Traditionally used for
- Headaches
- Dizziness
- Eye health
- Urinary & fluids
- Energy & fatigue
- Skin
Cautions & contraindications
- Pregnancy
- Liver conditions
- Kidney conditions
- Toxic — professional use only
☯ TCM Properties
Traditional Chinese Uses
Ci Ji Li, better known as Bai Ji Li, is the dried ripe fruit of Tribulus terrestris. In standard materia medica it is bitter and acrid and neutral to slightly warm, entering the Liver channel, and is classed among substances that calm the Liver and extinguish Wind. Its principal action is to calm ascendant Liver Yang, easing headache, dizziness and vertigo, and to course constrained Liver Qi, relieving chest and breast distension and palpable breast lumps.
It also dispels Wind to benefit the eyes, used for red, swollen, itchy or tearing eyes and superficial visual obstruction, and expels Wind from the skin to stop itching in wind rashes and urticaria. It is commonly paired with chrysanthemum (Ju Hua) and other Liver-cooling, eye-brightening herbs.
Western Herbalism Properties
Relationships
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Botanical Description
Ci Ji Li is the dried ripe fruit of Tribulus terrestris L. (Zygophyllaceae), the puncture vine or caltrops, a prostrate annual or short-lived perennial herb of warm temperate to tropical regions worldwide, common in sandy dry soils across northern China. The plant has pinnately compound opposite leaves with small ovate leaflets and solitary yellow five-petaled flowers in the leaf axils. The schizocarpic fruit splits into five wedge-shaped hard burs each bearing two pairs of sharp spines that readily puncture skin or tires, the diagnostic feature of the drug. In traditional Chinese medicine the fruit is acrid, bitter, slightly warm, and mildly toxic, entering the Liver channel; it calms the liver, subdues ascendant liver yang, expels wind, brightens the eyes, and is used for headache, dizziness, red itchy eyes, vitiligo, and urticaria. It is also a major Ayurvedic tonic (Gokshura).
Active Constituents
Protodioscin
Furostanol steroidal saponinConcentration: reported between 109 and 1530 mg per 100 g of plant material depending on organ and provenance; leaf tissue is much richer than fruit or stem
Regarded as the principal marker of the pro-sexual activity attributed to the herb, and proposed to act indirectly by raising luteinising hormone and nitric oxide availability rather than by supplying a steroid hormone itself. Content varies so widely between geographical sources and commercial products that reviewers describe standardisation of extracts as an absolute necessity before results can be compared.
Dioscin
Spirostanol steroidal saponinConcentration: roughly 1-87 mg per 100 g of plant material
A minor spirostanol saponin of the fruit and aerial parts, hydrolysed to diosgenin. It is one of the steroidal molecules implicated in the animal and human toxicity reports attributed to concentrated Tribulus preparations.
Harmane
Beta-carboline indole alkaloidConcentration: trace-level constituent, chiefly of the aerial parts
A monoamine oxidase inhibitor. Together with harmine, harmaline and norharmane it is the fraction implicated in the locomotor disorder ('staggers') seen in sheep grazing Tribulus, through disruption of dopaminergic and GABAergic signalling.
Kaempferol glycosides
Flavonol glycosideConcentration: total flavonoids about 0.04-0.5% of the dried herb; total polyphenols about 0.6-3%
Antioxidant and free-radical-scavenging constituents that accompany quercetin, rutin and isorhamnetin glycosides. They are not thought to account for the sexual-function claims made for the herb.
Tribulosin
Spirostanol steroidal saponinConcentration: content not consistently reported and varies markedly with provenance
One of the spirostanol saponins catalogued alongside tribestin and diosgenin in the fruit. Its individual contribution to the herb's pharmacology has not been separated from that of the saponin fraction as a whole.
⚠ Drug Interactions
Monoamine oxidase inhibitors (e.g. phenelzine, moclobemide, selegiline)
Tribulus contains the beta-carboline alkaloids harmane, harmine, harmaline and norharmane, which are monoamine oxidase inhibitors. The 2020 Biomolecules review of the species states explicitly that special precautions should be taken in patients under treatment with monoamine oxidase inhibitors. No human interaction study has been performed, so the concern is mechanistic rather than demonstrated.
Clinical note: Do not add Tribulus to an existing MAOI regimen. If a patient on an MAOI is already self-medicating with a Tribulus supplement, stop the supplement rather than the prescription and monitor blood pressure.
Hepatotoxic drugs (e.g. paracetamol/acetaminophen, methotrexate, isoniazid, anabolic steroids)
Severe hepatotoxicity from concentrated Tribulus supplements is documented in humans, not merely theoretical. A 46-year-old man taking daily Tribulus supplements for two months developed cholestatic drug-induced liver injury confirmed on biopsy, with a peak total bilirubin of 48 mg/dL and concurrent renal failure requiring plasmapheresis (Mohy-ud-din and Jonassaint, ACG Case Reports Journal 2024). Reviewers note the discrepancy between clean controlled-trial safety data for standardised extracts and these case reports, and raise contamination or adulteration of supplements as a possible explanation, since the toxic compound has never been identified.
Clinical note: Avoid concentrated Tribulus extracts in anyone with existing liver disease or on a hepatotoxic drug. Bodybuilding products combining Tribulus with anabolic agents are a particular risk. Baseline and follow-up liver function testing is reasonable if a patient insists on prolonged extract use; stop immediately for jaundice, dark urine or unexplained fatigue.
Nephrotoxic drugs (e.g. NSAIDs, aminoglycosides, ciclosporin)
Acute renal injury has accompanied Tribulus hepatotoxicity in reported cases (creatinine peaking at 7.1 mg/dL in the 2024 ACG case), and a separate report describes severe nephrotoxicity in a young healthy male. The 2020 Biomolecules review records a case of nephrotoxicity in a 28-year-old man after drinking Tribulus water and a case of bilirubin-induced toxic acute tubular necrosis. Ironically, several of these patients took the herb specifically to prevent kidney stones.
Clinical note: Do not recommend Tribulus for urolithiasis prophylaxis alongside NSAIDs or other nephrotoxic drugs. Check renal function if a patient on such drugs has been taking a concentrated extract.
Androgen deprivation therapy and 5-alpha-reductase inhibitors (e.g. leuprorelin, bicalutamide, finasteride)
Tribulus is marketed as a testosterone booster, but the 2025 Nutrients systematic review of ten trials in 483 men found that eight of ten reported no significant change in androgen profile, with modest rises of roughly 60-70 ng/dL confined to men who were hypogonadal at baseline. Any interference with androgen-suppressing therapy is therefore speculative, but the marketing claim itself makes patients on such therapy likely to use it.
Clinical note: Ask about supplement use in men on androgen deprivation therapy and in androgen-sensitive malignancy. Explain that the testosterone claim is not supported by the trial evidence, so there is no benefit to offset even a speculative risk.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 6–10 g | Daily | — | — | 中国药典 2020 monograph 【蒺藜】【用法与用量】6～10g。 【性味与归经】辛、苦，微温；有小毒。归肝经。 — Matched by hand: Tribulus terrestris; 刺蒺藜 is the traditional name of ChP 蒺藜. Chinese Pharmacopoeia 2020, quoted verbatim. |
Evidence Tier
Strong 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
2
2 verified · 0 unverified
Randomized controlled trial
1
1 verified · 0 unverified
Other clinical trial
0
Observational / case report
1
1 verified · 0 unverified
Show the study
In vitro / animal
0
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
Evaluation of the efficacy and safety of Tribulus terrestris in male sexual dysfunction—A prospective, randomized, double-blind, placebo-controlled clinical trial
Phase IV parallel-group randomised, double-blind, placebo-controlled trial in 180 men aged 18-65 with mild or moderate erectile dysfunction, with or without hypoactive sexual desire disorder, including patients with hypertension, diabetes and metabolic syndrome. Ninety received a standardised Bulgarian extract (Tribestan, 250 mg dry extract standardised to not less than 112.5 mg furostanol saponins, six tablets daily) and ninety received placebo for 12 weeks, with monthly IIEF assessment. This is the largest and best-controlled trial of the herb and the main basis for any claim of benefit in erectile dysfunction.
Effects of Tribulus (Tribulus terrestris L.) Supplementation on Erectile Dysfunction and Testosterone Levels in Men—A Systematic Review of Clinical Trials
Ten eligible trials with 483 participants. Doses of 400-750 mg/day for one to three months improved erectile dysfunction in three of the five studies that measured it, and benefit appeared restricted to men who already had diagnosed erectile dysfunction. Eight of ten studies found no significant change in androgen profile; the two showing an increase were confined to men hypogonadal at baseline, with gains of only about 60-70 ng/dL. Half the included studies scored as poor quality. The authors concluded that the evidence for erectile benefit is of low level and that no robust evidence supports raising testosterone.
Tribulus Terrestris for Female Sexual Dysfunction: A Systematic Review
Five randomised trials with 279 participants. After one to three months, pre- and postmenopausal women randomised to Tribulus had significantly higher sexual function scores, and premenopausal women had a significant rise in serum testosterone at three months. No serious adverse events were reported and no study measured health-related quality of life. Meta-analysis was impossible because of missing data and clinical heterogeneity, and the GRADE certainty of the evidence was rated very low.
Severe Liver and Renal Injury From Tribulus Terrestris
A 46-year-old man who had taken daily Tribulus supplements for about two months, stopping three weeks before presentation, developed jaundice, fatigue and weight loss. Total bilirubin peaked at 48 mg/dL and creatinine at 7.1 mg/dL. Liver biopsy showed severe cholestasis with minimal inflammation and no ductopenia or fibrosis, consistent with drug-induced liver injury. Three sessions of plasmapheresis brought bilirubin down and renal function recovered; he was discharged after three weeks and had normalised at two months. This is the case most often cited when counselling patients that concentrated Tribulus extracts are not benign.
⚠ Safety & Contraindications
- Pregnancy
- Liver conditions
- Kidney conditions
- Toxic — professional use only
Contraindications
Contraindicated in pregnancy. Use with caution in blood or qi deficiency.
Safety Warnings
- Concentrated supplement extracts carry a higher risk than the decocted fruit.
- Not for prolonged high-dose use.
⚠ Toxicity Information
Gastrointestinal upset at higher doses; hepatotoxicity has been reported with concentrated extracts, and photosensitivity is documented.
Historical Texts
Shen Nong Ben Cao Jing
Han dynasty (compiled by the 2nd century CE)References
- Stefanescu R, Tero-Vescan A, Negroiu A, Aurica E, Vari C-E. A Comprehensive Review of the Phytochemical, Pharmacological, and Toxicological Properties of Tribulus terrestris L. . Biomolecules (2020) [DOI]
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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