Ku Lian Pi
StarMelia azedarach L. / Melia toosendan Sieb. et Zucc.
Traditionally used for
- Skin
Cautions & contraindications
- Pregnancy
- Young children
- Liver conditions
- Toxic — professional use only
☯ TCM Properties
Expels Parasites; Kills Parasites and Eliminates Lice; Clears Damp-Heat from the Skin
Traditional Chinese Uses
Ku Lian Pi (chinaberry bark, melia bark) is a cold, bitter, toxic herb used in Chinese medicine as a powerful antiparasitic agent — effective against roundworms, pinworms, and hookworms. It is also used externally for fungal skin conditions. Because of its toxicity, it must be used in carefully controlled doses, for short durations only, and under professional supervision. Liver function should be monitored with repeated use.
Western Herbalism Properties
Relationships
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Botanical Description
Melia azedarach L. and the closely related Melia toosendan Siebold & Zucc. (Meliaceae), chinaberry or Persian lilac, are small to medium deciduous trees native to South and East Asia, reaching 7-15 m with bipinnate leaves, panicles of fragrant lilac flowers, and yellowish drupes about 1-1.5 cm in diameter that persist into winter. The medicinal Ku Lian Pi is the dried bark of the trunk, branches, or root, harvested in spring or autumn, longitudinally curled or in flat strips, grey-brown externally with longitudinal fissures and yellowish inner surface. It contains the limonoid triterpenes toosendanin (the principal anthelmintic constituent), azadirachtin-related compounds, and tannins. In traditional Chinese medicine, Ku Lian Pi is bitter and cold with toxicity, entering the spleen, stomach, and liver channels; it kills parasites and treats tinea, used internally for roundworm, pinworm, and hookworm infestation and topically for ringworm and scabies. It is hepatotoxic in overdose and must be used cautiously and not repeatedly. Also a major Ayurvedic herb (Mahanimba).
Active Constituents
Toosendanin
Ring-C-seco triterpenoid limonoidConcentration: reported in the bark at up to roughly 0.5%; root bark is conventionally reckoned about twice as potent as stem bark
The pharmacopoeial marker of the drug and the compound that carries both its anthelmintic action and its toxicity. It can be isolated from only two species, Melia toosendan and Melia azedarach, which is why the Pharmacopoeia accepts both as the source of Ku Lian Pi. It is a presynaptic neuromuscular blocker: it first facilitates and then progressively depresses transmitter release at the neuromuscular junction and at central synapses, and this is the mechanism behind the neurological picture of Melia poisoning.
Kulinone
Tirucallane-type triterpenoidA triterpenoid of the bark of Melia azedarach, reported alongside kulactone and 12-acetoxyamoorastatin. It is not used for standardisation and its contribution to the anthelmintic effect has not been established.
Kulactone
Triterpenoid lactoneA bark triterpenoid lactone characteristic of Melia azedarach. Like kulinone it is a marker of species identity rather than a therapeutically characterised principle.
12-Acetoxyamoorastatin
LimonoidA limonoid isolated from Melia azedarach bark. It belongs to the same broad class as toosendanin and shares the general cytotoxic and insecticidal profile of the Melia limonoids.
Meliatoxins A1, A2, B1 and B2
Limonoid (meliatoxin type)Ring-intact limonoids concentrated in the FRUIT of Melia azedarach rather than in the bark, and the fraction principally implicated in the fatal fruit poisonings of children and of dogs and pigs eating fallen fruit. Meliatoxin B1 is cytotoxic in the KB cell line. They are listed here because the fruit of this species is a recognised contaminant and substitute in the Melia trade, not because they are a normal constituent of correctly collected Cortex Meliae.
Nimbolinin B and 1-deacetylnimbolinin B
Nimbolinin-type limonoidAdditional limonoids reported from Melia species. More than 200 limonoids have now been isolated from the genus, and their collective pharmacology is dominated by cytotoxic, insecticidal and anti-botulism activity.
Condensed tannins
Tannin (polyphenol)Present in the bark as in most bark drugs, contributing astringency. They are not the anthelmintic principle and have no bearing on the toxicity that governs how this drug is dosed.
⚠ Drug Interactions
Chuan Lian Zi (Fructus Toosendan, the fruit of Melia toosendan)
These are two different drugs from the same genus and they are routinely confused. Ku Lian Pi is the dried stem bark and root bark, and the Chinese Pharmacopoeia accepts both Melia toosendan and Melia azedarach as its source. Chuan Lian Zi is the fruit and is restricted to Melia toosendan. The fruit of Melia azedarach, sold as Ku Lian Zi, is the part in which the meliatoxins concentrate and is the material behind the reports of children killed by eating chinaberry fruit; Melia azedarach is generally reckoned the more toxic of the two species. When Ku Lian Zi is substituted for Chuan Lian Zi the patient receives a materially more dangerous drug under a name that implies the safer one. The species pairing in this record is therefore correct for the bark drug and must not be read across to the fruit drug.
Clinical note: Ku Lian Pi is not a duplicate of Chuan Lian Zi: different part, different species basis, different function. Never accept fruit when bark was ordered, and require the supplier to state the species and the plant part for any Melia product. Treat any Melia azedarach fruit material as unsuitable for dispensing.
Acetaminophen, isoniazid, methotrexate and other hepatotoxic drugs
Severe Melia poisoning includes toxic hepatitis alongside internal haemorrhage, respiratory centre paralysis, mental disturbance, visual impairment, convulsions, coma and death. Milder poisoning presents 1 to 6 hours after ingestion with headache, dizziness, nausea, vomiting and abdominal pain. Toosendanin itself shows measurable cytotoxicity toward normal liver cells in vitro, and hepatotoxicity is the toxicity most consistently attributed to the Melia limonoids across the review literature. Children tolerate toosendanin less well than adults.
Clinical note: Do not combine Ku Lian Pi with other hepatotoxic agents. Keep to the pharmacopoeial dose of 4.5 to 9 g in decoction, use short courses only, and avoid the drug entirely in patients with existing liver disease, in pregnancy, and in young children unless there is no alternative and dosing is supervised.
Botulinum toxin injections and neuromuscular blocking agents
Toosendanin is a well-characterised presynaptic agent. It makes rat cerebral synaptosomes completely resistant to botulinum neurotoxin A-mediated cleavage of SNAP-25, and even after the toxin has bound it still partially antagonises that cleavage; it also blocks translocation of the botulinum light chain through the heavy-chain channel. It is an effective treatment for experimental botulism for exactly this reason. But the same compound depresses transmitter release at the neuromuscular junction after an initial facilitation, and respiratory centre paralysis is part of the severe Melia poisoning picture. Both directions of the interaction are pharmacologically real: the herb may blunt a therapeutic botulinum toxin injection, and at toxic doses it contributes its own neuromuscular blockade.
Clinical note: Do not prescribe Ku Lian Pi around therapeutic or cosmetic botulinum toxin treatment. Avoid it in myasthenia gravis, in any patient on long-term neuromuscular blockade, and in any patient with respiratory muscle weakness.
Fatty meals, oil-based purgatives and lipid-containing vehicles
Toosendanin and the related Melia limonoids are lipophilic. The classical rule for anthelmintic drugs of this class is that they are taken on an empty stomach and that oily vehicles are avoided, the rationale being that the drug should act in the gut lumen on the parasite rather than be absorbed into the circulation. A lipid vehicle would be expected to increase systemic exposure and therefore toxicity. No pharmacokinetic study has quantified this for Melia bark, so it is a mechanistic inference consistent with long-standing practice rather than a measured effect.
Clinical note: Give on an empty stomach and avoid oil-based purgatives on the same day. Do not use castor oil to accelerate expulsion after a Melia anthelmintic.
Antiparasitic co-therapy in children
The classical indication for this drug, ascariasis and enterobiasis, is overwhelmingly a paediatric one, while the review and poisoning literature is explicit that children have lower tolerance to toosendanin than adults. The drug's therapeutic window is therefore narrowest in exactly the population it is traditionally aimed at, and this is compounded when it is combined with other agents that share a hepatic or neurological toxicity.
Clinical note: Modern anthelmintics such as albendazole and mebendazole are safer and better evidenced for confirmed ascariasis and enterobiasis in children. Ku Lian Pi should not be the first choice in a child, and should not be stacked with another antiparasitic.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 3–6 g | — | — | — | ChP 2025. Caution in pregnancy and in impaired liver or kidney function. Corrected from a generic 'As needed' poultice filler value generated from tcm_category. |
| topical | Appropriate amount | — | — | — | ChP 2025. 外用适量，研末，用猪脂调敷患处。 |
Evidence Tier
Limited evidence · 2 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
1
0 verified · 1 unverified
Show the study
In vitro / animal
1
1 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
Human Melia azedarach poisoning
A poison-centre series of human poisonings specifically by Melia azedarach, not Melia toosendan. Neurological features dominated the presentation: weakness, myalgia, numbness and ptosis, consistent with the presynaptic neuromuscular action of toosendanin. Treatment was symptomatic and supportive and all patients in this series recovered without sequelae. The paper also reviews the animal toxicity literature, in which leaves, flowers and fruit have caused toxic effects in rats, and dogs and pigs have been poisoned by eating fallen fruit; although only the bark is the listed medicinal part, the whole plant appears to be toxic.
Antagonism of botulinum toxin type A-induced cleavage of SNAP-25 in rat cerebral synaptosome by toosendanin
Rat cerebral synaptosomes preincubated with toosendanin, the marker limonoid of Melia bark, became completely resistant to botulinum neurotoxin A-mediated cleavage of SNAP-25, and toosendanin still partially antagonised the cleavage when added after the toxin had bound. This establishes the compound as a genuine presynaptic agent acting at the level of light-chain translocation, and is the mechanistic basis both for its use against experimental botulism and for the neuromuscular features of Melia poisoning.
⚠ Safety & Contraindications
- Pregnancy
- Young children
- Liver conditions
- Toxic — professional use only
Contraindications
Contraindicated in pregnancy and in hepatic impairment.
Safety Warnings
- Cumulative hepatotoxicity; not for prolonged use.
- Doses in children must be calculated carefully — most reported fatalities are paediatric.
- Liver function should be monitored on any extended course.
⚠ Rule-Based Cautions
These entries come from the deterministic rule tables that gate Verscienta's formula tools — classical pair prohibitions, pregnancy and lactation contraindications, and dose ceilings.
Pregnancy
Avoid toxic
⚠ Toxicity Information
Nausea, vomiting, abdominal pain and dizziness; in overdose, hepatotoxicity and — reported in children — respiratory depression and death.
Historical Texts
Shen Nong Ben Cao Jing
Han dynastyReferences
- Wenxiang Fan, Linhong Fan, Zhengtao Wang, Li Yang. Limonoids From the Genus Melia (Meliaceae): Phytochemistry, Synthesis, Bioactivities, Pharmacokinetics, and Toxicology . Frontiers in Pharmacology (2022) [DOI]
- Hui Chang, Chao Wang, Lili Gong, Yinghan Zhang, Conglian Liang, Hongyan Liu. An overview of Fructus Meliae Toosendan: Botany, traditional uses, phytochemistry, pharmacology and toxicology . Biomedicine & Pharmacotherapy (2023) [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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