Ba Yue Zha
StarAkebia trifoliata (Thunb.) Koidz.
Traditionally used for
- Cough & breathing
- Digestion
- Urinary & fluids
- Mood & calm
Cautions & contraindications
- Kidney conditions
☯ TCM Properties
Harmonizes the Liver and Stomach; Invigorates Blood and Alleviates Pain; Dissipates Nodules and Softens Hardness; Promotes Urination; Eliminates Irritability
Traditional Chinese Uses
Ba Yue Zha (akebia fruit) is a cool, bitter herb used in Chinese medicine to move Liver Qi, clear Heat, dissolve lumps, and promote urination. It addresses Liver Qi stagnation with hypochondriac pain, chest tightness, and emotional distress, and is also used for swollen lymph nodes, goiter, and breast lumps from Phlegm-Qi accumulation. Its diuretic action extends to urinary discomfort from Heat or fluid retention in the lower burner.
Relationships
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Botanical Description
Akebia trifoliata, three-leaf akebia, is a vigorous deciduous to semi-evergreen woody twining vine of the family Lardizabalaceae native to mountain forest margins and thickets across central and eastern China, Korea and Japan. The slender, glabrous stems climb to 6-10 m and bear long-petiolate, trifoliolate leaves with broadly ovate, shallowly lobed or coarsely toothed leaflets 3-8 cm long. The plant is monoecious, producing pendulous racemes in spring that bear a few large, purple-brown female flowers about 2-3 cm across at the base and numerous smaller pale purple male flowers above, all lacking true petals but with three petaloid sepals. The distinctive fruit is a thick-walled, sausage-shaped, indehiscent to tardily dehiscent berry 6-10 cm long, ripening from green to dull violet-purple in autumn and containing many small black seeds embedded in white, sweet, edible pulp.
Active Constituents
Hederagenin
Pentacyclic triterpene (oleanane) aglyconeConcentration: the sapogenin of most Akebia triterpenoid saponins; the antidepressant preparations studied were enriched from the fruit to about 70% and later about 90% hederagenin, far above any level a crude decoction would deliver
The compound the antidepressant pharmacology of Fructus Akebiae is attributed to. In enriched extracts it inhibits reuptake at the serotonin, noradrenaline and dopamine transporters and raises extracellular monoamines in rat frontal cortex. Because the studied material was a deliberately concentrated fraction, these results describe the isolate, not the fruit as dispensed.
Triterpenoid saponins (hederagenin and oleanolic acid glycosides)
Triterpenoid saponinConcentration: the dominant secondary metabolite class of Akebia trifoliata and A. quinata; more than thirty triterpenoid saponins have been reported from the genus
The characteristic chemistry of the genus, and what the European Pharmacopoeia monograph and the modern pharmacology both key on. Reported members include hederagenin-3-O-alpha-L-arabinopyranoside, gypsogenic acid, lupeol esters and beta-amyrin acetate.
Fruit polysaccharides (ATFP-3)
PolysaccharideConcentration: purified fraction composed mainly of glucose (47.55%) and galactose (20.39%)
A purified polysaccharide from Akebia trifoliata fruit with a hydroxyl radical scavenging rate of 89.30% at 1.60 mg/mL and a 50% inhibitory concentration of 0.29 mg/mL. It extended lifespan and raised antioxidant enzyme activity in Caenorhabditis elegans under thermal and oxidative stress.
Phenylethanoid glycosides and chlorogenic acids
PhenylpropanoidConcentration: reported for the species; the reviews do not resolve content by plant organ, so these figures cannot be assumed to describe the fruit drug
Reported among the main constituent classes of Akebia trifoliata alongside the triterpenoids and coumarins. Because most Akebia phytochemistry has been done on stem and leaf, attributing these to Ba Yue Zha specifically is an inference and is flagged as such.
⚠ Drug Interactions
Guan Mu Tong (Aristolochia manshuriensis) substituted into the Akebia supply chain
Akebia is the intended safe source of Mu Tong, and Akebia trifoliata itself contains no aristolochic acids. The hazard is directional: from the 1950s the stem of Aristolochia manshuriensis was widely dispensed under the name Mu Tong, and aristolochic acids I and II are nephrotoxic and genotoxic. In a Taiwanese cohort of 38,995 end-stage renal disease patients, having been prescribed Mu Tong adulterated with Guan Mu Tong before 2004, or an estimated intake above 1 to 100 mg of aristolochic acid, was associated with increased risk of urothelial cancer. Ba Yue Zha is the fruit, not the stem drug, so it is not the material at issue, but it comes out of the same Akebia trade and the same species-verification problem. Molecular methods now discriminate the two: a loop-mediated isothermal amplification assay based on the Aristolochia manshuriensis internal transcribed spacer 2 sequence detects the adulterant within 60 minutes and about tenfold more sensitively than conventional PCR.
Clinical note: Buy Akebia material only from suppliers who can evidence species identity. Never accept anything called Mu Tong without knowing which plant it is. In a patient with unexplained renal impairment or urothelial disease, take a full history of past Mu Tong or Fang Ji use, including material dispensed before 2004.
Akebia-containing medicinal products in the United Kingdom, which are prohibited
The Medicines (Aristolochia and Mu Tong etc.) (Prohibition) Order 2001, Statutory Instrument 2001 No. 1841, prohibits the sale, supply and importation of any medicinal product consisting of or containing a plant of the genus Aristolochia, or of any of eight named species, or an extract of such a plant. The eight named species include Akebia quinata and Akebia trifoliata, along with Clematis armandii, Clematis montana, Cocculus laurifolius, Cocculus orbiculatus, Cocculus trilobus and Stephania tetrandra. A further article prohibits products labelled as containing Mu Tong or Fang Ji. The Order was made because these species had been confused with, or substituted by, aristolochic-acid-bearing material; the practical consequence is that correctly sourced, aristolochic-acid-free Akebia trifoliata is still banned in the UK. The position elsewhere differs sharply: a monograph for Akebia stem, admitting Akebia quinata, Akebia trifoliata or a mixture of the two, entered the European Pharmacopoeia in Supplement 9.6 in 2018 and remains in the 10th edition.
Clinical note: Do not supply Akebia in any form to patients in the United Kingdom, and do not import it there, however well documented the species identity. Check the current national position before dispensing Akebia anywhere, since the regulatory treatment of this genus varies more than for almost any other herb.
SSRIs, SNRIs, tricyclic antidepressants and monoamine oxidase inhibitors
A hederagenin-enriched Fructus Akebiae extract binds rat and cloned human serotonin, noradrenaline and dopamine transporters and inhibits uptake at all three in rat synaptosomes and transfected HEK293 cells, with potency comparable to or better than the corresponding selective inhibitors, while showing no significant affinity for a panel of central nervous system receptors. In vivo microdialysis at 12.6, 25 and 50 mg/kg raised extracellular serotonin, noradrenaline and dopamine in rat frontal cortex. This is a real triple reuptake inhibition signal, but it was produced by a preparation concentrated to about 90% hederagenin, there is no human study, and no interaction study with any antidepressant has been done.
Clinical note: Treat concentrated Akebia fruit saponin extracts, not the whole fruit in a formula, as the material of concern. In a patient on serotonergic drugs, ask specifically about proprietary Fructus Akebiae antidepressant products, and watch for agitation, tremor, clonus, sweating and hyperthermia if one is added.
Evidence Tier
Moderate evidence · 4 studiesRecorded studies by study design, strongest design at the top. This is a study-design tier only, not a GRADE rating: it does not weigh risk of bias, consistency or precision.
Systematic review / meta-analysis
0
Randomized controlled trial
0
Other clinical trial
0
Observational / case report
1
0 verified · 1 unverified
In vitro / animal
3
1 verified · 2 unverified
Show 3 studies
- Antidepressant effect of the extracts from Fructus Akebiae
- The extracts of Fructus Akebiae, a preparation containing 90% of the active ingredient hederagenin: Serotonin, norepinephrine and dopamine reuptake inhibitor
- Characterization and Anti-Aging Activity of Polysaccharides from Akebia trifoliata Fruit Separated by an Aqueous Two-Phase System
Other / unclassified
0
Verified: design read from PubMed for a DOI that resolves to the cited paper Unverified: taken from the study's recorded description
Clinical Studies
Antidepressant effect of the extracts from Fructus Akebiae
An extract of Fructus Akebiae enriched to roughly 70% hederagenin reduced immobility in the forced swim and tail suspension tests in mice after acute and sub-chronic dosing, and reversed the fall in sucrose consumption produced by chronic unpredictable mild stress in rats. It also lowered plasma adrenocorticotrophic hormone and serum corticosterone in stressed rats. Escitalopram produced the same pattern. The paper does not state which Akebia species the drug was sourced from, which matters because the pharmacopoeial Fructus Akebiae may be Akebia quinata, Akebia trifoliata or Akebia trifoliata var. australis.
The extracts of Fructus Akebiae, a preparation containing 90% of the active ingredient hederagenin: Serotonin, norepinephrine and dopamine reuptake inhibitor
The mechanistic follow-up. A Fructus Akebiae extract standardised to 90% hederagenin showed marked affinity for rat and cloned human serotonin, noradrenaline and dopamine transporters in competitive radioligand binding, and inhibited uptake at all three in rat synaptosomes and transfected HEK293 cells in a dose- and time-dependent way, with potency comparable to or better than the specific inhibitors used as comparators. At 10 micromolar it showed no significant affinity for a broad panel of central nervous system receptors. Microdialysis in freely moving rats at 12.6, 25 and 50 mg/kg raised extracellular serotonin, noradrenaline and dopamine in frontal cortex. As above, the source species is not identified.
Characterization and Anti-Aging Activity of Polysaccharides from Akebia trifoliata Fruit Separated by an Aqueous Two-Phase System
Polysaccharides were extracted from Akebia trifoliata fruit by an aqueous two-phase system and one fraction, ATFP-3, was purified and characterised as mainly glucose (47.55%) and galactose (20.39%). It scavenged hydroxyl radicals with a 50% inhibitory concentration of 0.29 mg/mL, improved survival of Caenorhabditis elegans under thermal and oxidative stress, extended lifespan, raised antioxidant enzyme activity and lowered lipofuscin accumulation and malondialdehyde. This study does use Akebia trifoliata fruit specifically; the model is an invertebrate one and carries no clinical implication.
Increased Risk of Urinary Tract Cancer in ESRD Patients Associated with Usage of Chinese Herbal Products Suspected of Containing Aristolochic Acid
A cohort of all 38,995 end-stage renal disease patients in Taiwan enrolled from 1998 to 2002 through the National Health Insurance reimbursement database, of whom 320 developed urothelial cancer. After adjustment for age, sex, residence in a blackfoot-disease endemic region, urinary tract infection and analgesic use, having been prescribed Mu Tong adulterated with Guan Mu Tong (Aristolochia manshuriensis) before 2004, or an estimated aristolochic acid intake above 1 to 100 mg, were each associated with increased urothelial cancer risk. The exposure here is the adulterated stem drug, not Akebia fruit, but it is the human evidence behind every restriction that now attaches to Akebia.
Historical Texts
Ben Cao Shi Yi
Tang dynasty, compiled by Chen Cangqi about 739 CEShi Liao Ben Cao
Tang dynasty, Meng ShenShi Xing Ben Cao
Five Dynasties, Chen ShiliangBen Cao Jing Shu
Ming dynasty, Miao XiyongBen Cao Hui Yan
Ming dynastyReferences
- Maciag D, Dobrowolska E, Sharafan M, Ekiert H, Tomczyk M, Szopa A. Akebia quinata and Akebia trifoliata - a review of phytochemical composition, ethnopharmacological approaches and biological studies . Journal of Ethnopharmacology (2021) [DOI]
- Huang P, Zang F, Li C, Lin F, Zang D, Li B, Zheng Y. The Akebia Genus as a Novel Forest Crop: A Review of Its Genetic Resources, Nutritional Components, Biosynthesis, and Biological Studies . Frontiers in Plant Science (2022) [DOI]
- Wu L, Wang B, Zhao M, Liu W, Zhang P, Shi Y, Xiong C, Wang P, Sun W, Chen S. Rapid Identification of Officinal Akebiae Caulis and Its Toxic Adulterant Aristolochiae Manshuriensis Caulis (Aristolochia manshuriensis) by Loop-Mediated Isothermal Amplification . Frontiers in Plant Science (2016) [DOI]
- Zhu YP. Toxicity of the Chinese Herb Mu Tong (Aristolochia manshuriensis) . Adverse Drug Reactions and Toxicological Reviews (2002) [DOI]
- United Kingdom Statutory Instruments. The Medicines (Aristolochia and Mu Tong etc.) (Prohibition) Order 2001 . Statutory Instrument 2001 No. 1841, in force 1 July 2001 (2001)
This information is for educational purposes only and is not intended to replace professional medical advice. Always consult a qualified healthcare provider before using any herbal remedy, especially if you are pregnant, nursing, or taking medications.
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