Western Herbalism Properties

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anti-inflammatorydiuretic

Traditional Uses

In Chinese folk and traditional medicine the dried stem of Clematis montana (allied to the Wei Ling Xian / Clematis group) has been used to treat rheumatism and inflammatory joint conditions and to promote urination (Chinese ethnopharmacology; genus review, Chawla et al., 2012). The fresh plant is irritant owing to protoanemonin and is used only after appropriate preparation.

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Botanical Description

Clematis montana, the Himalayan or mountain clematis, is a vigorous deciduous woody climber of the buttercup family (Ranunculaceae), capable of scrambling 6-12 m through trees and over supports by means of twining leaf-stalks. The leaves are opposite and divided into three leaflets that are ovate to lanceolate, toothed or lobed, and somewhat hairy. In late spring the plant produces a profuse display of flowers, either solitary or in small clusters from the leaf axils; each flower is 4-6 cm across and composed of four (sometimes five or six) spreading, petal-like sepals that are white to pink, surrounding a central boss of creamy stamens, and true petals are absent. The fruit is a head of numerous achenes, each bearing a long, silky, feathery plume that aids wind dispersal. Native to the Himalayas, southwestern and central China, and Taiwan, it grows in mountain forests, scrub, ravines, and along rocky slopes. The fresh plant contains the acrid irritant protoanemonin.

Native Region: Afghanistan, Assam, Bangladesh, China North-Central, China South-Central, China Southeast, East Himalaya, Inner Mongolia, Myanmar, Nepal, Pakistan, Qinghai, Taiwan, Tibet, West Himalaya

Active Constituents

Clematis montana lectin (CML)

Mannose-binding plant lectin (homodimeric protein)

Concentration: Isolated to homogeneity from the stem, the part used as the drug, by DEAE-Sepharose ion exchange and Sephacryl S-100 gel filtration. It is a homodimer of subunits of 11 968.9 Da. Yield from crude material was not the point of the study and no content figure for the raw herb has been published.

The most distinctive constituent of this species and one with no counterpart in the other official source of the same drug. Its haemagglutinating activity is inhibited by branched oligomannosides, confirming mannose specificity, and its 15-residue N-terminal sequence DNVKYSGQVKNTGSA matched no known lectin, as did its peptide mass fingerprint. In cell culture it showed antiviral activity against several viruses and inhibited L929, HeLa, MCF7 and HepG2 cells, inducing caspase-dependent apoptosis in L929; blocking the carbohydrate-binding site with sugars abolished both the cytotoxicity and the apoptosis, so the activity depends on mannose binding. One practical consequence deserves stating: this is a protein, and a protein of this size does not survive a boiling water decoction intact or cross the gut wall whole, so its relevance to the traditionally prepared drug is limited. It matters for tincture and powder forms, for the plant handled fresh, and as pharmacology in its own right.

Clemontanosides A, B, C and E

Oleanane-type triterpenoid saponins (bisdesmosidic glycosides of hederagenin and oleanolic acid)

Concentration: Four saponins named for this species were isolated and characterised from Himalayan material between 1989 and 1994; clemontanoside A is a bisglycoside. No quantitative content survey of the commercial drug has been published.

The saponin fraction is the expected pharmacological backbone of any Clematis drug and is the usual explanation for both its mild diuretic action and its mucosal irritancy, which are two faces of the same surface activity. These particular compounds were described as chemistry rather than pursued pharmacologically, so their individual activities are essentially unstudied. Their interest here is that they establish this species as chemically distinct: the compounds are named for it and were characterised from it, not transferred from a relative.

Oleanolic acid and hederagenin

Pentacyclic oleanane-type triterpenoid aglycones

Concentration: The aglycones released from the clemontanoside glycosides on hydrolysis, and present free in the plant.

Common triterpenoids of the genus with mild anti-inflammatory and hepatoprotective activity in preclinical work. In practical terms their value is analytical: oleanolic acid is the compound on which a validated identity test for the sister species has been built, so it is the most obvious handle for confirming that a batch of this drug is a Clematis at all rather than one of its adulterants.

Protoanemonin and anemonin, formed from ranunculin

Unsaturated gamma-lactone and its cyclobutane dimer

Concentration: Not assayed. Ranunculin is a family-wide constituent of the Ranunculaceae, released as protoanemonin when tissue is damaged; drying and heating convert protoanemonin to the far milder dimer anemonin, so the dried stem carries much less than the living plant.

This is why the fresh plant and the dried drug are not the same thing. Protoanemonin is a vesicant and mucosal irritant, and handling living Clematis is a recognised cause of contact dermatitis in gardeners. The medicinal article is a stem cut in spring or autumn, stripped of coarse bark and sun-dried, which is a preparation that destroys most of it. The compound is listed here specifically so that the fresh-versus-dried distinction is on the record, not because the dried drug is expected to deliver a meaningful dose of it.

⚠ Drug Interactions

Guan Mu Tong (Caulis Aristolochiae Manshuriensis, from Aristolochia manshuriensis)

Major Evidence: Established

This species is one of the two botanical sources the Chinese Pharmacopoeia accepts for Chuan Mu Tong, and it therefore inherits the whole Mu Tong substitution problem. Stems from three unrelated families have circulated under names built on Mu Tong: this species and Clematis armandii as Chuan Mu Tong, Akebia species as Mu Tong, and Aristolochia manshuriensis as Guan Mu Tong. Only Aristolochia contains aristolochic acids, which are nephrotoxins and Group 1 human carcinogens, and it was removed from the pharmacopoeia and banned in 2003. A Taiwanese population-based case-control study of 4594 incident urinary tract cancers against 174 701 controls found a significant dose-response relationship, with adjusted odds ratios reaching 2.1 for more than 200 g of prescribed Mu Tong and 2.0 for more than 500 mg estimated cumulative aristolochic acid, independent of arsenic exposure; fatal renal failure from Guan Mu Tong has been documented at autopsy. This species contains no aristolochic acid. The danger is entirely one of what arrives in the bag.

Clinical note: Never accept a herb labelled only Mu Tong, and treat the qualified name as a starting point rather than a guarantee. Where the stakes justify it, use an analytical identity method. An infrared fingerprint built from 24 Chuan Mu Tong samples separates the drug cleanly from both substitutes, with a correlation-coefficient acceptance floor of 0.9926 against which Guan Mu Tong scored 0.9021 to 0.9404 and Akebia Mu Tong 0.9549 to 0.9789, both rejected; note that its English title describes the calibration material as armand clematis stem, so how well it covers this species specifically is not stated. A complete chloroplast genome for this species is published, so DNA-based authentication is also available. Aristolochic acid injury is cumulative and irreversible, so there is no safe level of substituted material and no monitoring schedule that makes it acceptable.

Clematis armandii, the other official source of Chuan Mu Tong

Moderate Evidence: Established

The pharmacopoeia treats the two species as one drug and they are traded and dispensed interchangeably, but their published chemistry does not overlap. What has been characterised from Clematis armandii stems is a lignan-dominated profile, with seventeen lignans isolated and dihydrobenzofuran neolignans carrying anti-neuroinflammatory activity at low micromolar potency. What has been characterised from this species is a saponin profile, the clemontanosides, plus a mannose-binding lectin with no counterpart reported in the sister species. Neither profile has been shown to be absent from the other plant, because nobody has done the comparison properly, but the literature that a practitioner is likely to read under the heading Chuan-Mu-Tong was generated on Clematis armandii and should not be assumed to describe this species.

Clinical note: When citing evidence for Chuan Mu Tong, check which of the two species the study used. It is usually Clematis armandii. Treat this species as an accepted official source with its own sparse literature rather than as a documented equivalent.

Mu Tong (Akebiae Caulis, from Akebia species) in dispensing and formula substitution

Moderate Evidence: Established

Since the ban on Guan Mu Tong, the Chinese Pharmacopoeia has carried both Akebiae Caulis as Mu Tong and this species with Clematis armandii as Chuan Mu Tong. Classical formulas written before the distinction was enforced simply specify Mu Tong, so which drug a given pharmacy dispenses varies by region and by habit. Both are used for damp-heat strangury and to clear heart fire, and both are vastly safer than the Aristolochia they displaced, but they are different plants from different families. Molecular assays have been built specifically to determine which of them a finished patent medicine actually contains, which is a fair indication of how often the answer is not obvious.

Clinical note: Decide deliberately which modern drug a classical Mu Tong is to become, and write it out. In a patient history, record what was dispensed rather than what was written.

Garden-grown ornamental plants of this species used as self-collected herb

Moderate Evidence: Possible

This species is one of the most widely planted ornamental climbers in temperate gardens outside Asia, sold as anemone clematis or Himalayan clematis, which makes it unusual among Chinese medicinal plants in being physically available to Western patients who read that it is a medicine. Two problems follow. Fresh Ranunculaceae tissue releases protoanemonin, a vesicant that causes contact dermatitis and mucosal burns and that the traditional preparation, stripping the coarse bark and sun-drying the stem, is designed to destroy. And ornamental nursery stock is grown under horticultural rather than medicinal conditions, with pesticide and growth-regulator regimes that no medicinal monograph anticipates.

Clinical note: Advise patients not to harvest garden clematis for medicinal use. If a patient reports having done so, ask about skin and mouth irritation, and about what the plant was sprayed with. The drug is a dried stem prepared in a specific way; the living vine on a trellis is not that drug.

Loop and thiazide diuretics, and lithium

Theoretical Evidence: Theoretical

The drug's pharmacopoeial indication is to promote urination and relieve strangury, and it is described as bitter and cold with a downward-draining action. No diuretic effect has been quantified in humans for either official species, and no pharmacokinetic study exists, so this is inference from the stated indication rather than from measurement. The lithium note follows the general rule that altered renal sodium and water handling can shift lithium clearance, and lithium's margin is narrow enough that an unquantified effect still deserves recording.

Clinical note: Watch fluid balance and electrolytes when combining with a prescribed diuretic, particularly in older patients. In a patient on lithium, either avoid the herb or monitor lithium levels around any change in the herbal prescription.

Dosage Calculator

⚖ Dosage Calculator

A weight-based mathematical estimate for Himalayan clematis. Not a prescription.

Evidence Tier

2 studies on record

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

2

1 verified · 1 unverified

Show 2 studies

Clematis montana lectin, a novel mannose-binding lectin from traditional Chinese medicine with antiviral and apoptosis-inducing activities
Conformational study reveals amino acid residues essential for hemagglutinating and anti-proliferative activities of Clematis montana lectin

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

Clematis montana lectin, a novel mannose-binding lectin from traditional Chinese medicine with antiviral and apoptosis-inducing activities

Peng H, Lv H, Wang Y, Liu YH, Li CY, Meng L, Chen F, Bao JK (2009) Peptides in vitro

The isolation and characterisation of a lectin from the stem of this species, which is the medicinal part. It is a homodimer of 11 968.9 Da subunits whose haemagglutination is blocked by branched oligomannosides, with an N-terminal sequence and peptide mass fingerprint matching no previously described plant lectin. In cell culture it showed antiviral activity against several viruses and inhibited L929, HeLa, MCF7 and HepG2 cells, inducing caspase-dependent apoptosis in L929; saturating the carbohydrate-binding site abolished both effects. Entirely in vitro, with no animal or human work, and the protein is unlikely to survive decoction, so this bears on the plant's biochemistry rather than on the clinical use of the drug.

DOI: 10.1016/j.peptides.2009.06.027 Link

Conformational study reveals amino acid residues essential for hemagglutinating and anti-proliferative activities of Clematis montana lectin

Lu B, Zhang B, Qi W, Zhu Y, Zhao Y, Zhou N, Sun R, Bao J, Wu C (2014) Acta Biochimica et Biophysica Sinica in vitro Verified: In vitro / animal

Follow-up structural work on the same lectin, mapping which amino acid residues the haemagglutinating and anti-proliferative activities depend on. Protein biochemistry rather than pharmacology; it is cited here as confirmation that the lectin is a real, reproducible entity studied by more than one group, not as evidence of any therapeutic effect.

DOI: 10.1093/abbs/gmu085 Link

Historical Texts

Zhonghua Renmin Gongheguo Yaodian (Pharmacopoeia of the People's Republic of China), monograph for Chuan Mu Tong

Modern; the text described here is the 2020 edition, Volume I

Defines Chuan Mu Tong as the dried vine stem of Clematis armandii Franch., xiao mu tong, or of this species, known in Chinese as xiu qiu teng, gathered in spring and autumn with the coarse bark removed and sun-dried or sliced thick while fresh and dried. The drug is bitter and cold, enters the Heart, Small Intestine and Bladder channels, and is used to promote urination and relieve strangury, clear the heart and eliminate vexation, and unblock the channels and promote lactation, for strangury, oedema, vexation with dark red urine, mouth and tongue sores, amenorrhoea with scant lactation, and damp-heat painful obstruction. The stated dose is 3 to 6 g. This monograph is what makes the species a medicine in the modern sense, and it is the instrument through which the aristolochic acid-bearing Guan Mu Tong was excluded from the Mu Tong drugs after 2003.

Shennong Bencao Jing (Divine Husbandman's Classic of Materia Medica), entry for tong cao

Han dynasty compilation, first to second century CE

The classical slot into which this species was eventually placed, rather than a record of this species. The classic describes a drug called tong cao that promotes urination and unblocks the nine orifices and the blood vessels, with no binomial and no description that fixes a plant. Every later Mu Tong, including this Clematis, was assigned to that slot by subsequent authors. For this species the assignment is particularly late: it is a Himalayan and south-west Chinese vine, better known internationally as a garden ornamental than as a drug, and its standing in the materia medica rests on the modern pharmacopoeia naming it beside Clematis armandii rather than on any classical text describing it.

References

Bahuguna RP, Jangwan JS, Kaiya T, Sakakibara J. Clemontanoside-A, a bisglycoside from Clematis montana . Phytochemistry (1989) [DOI]
Jangwan JS, Bahuguna RP. Clemontanoside B, A New Saponin from Clematis Montana . International Journal of Crude Drug Research (1990) [DOI]
Thapliyal RP, Bahuguna RP. Clemontanoside-C, a saponin from Clematis montana . Phytochemistry (1993) [DOI]
Thapliyal RP, Bahuguna RP. Clemontanoside-E, a New Saponin from Clematis montana . International Journal of Pharmacognosy (1994) [DOI]
Song CZ. Chemical Constituents of Clematis montana . Chinese Journal of Natural Medicines (2008) [DOI]
Mao C, Zhang X, Shi J, Chen S. The complete chloroplast genome sequence of Clematis Montana Buch.-Ham. (Ranunculaceae) and its phylogenetic analysis . Mitochondrial DNA Part B (2020) [DOI]
Gao SS, Li JR, Wu FB, Wei XM, Bian JH, Chen JB, Cheng SQ, Sun SQ, Lv GH. Development of FTIR fingerprint for identification of armand clematis stem (Chuanmutong) and related herbs . China Journal of Chinese Materia Medica (2016) [DOI]
Lai MN, Wang SM, Chen PC, Chen YY, Wang JD. Population-Based Case-Control Study of Chinese Herbal Products Containing Aristolochic Acid and Urinary Tract Cancer Risk . JNCI Journal of the National Cancer Institute (2009) [DOI]

Himalayan clematis

Safety at a glance

Traditionally used for