Western Herbalism Properties

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Botanical Description

Clematis terniflora, the sweet autumn clematis, is a vigorous woody perennial vine of the family Ranunculaceae climbing 5-9 m through shrubs and trees on slender, ridged, twining petioles. The opposite leaves are pinnately compound with three to five leathery, glossy, ovate leaflets that are entire or shallowly lobed and have heart-shaped bases. In late summer and autumn it produces masses of fragrant, four-petalled (technically four-sepaled) white flowers about 2-3 cm across in axillary and terminal panicles, attracting many pollinators. The flowers are followed by silvery, plumose-tailed achenes gathered in fluffy seed heads. Native to northeast Asia (China, Japan, Korea, Taiwan, the Russian Far East), it is widely cultivated and has naturalised in parts of eastern North America.

Native Region: Amur, China North-Central, China South-Central, China Southeast, Inner Mongolia, Japan, Khabarovsk, Korea, Manchuria, Nansei-shoto, Ogasawara-shoto, Primorye, Taiwan

Active Constituents

Oleanane-type triterpenoid saponins

Triterpenoid saponin

Concentration: Dominant constituent class of the root and rhizome; reported as individual isolated glycosides rather than as a quantified total

The saponin fraction of the root and rhizome carries most of the anti-inflammatory activity attributed to this drug, and is the chemical basis on which Clematis roots are graded. Individual glycosides are built on hederagenin and oleanolic acid aglycones bearing sugar chains at C-3 and C-28.

Clematomandshurica saponins A-D

Triterpenoid saponin

Concentration: Isolated from the roots and rhizomes of Clematis terniflora var. mandshurica (published as Clematis mandshurica); no routine assay level established

Four saponins isolated from the roots and rhizomes of this taxon; saponins A and B inhibited cyclooxygenase-2 in vitro with IC50 values of 2.66 and 2.58 microM respectively. This is the most direct chemical evidence for the anti-inflammatory reputation of the root drug.

Terniflonoside A and four co-occurring flavonol glycosides

Flavonol glycoside

Concentration: Isolated from whole plants; not quantified

Terniflonoside A was described as a new flavonol glycoside from whole plants of Clematis terniflora alongside four previously known flavonol glycosides. Flavonol glycosides are the main polar phenolic class of the aerial parts and account for much of the radical-scavenging activity of leaf extracts.

(6-Hydroxy-1H-indol-3-yl)carboxylic acid methyl ester

Indole alkaloid

Concentration: Leaf constituent; rose roughly 7-fold after high-level UV-B irradiation followed by dark incubation

A cytotoxic indole alkaloid characterised from Clematis terniflora leaves. Its accumulation is stress-inducible rather than constitutive, so leaf material harvested under different light conditions is not chemically interchangeable. It is a leaf compound and has not been shown to be present in the root drug.

Protoanemonin (released from ranunculin)

Unsaturated lactone

Concentration: Not quantified for this species in the sources reviewed; documented across the genus Clematis in fresh material and largely lost on drying

Ranunculin in fresh Ranunculaceae tissue is enzymatically converted to protoanemonin when cells are crushed, and protoanemonin is a direct vesicant that blisters skin and mucous membranes. It dimerises to the far less irritant anemonin on drying, which is why the drug is always used dried. Fresh plant material should not be handled or ingested.

⚠ Drug Interactions

Aceclofenac

Minor Evidence: Probable

SKI306X (marketed as JOINS) is a standardised extract of the root of Clematis mandshurica, that is Clematis terniflora var. mandshurica, together with Trichosanthes kirilowii root and Prunella vulgaris spike, and is routinely co-prescribed with aceclofenac in Korea. In a randomised two-way crossover single-dose study in 54 healthy men, a fixed-dose combination of SKI306X 300 mg with aceclofenac 100 mg gave geometric mean ratios versus separate co-administration of 0.85 (90% CI 0.81 to 0.91) for aceclofenac Cmax and 1.03 (1.01 to 1.06) for AUClast, within conventional bioequivalence limits. The evidence is for the three-herb extract, not for Clematis alone.

Clinical note: No aceclofenac dose adjustment is indicated on current evidence. Do not extrapolate the finding to other NSAIDs or to single-herb Clematis root preparations, which have not been studied.

Wei Ling Xian (Clematidis Radix et Rhizoma from Clematis chinensis or Clematis hexapetala)

Moderate Evidence: Established

The Chinese Pharmacopoeia assigns the single drug Wei Ling Xian to three source taxa: Clematis chinensis, Clematis hexapetala and Clematis mandshurica, the last of which is the variety mandshurica of this species. Material sold as Wei Ling Xian may therefore be any of the three, and their triterpenoid saponin profiles are not identical. Clematis terniflora var. terniflora, the Japanese sweet autumn clematis, is not an official source of the drug, so a bare label of Clematis terniflora does not by itself establish pharmacopoeial identity.

Clinical note: Treat Wei Ling Xian and Clematis terniflora as the same drug unless the supplier states the variety. Ask which taxon was supplied before assuming that dose data or a study result carries across, and do not assume that material identified only to species is pharmacopoeial Wei Ling Xian.

Evidence Tier

Moderate evidence · 6 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

2

0 verified · 2 unverified

Show 2 studies

Efficacy of JOINS on Cartilage Protection in Knee Osteoarthritis: Prospective Randomized Controlled Trial
Comparison of pharmacokinetics and safety of fixed-dose combination of SKI306X and aceclofenac versus separate tablets in healthy subjects

Other clinical trial

0

Observational / case report

0

In vitro / animal

3

2 verified · 1 unverified

Show 3 studies

Anti-Inflammatory Effects of Clematis terniflora Leaf on Lipopolysaccharide-Induced Acute Lung Injury
Triterpene Saponins from Clematis mandshurica
The protective effects of ethanolic extract of Clematis terniflora against corticosterone-induced neuronal damage via the AKT and ERK1/2 pathway

Other / unclassified

1

1 verified · 0 unverified

Show the study

Efficacy and Safety of Celecoxib and a Korean SYSADOA (JOINS) for the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis

Verified: design read from PubMed for a DOI that resolves to the cited paper Unverified: taken from the study's recorded description

Clinical Studies

Efficacy and Safety of Celecoxib and a Korean SYSADOA (JOINS) for the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis

Yong-Beom Park, Jun-Ho Kim (2025) Journal of Clinical Medicine systematic review Verified: Other / unclassified

Systematic review and meta-analysis of 23 randomised controlled trials in 3,367 patients with knee osteoarthritis, comparing celecoxib with JOINS (SKI306X and the newer SKCPT formulation). Pain relief on the visual analogue scale and functional improvement on the WOMAC index with JOINS were comparable to celecoxib at both short-term and mid-term follow-up, with no significant difference in adverse event rates. JOINS is a three-herb extract whose Clematis component is the root of Clematis mandshurica, that is Clematis terniflora var. mandshurica; the trials do not isolate the contribution of Clematis.

DOI: 10.3390/jcm14041036 Link

Efficacy of JOINS on Cartilage Protection in Knee Osteoarthritis: Prospective Randomized Controlled Trial

Joong Il Kim, Ja Young Choi, Kwang Gi Kim, Myung Chul Lee (2017) Knee Surgery & Related Research RCT

Sixty-nine patients were randomised to JOINS 200 mg three times daily for one year or placebo. Cartilage thickness and volume on MRI did not differ between groups, but the delayed gadolinium-enhanced MRI index in the lateral tibial plateau improved in the JOINS group and worsened on placebo, and pain and Korean WOMAC scores improved significantly more with JOINS. The tested product is a three-herb extract containing Clematis mandshurica root, so the trial does not establish an effect of Clematis terniflora alone.

DOI: 10.5792/ksrr.17.004 Link

Anti-Inflammatory Effects of Clematis terniflora Leaf on Lipopolysaccharide-Induced Acute Lung Injury

Ji-Yeong Park, Min-Jong Kim, Young-Ae Choi, Yeon-Yong Kim, Soyoung Lee, Jae-Min Chung, Sang-Yong Kim, Gil-Saeng Jeong, Sang-Hyun Kim (2024) Evidence-Based Complementary and Alternative Medicine animal

An ethanol extract of Clematis terniflora leaves suppressed nitric oxide, COX-2, inducible nitric oxide synthase, TNF-alpha, IL-6 and IL-1beta in activated macrophages by blocking NF-kappaB and MAPK activation, and reduced histological injury, immune cell infiltration and protein-rich pulmonary oedema in a mouse model of lipopolysaccharide-induced acute lung injury. This is preclinical work on the leaf, not on the root and rhizome that constitute the pharmacopoeial drug.

DOI: 10.1155/2024/6653893 Link

Triterpene Saponins from Clematis mandshurica

Shepo Shi, Dan Jiang, Caixia Dong, Pengfei Tu (2006) Journal of Natural Products in vitro Verified: In vitro / animal

Four new triterpene saponins, clematomandshurica saponins A to D, were isolated with three known saponins from the roots and rhizomes of Clematis mandshurica, the taxon now treated as Clematis terniflora var. mandshurica. Saponins A and B inhibited cyclooxygenase-2 with IC50 values of 2.66 and 2.58 microM. Chemistry and enzyme assay only; no whole-animal or human data.

DOI: 10.1021/np060287z Link

The protective effects of ethanolic extract of Clematis terniflora against corticosterone-induced neuronal damage via the AKT and ERK1/2 pathway

Yoohun Noh, Seungui Cheon, In Hye Kim, Inyong Kim, Seung-Ah Lee, Do-Hee Kim, Yoonhwa Jeong (2018) BMB Reports in vitro Verified: In vitro / animal

Clematis terniflora ethanol extract at 300 and 500 micrograms per mL reduced corticosterone-induced apoptosis and mitochondrial damage in rat PC12 cells, lowered the endoplasmic reticulum stress proteins GRP78 and GADD153 and the pro-apoptotic protein BAD, and increased phosphorylated AKT and ERK1/2. Cell-culture work only; there is no human evidence for a neuroprotective indication.

DOI: 10.5483/bmbrep.2018.51.8.099 Link

Comparison of pharmacokinetics and safety of fixed-dose combination of SKI306X and aceclofenac versus separate tablets in healthy subjects

Xue Meng, Eun Sil Oh, Min Soo Park, Dasohm Kim, Jeong Hoon Kim, Choon Ok Kim (2017) Translational and Clinical Pharmacology RCT

Randomised open-label two-way crossover single-dose study in 54 healthy men comparing a fixed-dose combination of SKI306X 300 mg with aceclofenac 100 mg against the two given separately. Aceclofenac Tmax and half-life were similar between treatments and the geometric mean ratios for Cmax and AUClast were 0.85 (90% CI 0.81 to 0.91) and 1.03 (1.01 to 1.06), within bioequivalence limits, with one mild drug-related adverse event. The relevance here is that the Clematis-containing extract did not measurably alter aceclofenac exposure.

DOI: 10.12793/tcp.2017.25.4.196 Link

Historical Texts

Xin Xiu Ben Cao (Newly Revised Materia Medica)

Tang dynasty, 659 CE

Usually cited as the earliest materia medica entry for Wei Ling Xian, the root and rhizome drug to which this species contributes. The Tang text long predates species-level botany and cannot be read as describing Clematis terniflora specifically; the modern assignment of the drug to three Clematis species is a twentieth-century pharmacopoeial decision.

Kai Bao Ben Cao (Kaibao Materia Medica)

Northern Song dynasty, 973-974 CE

Carries the Wei Ling Xian entry forward into the Song pharmacopoeial line, which is why some modern sources name Kaibao rather than Xinxiu as the herb's first record. Either way the textual identity is the root drug, not a botanical species.

Ben Cao Gang Mu (Compendium of Materia Medica)

Ming dynasty, 1596

Li Shizhen's entry places Wei Ling Xian among the drugs that dispel wind-damp and free the channels, the indication that modern osteoarthritis research on Clematis-containing formulas continues to test. The classical drug is the dried root and rhizome; the leaf, on which most Clematis terniflora laboratory work has been done, is not the classical drug.

Wei Ling Xian Zhuan (Account of Wei Ling Xian)

Tang dynasty, 8th-9th century

A short monograph devoted to this single drug, transmitted in later materia medica, which credits a Korean monk with using the root to treat a man paralysed for decades and is largely responsible for the herb's reputation in wind-damp painful obstruction. It is a promotional account rather than an observational record, and modern efficacy claims should not lean on it.

References

Rakesh Chawla, Suresh Kumar, Anupam Sharma. The genus Clematis (Ranunculaceae): Chemical and pharmacological perspectives . Journal of Ethnopharmacology (2012) [DOI]
DaCheng Hao, XiaoJie Gu, PeiGen Xiao, Yong Peng. Chemical and biological research of Clematis medicinal resources . Chinese Science Bulletin (2012) [DOI]
Sheng Dong, Anqi Lu, Kexin Li, Shiqing Zhao, Jialong Zhao, Jiuzhi Yuan, Chongning Lv, Jincai Lu. Triterpenoid saponins from the roots and rhizomes of Clematis terniflora var. manshurica (Rupr.) Ohwi and their anti-inflammatory activities . Phytochemistry (2026) [DOI]
Yukio Kawata, Haruhisa Kizu, Tsuyoshi Tomimori. Studies on the Constituents of Clematis Species. VII. Triterpenoid Saponins from the Roots of Clematis terniflora DC. var. robusta TAMURA. . Chemical and Pharmaceutical Bulletin (1998) [DOI]
Lin Zhang, Xiaoling Luo, Jingkui Tian. Chemical constituents from Clematis terniflora . Chemistry of Natural Compounds (2007) [DOI]
Meng-Ya Chen, Zi-Han Zhu, Xin-Yu Yu, Ya-Ru Wu, Shi-Hui Qian, Zhen-Lin Li. Chemical constituents from the aerial parts of Clematis terniflora DC . Biochemical Systematics and Ecology (2027) [DOI]
Cuixia Gao, Bingxian Yang, Dandan Zhang, Meng Chen, Jingkui Tian. Enhanced metabolic process to indole alkaloids in Clematis terniflora DC. after exposure to high level of UV-B irradiation followed by the dark . BMC Plant Biology (2016) [DOI]
Ian A. Southwell, David J. Tucker. Protoanemonin in australian Clematis . Phytochemistry (1993) [DOI]
Cheng Tan, Wen-Yuan Zhu, Zhong-Sheng Min. Co-existence of contact leukoderma and pigmented contact dermatitis attributed to Clematis chinensis Osbeck . Contact Dermatitis (2008) [DOI]

Sweet autumn clematis