Traditionally used for
- Digestion
- Bowel health
- Menstrual & women's health
- Energy & fatigue
- Skin
Cautions & contraindications
- Liver conditions
☯ TCM Properties
Nourishes Yin , invigorates the spleen and promotes digestion; Regulates the Liver
Traditional Chinese Uses
Ge Shan Xiao is the root of Cynanchum auriculatum (one of the botanical sources of Bai Shou Wu). Sweet, bitter and neutral, entering the Spleen, Stomach, Liver and Kidney channels, it is a mild tonic used to nourish Yin, strengthen the Spleen and promote digestion, and regulate the Liver. Traditional applications center on weak digestion with poor appetite, epigastric or abdominal fullness and food retention, chronic diarrhea or dysentery, childhood nutritional impairment (gan ji), and vaginal discharge (leukorrhea); the pounded fresh root is also applied externally to sores and swellings.
It is typically decocted (about 9-15 g) and combined with Spleen-strengthening and digestive herbs. Because it both supports the Center and gently nourishes Yin, it suits deficiency-type indigestion rather than acute excess food stagnation. Identity here follows the stated scientific name; regional folk use of the name "Ge Shan Xiao" varies.
Relationships
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Botanical Description
Ge Shan Xiao ("across-the-mountain whistle/echo") is a regional folk-medicine name that cannot be reliably matched to a single botanical species in the principal modern references consulted. The same name has been applied in different districts to disparate species, and Bensky and Gamble, the Chinese Pharmacopoeia and the standard Zhong Yao Da Ci Dian entries consulted do not provide an unambiguous identification. Without verified correspondence, no morphology, parts used or therapeutic actions can responsibly be given. The entry is treated as botanically unidentifiable.
Active Constituents
Caudatin
C21 (pregnane) steroidal aglyconeOne of the two core aglycone families of this species, the other being kidjoranin; over fifty C21 steroidal compounds have been catalogued from Cynanchum auriculatum. Caudatin and its glycosides account for most of the reported antitumour and hepatoprotective activity in cell and rodent models. No quantitative content data for the crude drug have been published.
Cynanauriculosides and auriculosides
C21 steroidal (pregnane) glycosideThe species-characteristic glycoside series, named after Cynanchum auriculatum. Reported as cytotoxic and immunomodulatory in vitro. Because the same broad glycoside class occurs in Cynanchum bungei and Cynanchum wilfordii, these compounds do not distinguish the three drugs from one another.
Deacylmetaplexigenin
C21 steroidal aglyconeOne of four components quantified in a rat pharmacokinetic study of Cynanchum auriculatum root-tuber extract. In functional-dyspepsia rats its absorption was greater and elimination slower than in normal rats, and it accumulated in gastrointestinal tissue - relevant because disease state changed the exposure of the drug.
Qingyangshengenin
C21 steroidal aglyconeAlso quantified in the same rat pharmacokinetic study, with greater absorption and slower elimination in functional-dyspepsia animals. Reported to cross the blood-brain barrier in that model.
Cynandione A
Acetophenone dimerDescribed in the current review literature as the major bioactive acetophenone of this species, credited with the neuroprotective and hepatoprotective effects seen in cell models.
Baishouwubenzophenone
AcetophenoneAn acetophenone named for the drug. In the rat pharmacokinetic study its absorption fell and its clearance rose in functional-dyspepsia animals, the opposite direction of change to the steroidal aglycones.
Syringic acid
Phenolic acidA minor phenolic marker used in quality control; it showed the lowest systemic exposure of the four components measured in the rat pharmacokinetic study.
Axasterol acetate, metaplexigenin and stigmasterol
Sterol and pregnane markersReported in the review literature as chemical markers unique to Cynanchum auriculatum among the three Baishouwu species, and therefore usable to prove that a sample is this species rather than Cynanchum bungei or Cynanchum wilfordii. The alkaloid fraction of the three species is also reported to come only from Cynanchum auriculatum.
⚠ Drug Interactions
Polygonum multiflorum (He Shou Wu, Polygoni Multiflori Radix)
Three different drugs circulate under confusable Shou Wu names and are routinely mixed up. He Shou Wu is Polygonum multiflorum (Polygonaceae); Bai Shou Wu in Korean and northern Chinese usage is Cynanchum wilfordii (Apocynaceae); and this drug, Ge Shan Xiao or Bai Shou Wu of the Jiangsu and southwestern trade, is Cynanchum auriculatum. Cynanchum auriculatum is documented as a counterfeit of Polygonum multiflorum, particularly once the roots are cut into dried slices where the morphology is lost; molecular markers based on chloroplast trnL-F and ribosomal ITS regions and multiplex PCR were developed specifically to separate Polygonum multiflorum, Cynanchum wilfordii and Cynanchum auriculatum because market material could not be told apart. The consequence is asymmetric and severe in one direction: Polygonum multiflorum is the most common cause of herbal-product liver injury in China, with reported outcomes from transaminase elevation through transplant-requiring liver failure to death, its idiosyncratic hepatotoxicity attributed largely to 2,3,5,4'-tetrahydroxystilbene-2-O-glucoside. A patient who receives mislabelled Polygonum multiflorum in place of Cynanchum auriculatum is exposed to that risk without anyone knowing to watch for it. Note which species each piece of evidence used: the hepatotoxicity literature cited here is Polygonum multiflorum; the toxicity findings in the interaction below are Cynanchum auriculatum.
Clinical note: Never accept a root tuber labelled only Shou Wu or Bai Shou Wu. Require the binomial, and for sliced material require DNA or chromatographic authentication. If a patient on any Shou Wu preparation develops jaundice, dark urine, fatigue or right-upper-quadrant discomfort, stop the herb and check liver enzymes and bilirubin immediately - do not wait to establish which species it was.
Cynanchum wilfordii (Cynanchi Wilfordii Radix, Baek Su O)
Cynanchum auriculatum and Cynanchum wilfordii are visually indistinguishable as dried roots and share the Bai Shou Wu / Baek Su O name. Cynanchum auriculatum grows faster and larger, so it is economically preferable to farmers, and it is not recognised as a medicinal plant in the Korean Pharmacopoeia. In a 2015 Korean food-safety incident most of the Cynanchum wilfordii ingredient in commercial product was found to be Cynanchum auriculatum. A head-to-head 90-day rat study of the two species then found them to behave differently: the Cynanchum wilfordii water extract produced no adverse effects with a NOAEL above 5000 mg/kg/day, whereas the Cynanchum auriculatum water extract raised triglycerides and liver weights with hepatocyte vacuolation in males (NOAEL 1500 mg/kg/day in males, 2000 mg/kg/day in females), and Cynanchum auriculatum powder significantly raised ALT and AST in males (reported means around 207 U/L and 484 U/L) with hepatocyte necrosis, plus adrenal hypertrophy and vacuolation and ovarian damage in females, giving a NOAEL of only 150 mg/kg/day in both sexes. Following those findings Korea restricted Cynanchum wilfordii to water extract only in 2017 and prohibited Cynanchum auriculatum entirely. This is species-specific animal toxicology, not human case data, but it is the strongest safety signal available for this drug and it points the wrong way for the powdered form.
Clinical note: Treat Cynanchum auriculatum as the higher-risk member of the Baishouwu group rather than a benign tonic, and prefer the decocted water extract over powdered whole root, which was the more toxic form in rats. Do not supply it as a food or health-food ingredient to patients in South Korea, where it is prohibited.
Hepatotoxic drugs (paracetamol/acetaminophen, isoniazid, methotrexate, statins, azole antifungals)
The review literature on Cynanchum auriculatum reports hepatoprotection - total C21 steroidal glycosides recovered carbon-tetrachloride-injured liver, and a root-tuber extract attenuated diethylnitrosamine-induced liver injury and fibrosis in rats - and provides no toxicity data at all. That is contradicted by the only dedicated toxicology study, which found dose-dependent hepatocyte vacuolation, necrosis and transaminase elevation in rats given Cynanchum auriculatum, with a NOAEL for the powder of 150 mg/kg/day. Until that discrepancy is resolved the prudent reading is that this drug can injure the liver at high or prolonged dosing, so combining it with a known hepatotoxin adds risk rather than protecting against it.
Clinical note: Get baseline ALT, AST and bilirubin before any course longer than a few weeks and repeat them, especially where a hepatotoxic drug is co-prescribed or alcohol intake is significant. Avoid the powdered whole root at high dose.
Evidence Tier
Moderate evidence · 3 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
0
In vitro / animal
3
0 verified · 3 unverified
Show 3 studies
- Comparative sub-chronic toxicity studies in rats of two indistinguishable herbal plants, Cynanchum wilfordii (Maxim.) Hemsley and Cynanchum auriculatum Royle ex Wight
- Pharmacokinetics and tissue distribution of four major bioactive components of Cynanchum auriculatum extract: a UPLC–MS/MS study in normal and functional dyspepsia rats
- Baishouwu Extract Suppresses the Development of Hepatocellular Carcinoma via TLR4/MyD88/NF-κB Pathway
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
Comparative sub-chronic toxicity studies in rats of two indistinguishable herbal plants, Cynanchum wilfordii (Maxim.) Hemsley and Cynanchum auriculatum Royle ex Wight
Ninety-day rat study comparing water extract and powder of each species after the 2015 Korean incident in which Cynanchum auriculatum was found substituted for Cynanchum wilfordii. Cynanchum wilfordii water extract showed no adverse effect up to 5000 mg/kg/day. Cynanchum auriculatum water extract raised triglycerides and liver weight with hepatocyte vacuolation in males; Cynanchum auriculatum powder raised ALT and AST markedly in males with hepatocyte necrosis and caused adrenal and ovarian changes in females, with a NOAEL of 150 mg/kg/day. This is the key safety study for this species and it used Cynanchum auriculatum explicitly, not a relative.
Pharmacokinetics and tissue distribution of four major bioactive components of Cynanchum auriculatum extract: a UPLC–MS/MS study in normal and functional dyspepsia rats
Root-tuber extract of Cynanchum auriculatum given to normal and functional-dyspepsia rats. Baishouwubenzophenone absorption fell and clearance rose in diseased animals, while deacylmetaplexigenin and qingyangshengenin were absorbed more and eliminated more slowly and accumulated in stomach and small intestine; syringic acid exposure was lowest. Three components crossed the blood-brain barrier. Directly relevant to the food-stagnation indication because it shows the disease state itself changes exposure, but it is a rat study with no dosing implications for humans.
Baishouwu Extract Suppresses the Development of Hepatocellular Carcinoma via TLR4/MyD88/NF-κB Pathway
Extract of Cynanchum auriculatum root tubers, at 2 and 4 g/kg orally for 20 weeks, given to Sprague-Dawley rats receiving diethylnitrosamine 30 mg/kg for 11 weeks. It reduced serum injury markers and fibrosis indices and downregulated TLR4/MyD88/NF-kB signalling, but hepatocellular carcinoma incidence fell only from 100 percent to 87.5 percent at the high dose. The species is stated explicitly as Cynanchum auriculatum, which matters because much of the Baishouwu literature does not say which of the three species was used.
Historical Texts
Ben Cao Gang Mu
Ming dynastyReferences
- Wang Lu; Cai Fujie; Zhao Wei; Tian Jinli; Kong Degang; Sun Xiaohui; Liu Qing; Chen Yueru; An Ying; Wang Fulin; Liu Xue; Wu Yi; Zhou Honglei. Cynanchum auriculatum Royle ex Wight., Cynanchum bungei Decne. and Cynanchum wilfordii (Maxim.) Hemsl.: Current Research and Prospects . Molecules (2021) [DOI]
- Chen Wen-hua; Zhang Zhen-zhen; Ban Yan-fei; Rahman Khalid; Ye Bing-zhu; Sun Xiao-lei; Tan Hui-ying; Zheng Xiao-hua; Liu Hong-yan; Xu Ling-chuan; Yan Bin; Han Ting. Cynanchum bungei Decne and its two related species for “Baishouwu”: A review on traditional uses, phytochemistry, and pharmacological activities . Journal of Ethnopharmacology (2019) [DOI]
- Lee Beom-Joon; Lee Kyungjin. Discrimination and Proper Use of Polygoni Multiflori Radix, Cynanchi Wilfordii Radix, and Cynanchi Auriculati Radix in Korea: A Descriptive Review . Evidence-Based Complementary and Alternative Medicine (2015) [DOI]
- Sun Lili; Wang Meng; Liu Yali; Zhang Huijie; Liu Yanan; Ren Xiaoliang. Discrimination of Polygoni Multiflori radix and Cynanchi Auriculati radix using ultra-high performance liquid chromatography fingerprints and chemical pattern recognition . Biomedical Chromatography (2017) [DOI]
- Liu Yi; Wang Wenping; Sun Mingyi; Ma Baorui; Pang Linnuo; Du Yuanyuan. Polygonum multiflorum-Induced Liver Injury: Clinical Characteristics, Risk Factors, Material Basis, Action Mechanism and Current Challenges . Frontiers in Pharmacology (2019) [DOI]
- LiverTox: Clinical and Research Information on Drug-Induced Liver Injury (National Institute of Diabetes and Digestive and Kidney Diseases). Polygonum Multiflorum . LiverTox, NCBI Bookshelf NBK548795 (2020)
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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