☯ TCM Properties

Category: transforming phlegm

Temperature: warm

Taste: sweet, bitter

Meridians: lung

Functions:

Moistens the Lungs and Descends Qi; Kills Parasites and Eliminates Lice

Traditional Chinese Uses

Qiao Mai (buckwheat) is a cool, sweet-slightly-astringent food-herb used in Chinese medicine to clear Damp-Heat, promote urination, and consolidate the intestines to relieve diarrhea. It is also applied for swellings, boils, and scalds both internally and topically. As a common grain with mild medicinal properties, it is consumed as a dietary staple with particular benefit during hot, damp conditions or in those with heat-type digestive complaints.

Western Herbalism Properties

Actions:

antimicrobial

Pharmacological Effects

Smooth muscle relaxant: Alkaloid extract relaxed histamine-contracted guinea pig bronchi; water extract of S. sessilifolia relaxed guinea pig trachea (carbachol, histamine, KCl) independently of β-receptors, binding muscarinic receptors and L-type Ca2+ channel DHP sites; tuberostemonine paralyzed isolated mouse ileum.
Insecticidal/anthelmintic: Aqueous and 70% alcoholic extracts killed head and body lice and their eggs, and pubic lice within minutes; tuberostemonine inhibited motility of several parasitic helminths in vitro.
Antimicrobial: Alcoholic extract inhibited/killed M. tuberculosis H37RV in vitro; decoction inhibited various bacteria and fungi and reduced pathogenicity of influenza A virus in mice.

Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 498.

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Botanical Description

Stemona sessilifolia (Miq.) Miq., S. japonica (Blume) Miq., and S. tuberosa Lour. (Stemonaceae) are perennial herbaceous twining vines native to East and Southeast Asia, climbing 1-5 m by slender stems with opposite or whorled, parallel-veined ovate-lanceolate leaves and small greenish-purple axillary flowers. The plants bear a cluster of fleshy, spindle-shaped tuberous roots at the base, which constitute the medicinal Bai Bu. The roots are dug in spring or autumn, briefly blanched in boiling water, and dried in the sun, becoming pale yellow to brown, shriveled, and wrinkled longitudinally. They contain a complex of Stemona alkaloids (stemonine, tuberostemonine, stemonidine, neotuberostemonine) responsible for both antitussive and insecticidal activity. In traditional Chinese medicine, Bai Bu is sweet, bitter, and slightly warm, entering the lung channel; it moistens the lungs, descends qi, and stops cough, used for all types of cough both new and chronic, and is also applied externally and orally to kill parasites (head lice, pinworms, body lice).

Native Region: Anhui, Guangxi, Hubei, Jiangsu, Shandong, Sichuan, Yunnan, Zhejiang

Active Constituents

Neotuberostemonine

Stemona alkaloid, stenine (tuberostemonine) type

Concentration: A principal root alkaloid of Stemona tuberosa; content varies widely between the three official species and between provenances

One of the most potent antitussive constituents isolated from the tuberous root of Stemona tuberosa, suppressing citric-acid-induced cough in guinea pigs. Mapping with superior laryngeal nerve stimulation placed its action on the peripheral limb of the cough reflex rather than on the medullary cough centre.

Tuberostemonine

Stemona alkaloid, stenine (tuberostemonine) type

Concentration: Major alkaloid of Stemona tuberosa root; the marker used in most TLC and HPLC assays of the drug

Antitussive but distinctly weaker than neotuberostemonine and stemoninine in the guinea-pig citric-acid model. Acts peripherally on the cough reflex pathway.

Croomine

Stemona alkaloid, croomine (pyrrolo[1,2-a]azepine, croomine) type

Antitussive with potency comparable to neotuberostemonine, but the only one of the four major alkaloids shown to act at central sites in the cough reflex pathway. In the same guinea-pig experiments it produced marked central respiratory depression, which the authors proposed accounts in part for the adverse reactions reported for the crude drug.

Stemoninine

Stemona alkaloid, stemoninine type

Antitussive at a potency similar to croomine and neotuberostemonine, acting on the peripheral portion of the cough reflex pathway.

Neostenine

Stemona alkaloid, stenine type

Isolated from Stemona tuberosa alongside tuberostemonine J and H; showed significant antitussive activity in guinea pigs. Structure-activity work identified the saturated tricyclic pyrrolo[3,2,1-jk]benzazepine nucleus with all-cis ring junctions as the optimal antitussive scaffold in this series.

Protostemonine

Stemona alkaloid, protostemonine type

A widely distributed Stemona alkaloid type; protostemonine-group alkaloids underlie the insecticidal and antiparasitic reputation of the genus and are the basis of the traditional use of the root against lice and other ectoparasites.

Stilbenoids (dihydrostilbenes and stilbenes of the stilbostemin group)

Stilbenoid (bibenzyl and stilbene) phenolics

Non-alkaloidal Stemona metabolites that co-occur with the alkaloids and contribute antifungal and antibacterial activity. They are the chemotaxonomically most useful non-alkaloid marker group in the genus.

⚠ Drug Interactions

Codeine and other opioid antitussives

Moderate Evidence: Possible

Croomine, one of the four major Stemona tuberosa alkaloids, acts at central sites in the cough reflex pathway and produced obvious central respiratory depressant effects in guinea pigs. Combining the crude root with a centrally acting opioid antitussive gives two agents depressing respiratory drive at the same level. The evidence is animal pharmacology, not clinical, but it is direct evidence of central respiratory depression from a constituent of this drug.

Clinical note: Do not stack Bai Bu with codeine, dihydrocodeine or other opioid antitussives in patients with COPD, obstructive sleep apnoea, or any cause of reduced respiratory reserve, and do not exceed pharmacopoeial dose. Bai Bu is classed as slightly toxic; overdose reports describe nausea, vomiting, headache and respiratory depression.

Benzodiazepines and other sedative-hypnotics

Theoretical Evidence: Theoretical

Extrapolated from the demonstrated central respiratory depressant action of croomine in guinea pigs. No clinical interaction study exists, and no pharmacokinetic interaction has been characterised; the concern is pharmacodynamic additivity at the respiratory centre.

Clinical note: Flag rather than prohibit. Warn patients on sedative-hypnotics not to self-escalate the dose of Bai Bu-containing cough preparations, and review if new daytime somnolence or sleep-disordered breathing appears.

Stemona collinsiae, Stemona curtisii and other non-official Stemona species

Moderate Evidence: Probable

Only Stemona sessilifolia, Stemona japonica and Stemona tuberosa are official as Radix Stemonae, but the genus contains around thirty species whose alkaloid classes differ sharply between the tuberostemonine, protostemonine, stemoninine and croomine groups. Because the antitussive potency and the central versus peripheral site of action track the alkaloid class, material of a different Stemona species is not pharmacologically equivalent even when it is botanically Stemona.

Clinical note: Source Radix Stemonae from suppliers who identify the species, particularly for imported Southeast Asian material where Stemona collinsiae and Stemona curtisii are locally used. Do not assume that a batch labelled only Stemona is interchangeable with a previous batch.

Dosage

Form	Amount	Frequency	Duration	Population	Notes
decoction	3–9 g	Daily	—	—	中国药典 2020 【用法与用量】3～9g。外用适量，水煎或酒浸。【性味与归经】甘、苦，微温。归肺经。 — Chinese Pharmacopoeia 2020, quoted verbatim; route and cautions preserved. Replaces a cleared category-filler value.

Dui Yao — Herb Pairs

The classical two-herb combinations this herb appears in, each with an action neither herb has alone.

with Zi Wan 紫菀

Warm but moist, together they moisten the lungs, descend qi and stop cough without favoring cold or heat.

Lingering cough after an exterior condition with slight residual exterior pathogen.

Core pair of a classical formula — Zhi Sou San, Yi Xue Xin Wu (Cheng Guopeng, 1732)

Evidence Tier

Moderate evidence · 4 studies

Recorded 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

0

In vitro / animal

4

2 verified · 2 unverified

Show 4 studies

Antitussive and central respiratory depressant effects of Stemona tuberosa
Antitussive Activity of Stemona Alkaloids from Stemona tuberosa
Effect of Radix Stemonae concentrated decoction on the lung tissue pathology and inflammatory mediators in COPD rats
Comparative efficacy of chemical and botanical pediculicides in Thailand and 4% dimeticone against head louse, Pediculus humanus capitis

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

Antitussive and central respiratory depressant effects of Stemona tuberosa

Xu YT, Shaw PC, Jiang RW, Hon PM, Chan YM, But PPH (2010) Journal of Ethnopharmacology animal Verified: In vitro / animal

Guinea-pig study of four major Stemona tuberosa alkaloids in a citric-acid aerosol cough model, with superior laryngeal nerve stimulation used to separate central from peripheral sites of action. Croomine, neotuberostemonine and stemoninine had comparable antitussive effect and tuberostemonine was weaker. Neotuberostemonine, tuberostemonine and stemoninine acted on the peripheral cough reflex pathway; croomine acted centrally and showed obvious central respiratory depressant effects, which the authors offered as a partial explanation for the adverse reactions reported for the herb.

DOI: 10.1016/j.jep.2010.02.018 Link

Antitussive Activity of Stemona Alkaloids from Stemona tuberosa

Chung HS, Hon PM, Lin G, But PP, Dong H (2003) Planta Medica animal Verified: In vitro / animal

Bioactivity-guided fractionation of Stemona tuberosa root yielded four new stenine-type alkaloids (tuberostemonine J and H, epi-bisdehydrotuberostemonine J, neostenine) plus known neotuberostemonine, tested in guinea pigs after citric-acid aerosol cough induction. Neotuberostemonine and neostenine showed significant antitussive activity; structure-activity analysis identified the saturated tricyclic pyrrolo[3,2,1-jk]benzazepine nucleus with all-cis ring junctions as the key antitussive scaffold.

DOI: 10.1055/s-2003-45100 Link

Effect of Radix Stemonae concentrated decoction on the lung tissue pathology and inflammatory mediators in COPD rats

Wang Z, Yang W, Yang P, Gao B, Luo L (2016) BMC Complementary and Alternative Medicine animal

Thirty Sprague-Dawley rats in blank, COPD model and Radix Stemonae groups over 112 days. Gavage with the concentrated decoction improved body weight and pulmonary function versus model, reduced airway inflammation and emphysema on histology, and lowered serum TNF-alpha, IL-8 and LTB4 relative to the model group, though these remained above blank-group levels. A small single-centre animal study, not a clinical trial.

DOI: 10.1186/s12906-016-1444-y Link

Comparative efficacy of chemical and botanical pediculicides in Thailand and 4% dimeticone against head louse, Pediculus humanus capitis

Yingklang M, Gordon CN, Jaidee PH, Thongpon P, Pinlaor S (2023) PLOS ONE in vitro

Ex vivo pediculicidal testing of Thai drugstore shampoos, one of which contained 0.15% Stemona root crude extract, against head lice, compared with 4% dimeticone liquid gel. Dimeticone killed 100% of lice in 15 minutes; the chemical and botanical products, the Stemona-based shampoo among them, failed to kill the great majority of lice at 10 minutes (0 to 50% mortality) and at 30 minutes (17 to 60% mortality). This is direct negative evidence against the classical louse-killing indication as delivered in a low-concentration commercial extract.

DOI: 10.1371/journal.pone.0287616 Link

⚠ Safety & Contraindications

Side Effects

Oral preparations caused heartburn, dry mouth/nose/pharynx, dizziness, chest discomfort, shortness of breath and anorexia; incidence 20–30%.

Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 498.

Historical Texts

Ming Yi Bie Lu (Miscellaneous Records of Famous Physicians)

Six Dynasties, c. 500 CE, compiled by Tao Hongjing

Earliest surviving materia medica entry for Bai Bu, listed as a middle-grade drug. Tao Hongjing's commentary compares the root to Tian Men Dong (Asparagus cochinchinensis), which it resembles in appearance, noting the more bitter taste of Bai Bu.

Ben Cao Gang Mu (Compendium of Materia Medica)

Ming dynasty, 1596, Li Shizhen

Li Shizhen separates Bai Bu from Tian Men Dong on thermal nature: both treat Lung disease and kill parasites, but Tian Men Dong is cold and suits heat cough while Bai Bu is slightly warm and suits cold cough. The parasiticidal and delousing use, applied externally, is recorded here.

Yi Xue Xin Wu (Medical Revelations), source text of Zhi Sou San

Qing dynasty, 1732, Cheng Guopeng

Bai Bu appears as a principal herb in Zhi Sou San (Stop Coughing Powder), the formula through which most contemporary clinical use of the drug reaches the patient. The honey-fried form (Zhi Bai Bu) is preferred here for chronic Lung-deficiency cough over the raw drug.

References

Greger H. Structural classification and biological activities of Stemona alkaloids . Phytochemistry Reviews (2019) [DOI]
Jiang RW, Hon PM, Zhou Y, Chan YM, Xu YT, Xu HX, Greger H, Shaw PC, But PPH. Alkaloids and Chemical Diversity of Stemona tuberosa . Journal of Natural Products (2006) [DOI]
Xiong H, Sun S, Zhang W, Zhao D, Liu X, Tian Y, Feng S. Spatial metabolomics method to reveal the differences in chemical composition of raw and honey-fried Stemona tuberosa Lour. by using UPLC-Orbitrap Fusion MS and desorption electrospray ionization mass spectrometry imaging . Phytochemical Analysis (2025) [DOI]

Bai Bu

Traditionally used for