpddr.2025.100583
18. Twardowschy A, Freitas CS, Baggio CH, et al. Antiulcerogenic activity of bark extract of Tabebuia avellanedae, Lorentz ex Griseb. J Ethnopharmacol. 2008;118(3):455-9. doi:10.1016/j.jep.2008.05.013
19. Ryan RYM, Fernandez A, Wong Y, et al. The medicinal plant Tabebuia impetiginosa potently reduces pro-inflammatory cytokine responses in primary human lymphocytes. Sci Rep. 2021;11(1):5519. doi:10.1038/s41598-021-85211-8
20. Park HJ, Lee SW, Kwon DJ, et al. Oral administration of taheebo (Tabebuia avellanedae Lorentz ex Griseb.) water extract prevents DSS-induced colitis in mice by up-regulating type II T helper immune responses. BMC Complement Altern Med. 2017;17(1):448. doi:10.1186/s12906-017-1952-4
21. da Silva CR, S Campos R, de A Neto JB, et al. Antifungal activity of β-lapachone against azole-resistant Candida spp. and its aspects upon biofilm formation. Future Microbiol. 2020;15:1543-1554. doi:10.2217/fmb-2020-0011
22. Everingham-Gordon R, Steels E, Watson CJ, et al. Treatment recommendations for recurrent vulvovaginal candidiasis across complementary and conventional disciplines: a national survey of Australian healthcare professionals. Int J Clin Pharm. 2026;48(5):1926-1936. doi:10.1007/s11096-026-02165-5
23. Block JB, Serpick AA, Miller W, et al. Early clinical studies with lapachol (NSC-11905). Cancer Chemother Rep 2. 1974;4(4):27-8.
24. Preusch PC, Suttie JW. Lapachol inhibition of vitamin K epoxide reductase and vitamin K quinone reductase. Arch Biochem Biophys. 1984;234(2):405-12. doi:10.1016/0003-9861(84)90286-8
25. Miranda SEM, de Alcantara Lemos J, Ottoni FM, et al. Preclinical evaluation of L-fucoside from lapachol-loaded nanoemulsion as a strategy to breast cancer treatment. Biomed Pharmacother. 2024;170:116054. doi:10.1016/j.biopha.2023.116054
26. Lima Bezerra JJ, Johanes I, Vieira Pinheiro AA. Anticancer potential and toxicity of the genus Handroanthus Mattos (Bignoniaceae): A systematic review. Toxicon. 2022;217:131-142. doi:10.1016/j.toxicon.2022.08.007
27. Axe J. The Cancer Support Protocol. DrAxe.com protocol; 2026 (FAQ: supplements during chemotherapy or radiation only with your team's approval; clear every pill first).
28. Axe J, Motley C. Microbiome Transformation Killing Parasites, Candida and More. The Dr. Axe Show Podcast, Episode 58. 2021 (pau d'arco paired with ginger or cinnamon because it is so cooling, 41:09–41:32).
29. Son DJ, Lim Y, Park YH, et al. Inhibitory effects of Tabebuia impetiginosa inner bark extract on platelet aggregation and vascular smooth muscle cell proliferation through suppressions of arachidonic acid liberation and ERK1/2 MAPK activation. J Ethnopharmacol. 2006;108(1):148-51. doi:10.1016/j.jep.2006.04.016
30. Guerra Mde O, Mazoni AS, Brandão MA, et al. Toxicology of Lapachol in rats: embryolethality. Braz J Biol. 2001;61(1):171-4. doi:10.1590/s0034-71082001000100021
31. Felício AC, Chang CV, Brandão MA, et al. Fetal growth in rats treated with lapachol. Contraception. 2002;66(4):289-93. doi:10.1016/s0010-7824(02)00356-6

Dr. Josh Axe, DC, DNM, CNS

Doctor of Natural Medicine · Founder, DrAxe.com

Dr. Axe is a certified doctor of natural medicine, clinical nutritionist, and multiple New York Times bestselling author. He has spent 20+ years in clinical practice helping people heal at the root cause and founded one of the most-visited natural-health platforms in the world.

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