Gong Lao Ye
StarMahonia bealei (Fort.) Carr.
Traditionally used for
- Cough & breathing
- Bowel health
- Urinary & fluids
- Skin
- Liver & jaundice
Cautions & contraindications
- Pregnancy
- Breastfeeding
- Young children
☯ TCM Properties
Clears Deficiency Heat; Nourishes Yin; Resolves Phlegm and Stops Cough; Dries Dampness; Resolves Toxicity; Cools the Blood
Traditional Chinese Uses
Gong Lao Ye (mahonia leaf, Oregon grape leaf) is a bitter, cold herb used in Chinese medicine to clear Heat and Damp-Heat, with a particular affinity for conditions involving the Liver, Gallbladder, and skin. It is used for jaundice from Damp-Heat, urinary tract infections, dysentery, and inflammatory skin conditions including eczema and psoriasis-type patterns. Its Yin-nourishing quality also gives it applicability in deficiency-heat patterns, distinguishing it from purely excess-clearing bitter herbs.
Relationships
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Botanical Description
Mahonia bealei (now Berberis bealei) is an evergreen shrub in the Berberidaceae growing 2-4 m tall with stout, sparsely branched stems and yellow inner bark and wood. The large odd-pinnate compound leaves are 30-50 cm long with 9-15 thick, leathery, blue-green leaflets that are ovate to broadly ovate, with several stiff spiny teeth on each margin. Dense erect or spreading racemes of fragrant pale yellow flowers are borne in clusters at the stem tips in late winter to early spring, followed by drooping bunches of blue-black, glaucous, berry-like fruits. Native to mountain forests of central and southern China, it is now widely cultivated as an ornamental and has become naturalised in parts of the southeastern United States.
Active Constituents
Berberine
Protoberberine isoquinoline alkaloidConcentration: the principal alkaloid of the genus; root and stem are markedly richer than the leaf drug Folium Mahoniae, so leaf material carries less than the Caulis or Radix
Berberine accounts for most of the antimicrobial and anti-inflammatory activity attributed to this herb and for essentially all of its interaction risk. It inhibits CYP3A4 and P-glycoprotein and displaces bilirubin from albumin. Anything a practitioner needs to worry about with Gong Lao Ye follows from this molecule, so the leaf drug should be handled as a berberine-containing herb even though the leaf is the weakest part of the plant.
Palmatine
Protoberberine isoquinoline alkaloidConcentration: one of the principal quaternary alkaloids of the genus alongside berberine and jatrorrhizine; concentrated in root and stem
Palmatine from Mahonia bealei reduced intestinal tumour burden in ApcMin/+ mice with suppression of inflammatory cytokines. It shares berberine's quaternary protoberberine skeleton and should be assumed to share its enzyme-inhibition liabilities until shown otherwise.
Jatrorrhizine
Protoberberine isoquinoline alkaloidConcentration: the third of the three quaternary alkaloids routinely assayed in Mahonia material; concentrated in root and stem rather than leaf
A demethylated congener of palmatine, routinely quantified with berberine and palmatine when Mahonia material is authenticated, and contributing to the antimicrobial activity of the drug.
Magnoflorine
Aporphine isoquinoline alkaloidConcentration: isolated from Mahonia bealei; not part of the standard three-alkaloid assay
A quaternary aporphine alkaloid of Mahonia bealei, chemically distinct from the protoberberines and not covered by berberine-based quality assays.
⚠ Drug Interactions
Ciclosporin (cyclosporin A)
This is the best-characterised berberine interaction in humans. In a randomised controlled trial in 52 renal transplant recipients given ciclosporin plus berberine 0.2 g three times daily for 3 months, final ciclosporin trough concentrations and concentration/dose ratios were 29.3% and 27.8% higher than in 52 recipients on ciclosporin alone. In a formal pharmacokinetic substudy of six recipients, 12 days of berberine raised ciclosporin AUC by 34.5% and Cmin by 88.3%, prolonged tmax by 1.7 h and half-life by 2.7 h, and reduced apparent clearance by 40.4%. The authors attribute this to hepatic and intestinal CYP3A4 inhibition; berberine also inhibits P-glycoprotein, which handles ciclosporin efflux. The study used isolated berberine rather than Mahonia bealei, but the leaf drug delivers the same alkaloid.
Clinical note: Do not add or remove Gong Lao Ye in a transplant recipient without the transplant team's involvement and ciclosporin level monitoring. The dangerous moment is often stopping the herb, not starting it, because the dose will by then have been titrated against a berberine-inhibited clearance. The same caution applies to tacrolimus and sirolimus, which share CYP3A4 and P-glycoprotein handling.
CYP3A4 substrates (e.g. midazolam, simvastatin, calcium-channel blockers, many direct oral anticoagulants)
In a two-phase randomised crossover study in healthy men, 2 weeks of berberine 300 mg three times daily inhibited CYP3A4: midazolam Cmax and AUC rose by 38% and 40%, oral clearance fell 27%, tmax lengthened from 3.03 to 3.66 h and half-life from 0.66 to 0.99 h. Berberine also inhibits P-glycoprotein, so intestinal absorption of dual substrates is increased as well. The study used isolated berberine, not Mahonia bealei; the leaf drug is a weaker source of the alkaloid than the root or stem, so the size of the effect from a leaf decoction is unknown.
Clinical note: Treat Gong Lao Ye as a CYP3A4 and P-glycoprotein inhibitor. Avoid combining it with narrow-therapeutic-index CYP3A4 substrates, and if the combination is unavoidable, monitor for exaggerated drug effect rather than assuming a herbal preparation is inert.
CYP2D6 and CYP2C9 substrates (e.g. metoprolol, dextromethorphan, warfarin, phenytoin)
In the same healthy-volunteer crossover study, 2 weeks of berberine 300 mg three times daily produced a ninefold rise in the 0-8 h urinary dextromethorphan/dextrorphan ratio, indicating substantial CYP2D6 inhibition, and a doubling of the losartan/E-3174 ratio, indicating CYP2C9 inhibition. CYP2C19 and CYP1A2 probe pharmacokinetics were unchanged. Again the agent studied was isolated berberine, not Mahonia bealei.
Clinical note: Watch for exaggerated beta-blocker or antidepressant effect in CYP2D6 substrates, and check INR if the herb is added to or removed from warfarin therapy.
Bilirubin displacement in neonates and jaundiced infants (kernicterus risk)
Berberine displaces bilirubin from albumin. Measured by the peroxidase kinetic method, it was on a molar basis roughly tenfold more potent a displacer than phenylbutazone, itself a known potent displacer, and about a hundredfold more potent than papaverine. In rats, intraperitoneal berberine at 10 and 20 micrograms/g daily for a week significantly reduced bilirubin protein binding and produced a persistent rise in both unbound and total serum bilirubin, the latter suggesting inhibition of bilirubin metabolism as well as displacement. The work was done on berberine from Coptis chinensis (huanglian), but the mechanism is a property of the molecule, not of the source plant, and applies to any berberine-rich herb including Mahonia bealei.
Clinical note: Do not give Gong Lao Ye or any berberine-rich herb to a neonate or a jaundiced infant, and avoid it in pregnancy near term and in breastfeeding mothers of jaundiced newborns. This is a genuine contraindication rather than a precaution: the injury of concern is kernicterus.
Ilex cornuta leaf (Gou Gu Ye), traded under the same name Gong Lao Ye
Market survey work on confused species documents that the dried leaf of Ilex cornuta (Aquifoliaceae), properly Gou Gu Ye, is traded under the name Gong-lao-ye and is routinely confused with the leaf of Mahonia bealei (Shi Da Gong Lao Ye, Berberidaceae). The two are unrelated families. Ilex cornuta contains none of the protoberberine alkaloids, so a substituted lot has no berberine pharmacology and none of the CYP3A4, P-glycoprotein or bilirubin-displacement liabilities; conversely a prescription written for Ilex cornuta and filled with Mahonia brings all of them. Mahonia bealei is also confused in trade with Mahonia fortunei and with Berberis soulieana, which is a lesser problem since those are also berberine-bearing Berberidaceae.
Clinical note: Specify the binomial, not the pinyin, when ordering. If a supply is labelled only Gong Lao Ye, establish whether it is Mahonia leaf or Ilex cornuta leaf before dispensing, particularly if the patient is on ciclosporin or another narrow-therapeutic-index CYP3A4 substrate.
Evidence Tier
Moderate 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
0
Randomized controlled trial
2
2 verified · 0 unverified
Other clinical trial
0
Observational / case report
0
In vitro / animal
2
2 verified · 0 unverified
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
Mahonia bealei (Fort.) Carr. Leaf extract modulates the TLR2/MyD88/NF-κB signaling pathway to inhibit PGN-induced inflammation in RAW264.7 cells
A leaf extract of Mahonia bealei, the part used as Folium Mahoniae, was profiled by UPLC-Q-TOF-MS/MS (19 major components) and tested against peptidoglycan-stimulated RAW264.7 macrophages. It suppressed NO, PGE2, TNF-alpha, IL-1beta and IL-6 while raising IL-10, reduced TLR2 and MyD88 mRNA and protein, and inhibited phosphorylation of IkB, NF-kB and IKK. Cell-line work only, but it is one of the few studies using the leaf drug itself rather than isolated berberine.
Palmatine from Mahonia bealei attenuates gut tumorigenesis in ApcMin/+ mice via inhibition of inflammatory cytokines
Palmatine isolated from Mahonia bealei reduced intestinal tumour formation in ApcMin/+ mice, an effect the authors attribute to inhibition of inflammatory cytokines. A single-constituent mouse study; it does not support any clinical use of the herb in colorectal neoplasia.
Effects of berberine on the blood concentration of cyclosporin A in renal transplanted recipients: clinical and pharmacokinetic study
The agent studied was isolated berberine, not Mahonia bealei, but berberine is the constituent that carries this herb's interaction risk. 52 renal transplant recipients received ciclosporin plus berberine 0.2 g three times daily for 3 months and 52 received ciclosporin alone. Final ciclosporin trough concentrations and concentration/dose ratios were 29.3% and 27.8% higher with berberine. In six recipients studied pharmacokinetically, 12 days of berberine raised ciclosporin AUC by 34.5%, Cmin by 88.3% and half-life by 2.7 h, and cut apparent clearance by 40.4%. Liver and renal function were unaffected. The authors attribute the effect to hepatic and intestinal CYP3A4 inhibition.
Repeated administration of berberine inhibits cytochromes P450 in humans
A two-phase randomised crossover study in healthy men. After 2 weeks of berberine 300 mg three times daily, CYP2D6 activity fell markedly (ninefold rise in urinary dextromethorphan/dextrorphan), CYP2C9 activity halved (doubled losartan/E-3174 ratio) and CYP3A4 was inhibited (midazolam Cmax +38%, AUC +40%, oral clearance -27%). CYP2C19 and CYP1A2 probes were unchanged. Again the agent was isolated berberine rather than Mahonia bealei, and the leaf drug is a weaker berberine source than root or stem, so the magnitude of the effect from a leaf decoction is not established.
References
- He JM; Mu Q. The medicinal uses of the genus Mahonia in traditional Chinese medicine: An ethnopharmacological, phytochemical and pharmacological review . Journal of Ethnopharmacology (2015) [DOI]
- Chan E. Displacement of Bilirubin from Albumin by Berberine . Biology of the Neonate (1993) [DOI]
- Zhao Z; Yuen JPS; Wu J; Yu T; Huang W. A Systematic Study on Confused Species of Chinese Materia Medica in the Hong Kong Market . Annals of the Academy of Medicine, Singapore (2006) [DOI]
- Ji X; Li Y; Liu H; Yan Y; Li J. Determination of the alkaloid content in different parts of some Mahonia plants by HPCE . Pharmaceutica Acta Helvetiae (2000) [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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