Han Fang Ji
StarStephania tetrandra S.Moore
Traditionally used for
- Cough & breathing
- Urinary & fluids
- Pain & joints
Cautions & contraindications
- Liver conditions
☯ TCM Properties
Promotes urination and reduces edema especially in the lower body; Expels Wind-Dampness and alleviates pain ( purges Damp-Heat )
Traditional Chinese Uses
Han Fang Ji (Radix Stephaniae Tetrandrae), the root of Stephania tetrandra, is a bitter, pungent, cold herb that drains Dampness, entering the Bladder, Spleen, Kidney and Lung channels. It promotes urination and reduces edema, being especially valued for Damp accumulation in the lower body with leg swelling and difficult urination; a classic pairing is with Huang Qi in Fang Ji Huang Qi Tang for edema and heavy, achy limbs from Wind-Damp with Qi deficiency. It also expels Wind-Dampness and clears Damp-Heat to relieve hot, swollen, painful joints (Bi syndrome).
Safety note: authentic Stephania tetrandra does NOT contain aristolochic acid. Nephrotoxicity historically blamed on "Fang Ji" stemmed from fraudulent substitution with Aristolochia species (Guang Fang Ji, A. fangchi), which is banned. Correct botanical identification is essential; source only verified Stephania tetrandra.
Relationships
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Botanical Description
Stephania tetrandra is a perennial climbing vine of the Menispermaceae family native to southern China and Taiwan. It produces slender twining stems that scramble over neighboring vegetation, bearing alternate, peltate leaves with broadly rounded to triangular blades and long petioles attached near the center of the leaf. Small, inconspicuous greenish-yellow unisexual flowers are borne in axillary cymes, followed by small drupes that turn red at maturity. The plant develops thick, fleshy tuberous roots which are the principal medicinal organ; these are dug in autumn, sliced transversely, and dried. The transverse section shows characteristic radiating vascular bundles within a pale, starchy parenchyma, a feature used to distinguish it from related Menispermaceous and Aristolochiaceous species.
Active Constituents
Tetrandrine
Bisbenzylisoquinoline alkaloidConcentration: Principal alkaloid of the root; the Chinese Pharmacopoeia sets a combined minimum of 1.6% tetrandrine plus fangchinoline in the dried root
An L-type voltage-dependent calcium channel antagonist that inhibits calcium influx into vascular smooth muscle, producing vasorelaxation and a measurable fall in blood pressure in spontaneously hypertensive rats; it also blocks two-pore channels and reverses P-glycoprotein-mediated multidrug resistance in vitro.
It is the compound that was absent from the adulterated Belgian slimming-clinic batches, and its presence or absence is the practical chemical marker distinguishing genuine Han Fang Ji from Aristolochia fangchi.
Fangchinoline
Bisbenzylisoquinoline alkaloidConcentration: Second major alkaloid; assayed together with tetrandrine to the 1.6% Pharmacopoeia minimum
Structurally identical to tetrandrine except for a hydroxyl in place of a methoxy group at C7, and shares its calcium-antagonist and antiproliferative activity in preclinical models, generally at somewhat different potency.
Cyclanoline
Quaternary protoberberine alkaloidConcentration: Minor constituent of the root
A water-soluble quaternary alkaloid reported among the minor alkaloids of the root; it is not the compound to which the drug's calcium-antagonist activity is attributed.
Fenfangjines
Bisbenzylisoquinoline alkaloidsConcentration: Minor constituents, characterised as a structural series from the root
A family of minor bisbenzylisoquinoline alkaloids isolated from Stephania tetrandra root and used chemotaxonomically; their individual pharmacology is largely uncharacterised.
⚠ Drug Interactions
Aristolochia fangchi (Guang Fang Ji)
This is a substitution hazard, not a pharmacological interaction, and the direction matters. Han Fang Ji, the root of Stephania tetrandra, is not itself nephrotoxic and contains no aristolochic acid. What harmed the Belgian slimming-clinic patients was that Aristolochia fangchi was dispensed in its place: analysis of the implicated batches found no tetrandrine but aristolochic acids instead.
The exposure mechanism is a three-way collision of trade names. Han Fang Ji (Stephania tetrandra), Guang Fang Ji (Aristolochia fangchi) and Mu Fang Ji (Cocculus species) are all traded as "Fang Ji" under the shared pinyin, and the dried root slices are difficult to tell apart by eye. Vanherweghem's 1993 Lancet series and the 1998 review of the outbreak documented over 100 cases of rapidly progressive interstitial renal fibrosis; Nortier's 2000 New England Journal of Medicine follow-up found urothelial carcinoma in 18 of 39 patients who underwent prophylactic nephroureterectomy, with aristolochic acid-DNA adducts in the tissue.
Aristolochic acid is a Group 1 human carcinogen and Aristolochia species are banned or restricted in the United States, the European Union, China and elsewhere; Stephania tetrandra is not.
Clinical note: Do not treat this as a reason to avoid Han Fang Ji; treat it as a reason to demand species-authenticated material. Source only from suppliers who identify to binomial and assay tetrandrine plus fangchinoline against the Pharmacopoeia minimum, and reject any product labelled only "Fang Ji" or "Fangji". If a patient has taken an unauthenticated Fang Ji product over months, especially in a weight-loss formula, check renal function and consider urological surveillance.
Antihypertensive drugs, particularly calcium channel blockers
Tetrandrine is a genuine L-type calcium channel antagonist, not merely a calcium-blocking curiosity: it inhibits KCl-induced intracellular calcium rise and L-type calcium currents in vascular smooth muscle, and lowers blood pressure in spontaneously hypertensive rats and in hypertensive patients. Co-administration with dihydropyridines, verapamil, diltiazem or other antihypertensives is therefore expected to be additive on the same target.
Clinical note: Monitor blood pressure when adding Han Fang Ji to an established antihypertensive regimen, and warn patients about postural symptoms. The interaction is pharmacodynamic and dose-related; reducing the herb rather than the prescribed drug is usually the appropriate adjustment.
CYP3A4 substrates
Tetrandrine inhibits CYP3A4 in vitro and alters the pharmacokinetics of co-administered CYP3A4 substrates in animal studies. Human pharmacokinetic interaction data for the whole decoction are lacking, so the magnitude at ordinary decoction doses is not established.
Clinical note: Exercise caution with narrow-therapeutic-index CYP3A4 substrates such as ciclosporin, tacrolimus and certain statins. Separate dosing does not reliably mitigate enzyme inhibition; monitor drug levels where they are routinely measured.
P-glycoprotein substrate chemotherapy (daunorubicin, doxorubicin, vincristine)
Tetrandrine is a well-characterised P-glycoprotein inhibitor and has been studied deliberately as a multidrug-resistance reversal agent; it produces persistent reversal of P-glycoprotein-mediated daunorubicin resistance in MOLT-4 leukaemia cells. The same mechanism that is exploited therapeutically would raise systemic exposure to P-glycoprotein substrate cytotoxics if the herb were taken unplanned alongside them.
Clinical note: Do not add Han Fang Ji to an active cytotoxic chemotherapy regimen without oncology input. The evidence is in vitro and in tetrandrine-specific trials, not in patients taking the crude decoction, so the size of the effect is unknown.
Hepatotoxic drugs, at sustained high tetrandrine dose
Chronic toxicity studies in dogs found that tetrandrine at 40 mg/kg for two months produced focal hepatocyte necrosis and abnormal liver function, with frank hepatic necrosis after six months of continuous dosing, and demonstrated tissue accumulation in liver, lung, kidney and adrenal gland proportional to dose. Tetrandrine is also the only plant-derived drug approved in China for silicosis, where it is given long-term at 60 mg three times daily, and pulmonary and hepatic adverse effects are the recognised dose-limiting concerns of that regimen.
This toxicity belongs to isolated tetrandrine at pharmaceutical doses over months, not to ordinary short-course decoction use of the crude root, and the distinction should be preserved when counselling.
Clinical note: Avoid stacking prolonged high-dose tetrandrine with other hepatotoxins including alcohol, methotrexate or isoniazid. For long courses, check baseline and periodic liver function; for short decoction courses at conventional dosage this concern is largely theoretical.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 5–10 g | Daily | — | — | 中国药典 2020 monograph 【防己】【用法与用量】5～10g。 【性味与归经】苦，寒。归膀胱、肺经。 — Han Fang Ji (汉防己) is the same drug as Fang Ji (防己), Stephania tetrandra; 汉 is the qualifier that distinguishes it from 广防己 Guang Fang Ji, which is Aristolochia fangchi and must NOT be dispensed. That prefix pair exists specifically to separate the safe Menispermaceae drug from the aristolochic-acid one, so the two records are kept distinct rather than merged. Dose is the ChP 防己 value; see the fang-ji record, which carries the identical latin_name. |
Dui Yao — Herb Pairs
The classical two-herb combinations this herb appears in, each with an action neither herb has alone.
Qi is strengthened to secure the exterior while water and wind-damp are drained, treating edema from qi deficiency.
Wind edema or wind-damp with sweating, heaviness and aversion to wind.
Core pair of a classical formula — Fang Ji Huang Qi Tang, Jin Gui Yao Lue (Zhang Zhongjing)
Evidence Tier
Strong evidence · 7 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
1
0 verified · 1 unverified
Randomized controlled trial
0
Other clinical trial
0
Observational / case report
3
1 verified · 2 unverified
Show 3 studies
- Urothelial Carcinoma Associated with the Use of a Chinese Herb (Aristolochia fangchi)
- Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs
- Tetrandrine slows disease progression on high-resolution computed tomography and lung function decline in artificial stone-associated silicosis: a retrospective cohort study
In vitro / animal
3
2 verified · 1 unverified
Show 3 studies
- Tetrandrine, an alkaloid from S. tetrandra exhibits anti-hypertensive and sleep-enhancing effects in SHR via different mechanisms
- Studies of the chronic toxicity of tetrandrine in dogs: An inhibitor of silicosis
- Differentiation between two "fang ji" herbal medicines, Stephania tetrandra and the nephrotoxic Aristolochia fangchi, using hyperspectral imaging
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
Urothelial Carcinoma Associated with the Use of a Chinese Herb (Aristolochia fangchi)
Prospective cohort of 39 patients with end-stage aristolochic acid nephropathy who underwent prophylactic nephroureterectomy after taking a slimming preparation in which Aristolochia fangchi had been substituted for Stephania tetrandra. Urothelial carcinoma was found in 18 patients and mild to moderate dysplasia in 19 more, and aristolochic acid-DNA adducts were detected in the tissue.
This is the definitive documentation that the harm came from the substituted Aristolochia, not from Han Fang Ji.
Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs
The original Belgian case series identifying rapidly progressive interstitial renal fibrosis in young women attending a Brussels slimming clinic, and linking it to the Chinese herbal component of the regimen. Nine cases were reported initially; the outbreak eventually exceeded 100 patients.
Misuse of Herbal Remedies: The Case of an Outbreak of Terminal Renal Failure in Belgium (Chinese Herbs Nephropathy)
Review of the Belgian outbreak by the nephrologist who first described it. It states plainly that the prescribed Stephania tetrandra was inadvertently replaced by Aristolochia fangchi in the powdered extracts delivered to Belgium and France, and that phytochemical analysis of the batches labelled Stephania found aristolochic acids rather than tetrandrine.
Tetrandrine, an alkaloid from S. tetrandra exhibits anti-hypertensive and sleep-enhancing effects in SHR via different mechanisms
In spontaneously hypertensive rats, tetrandrine lowered blood pressure and separately increased non-rapid-eye-movement sleep, and the authors attribute the two effects to different mechanisms. Supports the antihypertensive pharmacology of the isolated alkaloid; it is an animal study, not a human trial.
Tetrandrine slows disease progression on high-resolution computed tomography and lung function decline in artificial stone-associated silicosis: a retrospective cohort study
Retrospective cohort in artificial stone-associated silicosis, in which tetrandrine treatment was associated with slower radiographic progression on high-resolution CT and slower decline in lung function than in untreated controls. Tetrandrine is the only plant-derived drug approved in China for silicosis; this is observational rather than randomised evidence.
Studies of the chronic toxicity of tetrandrine in dogs: An inhibitor of silicosis
Chronic dosing in dogs found that tetrandrine at 40 mg/kg for two months caused focal hepatocyte necrosis and abnormal liver function, progressing to hepatic necrosis by six months, and that the drug accumulated dose-proportionally in liver, lung, kidney and adrenal gland. This is the principal source for the high-dose hepatotoxicity warning.
Differentiation between two "fang ji" herbal medicines, Stephania tetrandra and the nephrotoxic Aristolochia fangchi, using hyperspectral imaging
Analytical authentication study. Hyperspectral imaging with chemometric modelling separated Stephania tetrandra from Aristolochia fangchi in powdered and sliced material, addressing the morphological similarity that drives the substitution. Laboratory method development rather than clinical research.
Historical Texts
Shen Nong Ben Cao Jing
Han dynasty, compiled c. 200 BCE to 200 CEJin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet), Zhang Zhongjing
Eastern Han dynasty, c. 220 CEBen Cao Gang Mu (Compendium of Materia Medica), Li Shizhen
Ming dynasty, 1578, printed 1596Ben Cao Qiu Zhen (Seeking Truth in the Materia Medica), Huang Gongxiu
Qing dynasty, 1769References
- Zhang Y, Qi D, Gao Y, Liang C, Zhang Y, Ma Z, Liu Y, Peng H, Zhang Y, Qin H, Song X, Sun X, Li Y, Liu Z. History of uses, phytochemistry, pharmacological activities, quality control and toxicity of the root of Stephania tetrandra S. Moore: A review . Journal of Ethnopharmacology (2020) [DOI]
- Jiang Y, Liu M, Liu H, Liu S. A critical review: traditional uses, phytochemistry, pharmacology and toxicology of Stephania tetrandra S. Moore (Fen Fang Ji) . Phytochemistry Reviews (2020) [DOI]
- Bhagya N, Chandrashekar KR. Tetrandrine - A molecule of wide bioactivity . Phytochemistry (2016) [DOI]
- Debelle FD, Vanherweghem JL, Nortier JL. Aristolochic acid nephropathy: A worldwide problem . Kidney International (2008) [DOI]
- Liu ZL, Hirano T, Tanaka S, Onda K, Oka K. Persistent reversal of P-glycoprotein-mediated daunorubicin resistance by tetrandrine in multidrug-resistant human T lymphoblastoid leukemia MOLT-4 cells . Journal of Pharmacy and Pharmacology (2003) [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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