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Cura x Cura

Ma Dou Ling马兜铃

Aristolochiae Fructus · Aristolochia Fruit · Birthwort Fruit

Herbs that Transform Phlegm and Stop Coughing 化痰止咳平喘药《药性论》

Overview

  • · — withdrawn.*

Ma Dou Ling is no longer used. It contains aristolochic acid, which destroys kidney tissue and causes urinary-tract cancer, and it has been removed from the Chinese Pharmacopoeia. This entry exists so that readers who meet the name in an old prescription can find out what happened to it, and what replaced it. Nothing here is a recommendation to use it.

The dried fruit of Aristolochia debilis or A. contorta, bitter and slightly cold, entered the Tang materia medica as a Lung herb: it cooled Lung heat, sent counterflow qi downward to quiet cough and wheeze, and was applied to bleeding haemorrhoids. It is best known from Bu Fei E Jiao Tang 补肺阿胶汤, where it sat with E Jiao and Niu Bang Zi for a child's dry, blood-flecked cough. From the 1990s onward, kidney failure in patients who had taken aristolochia-containing preparations was traced to the plant's aristolochic acid, and the whole aristolochia group was progressively withdrawn —, and Qing Mu Xiang in 2003–2004, and Ma Dou Ling itself along with Tian Xian Teng when the 2020 Chinese Pharmacopoeia was issued.

Nature & Flavor

Bitter, slightly acrid · Cold

Channels

Lung · Large Intestine

Typical Dosage

3–10 g in decoction
马兜铃Photography for this entry is on its way.

Actions

3 core actions

  • Cooled Lung heat, quieted cough and wheezeThe main classical use: a hot, dry cough with sticky or blood-streaked sputum, and Lung-heat wheezing. **Replaced in practice by** Sang Bai Pi 桑白皮, Pi Pa Ye 枇杷叶, Huang Qin 黄芩, Gua Lou Pi 瓜蒌皮, Xing Ren, Zi Wan 紫菀 and Kuan Dong Hua 款冬花, chosen according to the pattern.
  • Cooled the intestines for haemorrhoidsBleeding and swollen haemorrhoids, taken internally or used as a wash. **Replaced by** Di Yu 地榆 and Huai Hua 槐花 for the bleeding, and by the ordinary heat-clearing, blood-cooling herbs for the rest.
  • Its relatives were withdrawn tooThe stem Tian Xian Teng and the root Qing Mu Xiang come from the same plants and carry the same acid; both are gone. was replaced by (Clematis) and Tong Cao; by Fang Ji (Stephania tetrandra,); Qing Mu Xiang by Mu Xiang 木香 or Xiang Fu 香附 where qi-moving pain relief was wanted.

In Formulas

Formulas containing Ma Dou Ling

Indications & Clinical Uses

  • Historical only: Lung-heat cough and wheezing with thick or blood-streaked sputum
    - Historical only: bleeding, swollen haemorrhoids
    - No current indication exists. Where an old prescription calls for Ma Dou Ling, a substitute is used instead.

Western Medical Keywords

Searchable condition terms

Aristolochic acid nephropathyChronic kidney diseaseUrothelial carcinomaBanned herbCough

Contraindications

Cautions

Ma Dou Ling is banned. It contains aristolochic acid — a substance that destroys kidney tubules and causes cancer of the urinary tract. Do not take it, do not dispense it, and do not fill an old prescription that names it.

  • What it does to the kidneys. Aristolochic acid causes a progressive scarring nephropathy: the kidney tubules are destroyed and replaced by fibrous tissue, kidney function declines, and the damage does not reverse when the herb is stopped. Many of the reported patients reached end-stage renal failure and needed dialysis or a transplant. It was first described in Belgium in the early 1990s in women taking a slimming preparation that contained an aristolochia species, and was called Chinese herb nephropathy before the specific chemical cause was identified.
    - Cancer. Aristolochic acid forms DNA adducts that persist in tissue for decades and produce a characteristic mutation pattern. It is classified by the International Agency for Research on Cancer as carcinogenic to humans (Group 1), and it causes urothelial carcinoma of the renal pelvis, ureter and bladder. Cancers have appeared many years after exposure ended.
    - There is no safe dose. The injury is cumulative and dose-related but has no demonstrated threshold, and short courses have been followed by renal failure. Claims that a small amount, a processed form, honey-frying, or a short course make it acceptable are not supported.
    - Regulatory status. The 2020 Chinese Pharmacopoeia does not include Ma Dou Ling or Tian Xian Teng;, and Qing Mu Xiang were withdrawn in 2003–2004; the aristolochia species were removed from the formulas that once contained them, notably Long Dan Xie Gan Wan, which was reformulated with Mu Tong in place of. The European Union prohibited aristolochia-containing medicines in 2001, the United Kingdom banned them the same year, and the US Food and Drug Administration issued import alerts and consumer warnings in 2001. Supplying it is a regulatory offence in most jurisdictions.
    - If you have taken it. Anyone who knowingly took an aristolochia-containing preparation should tell their physician, have kidney function and urine checked, and ask about long-term surveillance of the urinary tract, because the cancer risk persists long after exposure.
    - Check old formulas by name. Aristolochic acid species travel under several names: Ma Dou Ling, Tian Xian Teng, Qing Mu Xiang,,,,,. Any of these in an old prescription must be substituted, not sourced.

Contraindicated in pregnancy: Contraindicated — as it is for everyone. Aristolochic acid is nephrotoxic and genotoxic, crosses the placenta, and has no acceptable use in pregnancy or breastfeeding, or at any other time. Nothing about pregnancy makes this a special case; the herb is simply not used.

For licensed practitioners’ reference only

References

  1. Yao Xing Lun《药性论》(classical source, public domain) — where the fruit first enters the materia medica.
    2. Bensky, Clavey & Stöger. Chinese Herbal Medicine: Materia Medica, 3rd ed., which treats the aristolochia group as withdrawn.
    3. 《中华人民共和国药典》2020 年版 — 马兜铃 and 天仙藤 are no longer included.
    4. The International Agency for Research on Cancer classifies aristolochic acid, and plant material containing it, as carcinogenic to humans (Group 1).
    5. Aristolochia-containing medicines are prohibited in the European Union and the United Kingdom, and are subject to US Food and Drug Administration import alerts and consumer warnings.

Professional reference notice. Entries are scholarly references for licensed TCM practitioners and students — not medical advice, and not a recommendation to self-prescribe. Chinese herbal formulas should be used under the guidance of a qualified practitioner. Content is an original editorial compilation by Cura x Cura, cross-checked against the cited references.