Ma Huang
StarEphedra sinica Stapf
Traditionally used for
- Cough & breathing
- Colds & fever
- Urinary & fluids
- Pain & joints
Cautions & contraindications
- Heart conditions
- Seizure disorders
☯ TCM Properties
Induces Sweating and Releases the Exterior; Disperses Wind-Cold; Descends Lung Qi and Calms Wheezing; Promotes Urination and Reduces Edema; Disperses Cold and unblocks painful obstruction
Traditional Chinese Uses
Ma Huang (ephedra stem) is a powerful, pungent, warm herb used to open the pores and cause sweating in Wind-Cold external invasions, to calm wheezing and coughing by dispersing obstructed Lung Qi, and to reduce edema. It is one of the fastest-acting herbs in the Chinese materia medica and is contraindicated in those with Wei Qi deficiency, spontaneous sweating, or cardiovascular conditions. Its active alkaloids form the pharmacological basis for ephedrine.
Western Herbalism Properties
Pharmacological Effects
- Sympathomimetic / cardiovascular: Ephedrine acts on alpha- and beta-adrenergic receptors, raising cardiac output, contractility, heart rate and systolic/diastolic pressure; dilates coronary, cerebral and muscle vessels while constricting renal, splenic, skin and mucosal vessels. Raised pulmonary artery pressure in cats (i.v.); acts directly and indirectly on rabbit artery strips.
- Antiasthmatic / smooth muscle: Ephedrine relaxes bronchi by indirect catecholamine release, direct beta-agonism, inhibition of allergic mediator release and alpha-mediated reduction of mucosal swelling. l-ephedrine, d-pseudoephedrine and dl-ephedrine relaxed acetylcholine-contracted guinea pig trachea; d-norpseudoephedrine behaves as a beta-blocker. Ephedrine also inhibits guinea pig ileum contractions.
- Diaphoretic and antipyretic: Aqueous extract (75-300 mg/kg p.o.) produced dose-dependent sweating in rats; ephedrine (2 mg/kg) and methylephedrine (4 mg/kg) also did; 50-60 mg oral ephedrine hastened sweating in humans in a warm environment. The essential oil (and l-alpha-terpineol) was antipyretic in febrile rabbits and hypothermic in mice.
- Diuretic: Pseudoephedrine increased urine volume in anesthetized dogs at 0.05-0.10 mg/kg; 0.5-1.0 mg/kg i.v. raised output 2-5-fold for 30-60 min.
- Antiinflammatory and antiallergic: Methanolic extract reduced capillary permeability and paw edema in mice; ephedrine, pseudoephedrine and ephedroxane were anti-inflammatory. Ephedrine and methylephedrine bind histamine H1 receptors (d-isomers stronger; d-methylephedrine a competitive H1 antagonist); water/ethanol extracts inhibit allergic mediator release.
- Antimicrobial: Decoction inhibited S. aureus, B. anthracis, B. diphtheriae, B. dysenteriae, B. typhosus and P. aeruginosa in vitro; volatile oil inhibited Asian influenza virus A.
- CNS: Ephedrine and pseudoephedrine cross the blood-brain barrier and stimulate the brain stem (insomnia, tremor, respiratory and vasomotor stimulation); ephedroxane is CNS-depressant; the volatile oil first stimulated then depressed rabbit respiration.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 45.
Used In Formulas (53)
Relationships
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Botanical Description
Ephedra sinica is a low, much-branched gymnosperm shrub in the Ephedraceae, native to northern China, Mongolia and adjacent parts of Russia, where it inhabits dry steppes, sandy slopes and gravelly desert margins. Plants typically grow 20-40 cm tall, forming dense clumps of slender, jointed, bright green photosynthetic stems that resemble those of horsetails. The leaves are reduced to small, scale-like sheaths at the nodes, leaving the photosynthesis to the green stems. The species is dioecious: male cones are small and yellow, while female cones, borne on separate plants, ripen into fleshy, berry-like red structures about 6-8 mm long, each enclosing one or two seeds. The plant has a deep, woody taproot adapted to arid conditions. It is the principal commercial source of the alkaloid ephedrine and has been harvested for centuries from wild populations in Inner Mongolia and surrounding regions.
Active Constituents
L-Ephedrine
Phenethylamine (amphetamine-type) alkaloidConcentration: 40-90% of total alkaloids; ~0.5-2.5% of dried herb
The principal bioactive alkaloid. A mixed-acting sympathomimetic that both releases endogenous noradrenaline and directly stimulates alpha- and beta-adrenergic receptors, producing bronchodilation, increased cardiac output, elevated blood pressure, CNS stimulation and thermogenesis. Accounts for the classic anti-asthmatic (wheeze-calming) action of Ma Huang.
D-Pseudoephedrine
Phenethylamine alkaloid (diastereomer of ephedrine)Concentration: ~20-45% of the alkaloid fraction
A nasal and systemic decongestant with weaker CNS and cardiac effects than ephedrine but stronger diuretic activity. Contributes to Ma Huang's traditional action of promoting urination and reducing edema.
L-Methylephedrine
N-methylated phenethylamine alkaloidConcentration: Minor alkaloid, typically <10% of alkaloid fraction
Possesses bronchodilating and antitussive activity; used pharmaceutically as a cough suppressant. Supports the descending-Lung-Qi, wheeze-calming function.
L-Norephedrine (phenylpropanolamine)
Phenethylamine alkaloid (nor-derivative)Concentration: Minor alkaloid
A sympathomimetic amine contributing to vasoconstrictor and appetite-suppressant activity of the alkaloid pool.
Ephedrannins (ephedra tannins / proanthocyanidins)
Condensed tannins / polyphenolsConcentration: Present in variable amounts
Macromolecular condensed tannins (e.g., ephedrannin A/B) with anti-inflammatory, antioxidant and blood-pressure-lowering effects that partly counterbalance the pressor alkaloids.
Ephedroxane and herbacetin-type flavonoids
Flavonoids / oxazolidinoneConcentration: Trace to minor
Contribute anti-inflammatory and anti-allergic activity; ephedroxane shows anti-inflammatory effects distinct from the alkaloids.
Volatile oil (l-alpha-terpineol, terpinen-4-ol, 2,3,5,6-tetramethylpyrazine)
Terpenoid essential oil / pyrazineConcentration: ~0.25% of dried herb
The aromatic fraction contributes diaphoretic and antiviral activity; terpinen-4-ol and related terpenes support the surface-releasing (exterior-venting) function.
Ephedra polysaccharides
PolysaccharidesConcentration: Variable
Show immunomodulatory and anti-inflammatory activity in preclinical models, contributing to non-alkaloid pharmacology of the herb.
⚠ Drug Interactions
Monoamine oxidase inhibitors (phenelzine, tranylcypromine, selegiline)
MAO inhibition blocks metabolism of catecholamines released by ephedrine; the resulting accumulation of noradrenaline can trigger severe hypertension, hyperthermia and cardiac arrhythmia.
Clinical note: Contraindicated together; avoid ephedra within 2 weeks of MAOI therapy.
Caffeine and other CNS stimulants
Additive sympathomimetic and CNS-stimulant effects markedly increase heart rate, blood pressure and the risk of arrhythmia, seizure and stroke. Ephedra-caffeine combinations drove most reported serious adverse events.
Clinical note: Avoid combining ephedra with caffeine-containing products; this pairing was central to the U.S. ban of ephedra dietary supplements.
Cardiac glycosides (digoxin)
Sympathomimetic stimulation from ephedrine may sensitize the myocardium and, combined with digoxin's effects on cardiac excitability, increase the likelihood of ectopic beats and arrhythmias.
Clinical note: Use caution and monitor for palpitations in patients on digoxin.
Antihypertensive agents (beta-blockers, guanethidine, methyldopa)
Ephedrine's pressor action antagonizes antihypertensive drugs and may reduce their efficacy; with non-selective beta-blockade, unopposed alpha-adrenergic vasoconstriction can raise blood pressure.
Clinical note: Monitor blood pressure; avoid in poorly controlled hypertension.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 2–10 g | Daily | — | — | 中国药典 2020 【用法与用量】2～10g。 【性味与归经】辛、微苦，温。归肺、膀胱经。 — Chinese Pharmacopoeia 2020, quoted verbatim; route and cautions preserved. Replaces a cleared category-filler value. |
Preparation Methods
Raw Ma Huang (sheng ma huang) decoction
Parts: dried herbaceous stem
Typical dose 1.5-9 g decocted in water. Traditionally the stems are cut and the foam that rises during boiling is skimmed off (said to reduce the herb's tendency to cause irritability/restlessness). The raw form has the strongest diaphoretic (sweat-inducing, exterior-releasing) action and is preferred for wind-cold exterior patterns and acute wheezing.
Honey-fried Ma Huang (zhi ma huang / mi zhi ma huang)
Parts: dried stem stir-fried with honey
The stems are stir-fried with honey until no longer sticky. Honey-processing moderates the harsh diaphoretic effect and enhances the moistening, Lung-Qi-descending and wheeze-calming action, making it the preferred form for cough and wheezing where strong sweating is undesirable.
Ma Huang rong (defatted / powdered form)
Parts: dried stem, crushed to fibrous 'velvet'
The stem is pounded into a soft fibrous mass; this gentler form is used for weak or elderly patients requiring a milder surface-releasing action.
Dui Yao — Herb Pairs
The classical two-herb combinations this herb appears in, each with an action neither herb has alone.
Dispersing and opening the Lung combined with astringing Lung qi, the pair calms wheezing without the dispersal exhausting the Lung or the astringency trapping the pathogen.
Wheezing with phlegm-heat and an exterior wind-cold constraint. Bai Guo is toxic raw or in excess.
Core pair of a classical formula — Ding Chuan Tang, She Sheng Zhong Miao Fang (Zhang Shiche)
Together they strongly warm the channels, scatter cold and relieve pain, dispersing cold-damp lodged in the joints.
Painful cold obstruction with severe joint pain that prevents bending and stretching. Chuan Wu is highly toxic and must be processed and decocted appropriately.
Core pair of a classical formula — Wu Tou Tang, Jin Gui Yao Lue (Zhang Zhongjing)
Together they open the pores and strongly induce sweating, releasing wind-cold from the exterior more powerfully than either alone.
Exterior excess wind-cold with no sweating. Too strong for patients who are already sweating or deficient.
Core pair of a classical formula — Ma Huang Tang, Shang Han Lun (Zhang Zhongjing)
Descending lung qi and clearing phlegm from the throat is combined with dispersing the lung, relieving wheezing with a rattling sound in the throat.
Cold-phlegm wheezing with a sound like a frog in the throat.
Core pair of a classical formula — She Gan Ma Huang Tang, Jin Gui Yao Lue (Zhang Zhongjing)
Dispersing lung qi is joined with clearing lung heat, so wheezing from heat constrained in the lung is relieved while the warmth of the dispersing herb is restrained.
Cough and wheezing with fever from heat lodged in the lung.
Core pair of a classical formula — Ma Xing Shi Gan Tang, Shang Han Lun (Zhang Zhongjing)
One disperses and opens the lungs, the other descends lung qi; the combined dispersing and descending restores lung function and strengthens the calming of wheezing and cough.
Also core to Ma Huang Tang (Shang Han Lun).
Core pair of a classical formula — San Ao Tang, Tai Ping Hui Min He Ji Ju Fang
The combination releases the exterior while warming and supporting the yang, addressing an exterior cold invasion in a patient with underlying yang deficiency.
Shaoyin constitution with exterior cold: chills, slight fever, deep pulse. Fu Zi must be properly prepared.
Core pair of a classical formula — Ma Huang Xi Xin Fu Zi Tang, Shang Han Lun (Zhang Zhongjing)
Evidence Tier
Strong 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
1
1 verified · 0 unverified
Randomized controlled trial
1
1 verified · 0 unverified
Other clinical trial
0
Observational / case report
0
In vitro / animal
0
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
Efficacy and Safety of Ephedra and Ephedrine for Weight Loss and Athletic Performance: A Meta-analysis
Pooling 52 controlled trials, ephedrine/ephedra (often with caffeine) produced modest short-term weight loss of roughly 0.9 kg per month over placebo but was associated with a 2-3-fold increase in psychiatric, autonomic, gastrointestinal and palpitation-related adverse events. The safety findings contributed to the 2004 U.S. FDA ban on ephedra-containing supplements.
Herbal ephedra/caffeine for weight loss: a 6-month randomized safety and efficacy trial
In 167 overweight adults, a standardized ephedra (90 mg ephedrine alkaloids)/caffeine herbal combination produced greater weight and fat loss and improved lipids over 6 months versus placebo. Blood pressure and heart rate rose modestly and more participants reported dry mouth, insomnia and palpitations.
⚠ Safety & Contraindications
- Heart conditions
- Seizure disorders
Contraindications
- Use with caution in hypertension or insomnia.
- Do not overdose because of its strong diaphoretic action.
- Contraindicated in spontaneous sweating from exterior deficiency, night sweating from Yin deficiency, and asthma from Qi deficiency.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 45.
Side Effects
- Overdosage in humans commonly causes nervousness, insomnia, central stimulation, raised blood pressure and palpitations.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 45.
⚠ 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.
Breastfeeding
Avoid passes into milk — infant irritability/tachycardia
Dose Ceiling
≤10g — ephedra 3–9g; higher risks hypertension/arrhythmia
Historical Texts
Shennong Bencao Jing (Divine Farmer's Materia Medica)
Eastern Han dynasty, c. 200 CEShang Han Lun (Treatise on Cold Damage), by Zhang Zhongjing
Eastern Han dynasty, c. 200 CEBen Cao Gang Mu (Compendium of Materia Medica), by Li Shizhen
Ming dynasty, 1596 CEReferences
- Zheng Q, Mu X, Pan S, Luan R, Zhao P. Ephedrae herba: A comprehensive review of its traditional uses, phytochemistry, pharmacology, and toxicology . Journal of Ethnopharmacology (2023) [DOI]
- Zhang Y, et al.. Ephedrae Herba: A Review of Its Phytochemistry, Pharmacology, Clinical Application, and Alkaloid Toxicity . Molecules (2023) [DOI]
- Shekelle PG, Hardy ML, Morton SC, et al.. Efficacy and Safety of Ephedra and Ephedrine for Weight Loss and Athletic Performance: A Meta-analysis . JAMA (2003) [DOI]
- Bensky D, Clavey S, Stoger E. Chinese Herbal Medicine: Materia Medica, 3rd Edition . Eastland Press (2004) [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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