Mo Yao
StarCommiphora myrrha Engl.
Traditionally used for
- Menstrual & women's health
- Pain & joints
- Skin
Cautions & contraindications
- Pregnancy
- Bleeding disorders
☯ TCM Properties
Invigorates Blood and Dispels Stasis; Alleviates Pain; Reduces Swelling; Promotes Tissue Regeneration and Heals Sores
Traditional Chinese Uses
Mo Yao (myrrh resin) is a neutral, bitter herb that invigorates Blood and disperses stasis to relieve pain and promote healing. It is used for pain and swelling from traumatic injuries, for menstrual pain and irregularities from Blood stagnation, and for carbuncles and sores in both the suppurating and healing stages. Applied topically, it promotes wound healing and reduces the pain of non-healing ulcers. It is frequently paired with Ru Xiang (frankincense) for enhanced Blood-moving and pain-relieving effects.
Western Herbalism Properties
Relationships
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Botanical Description
Commiphora myrrha (T.Nees) Engl. (Burseraceae) is a small thorny deciduous tree or large shrub 3-5 m tall native to the arid regions of the Horn of Africa and the southern Arabian Peninsula, with knotty contorted branches, peeling papery bark, and trifoliolate leaves with a larger terminal leaflet. When the bark is wounded, a pale yellow aromatic oleo-gum-resin exudes and hardens on exposure to air into reddish-brown irregular tears known as myrrh, or Mo Yao in Chinese medicine. The resin is collected, sorted, and may be processed by dry-frying or with vinegar. In TCM, Mo Yao is bitter in flavor and neutral in nature, entering the Heart, Liver, and Spleen channels; it invigorates blood, dispels stasis, alleviates pain, reduces swelling, and promotes healing of sores.
Active Constituents
Furanoeudesma-1,3-diene
FuranosesquiterpeneConcentration: one of the two dominant components of the volatile oil of the oleo-gum-resin; no reliable figure for the crude drug as dispensed
The compound most often credited with myrrh's analgesic action; it was reported in 1996 to bind brain opioid receptors and to produce antinociception in mice that naloxone reversed. In LPS-stimulated RAW 264.7 macrophages it inhibits nitric oxide release with an IC50 of 46.0 microM, which is only moderate potency.
Curzerene
FuranosesquiterpeneConcentration: co-dominant with furanoeudesma-1,3-diene in GC-MS profiles of Commiphora myrrha oleo-gum-resin essential oil
A furanoelemane-type rearrangement product of germacrane sesquiterpenes and a marker of genuine Commiphora myrrha resin oil. It contributes to the resin's antimicrobial and insecticidal activity; it has no established human pharmacology of its own.
29-Norlanost-8,24-dien-1alpha,3beta-diol
TriterpeneConcentration: a minor isolate of the resin fraction
One of 43 compounds isolated from Commiphora myrrha resin in 2024, of which 21 were new natural products. Several of the co-isolated sesquiterpenoids reduced nitric oxide release in stimulated macrophages by up to 40 percent, a weak anti-inflammatory signal.
Water-soluble gum fraction
PolysaccharideConcentration: the bulk of the oleo-gum-resin by mass; the drug is a true oleo-gum-resin, not a pure resin
The gum is the fraction that disperses in a decoction and carries little of the sesquiterpene pharmacology. Its main practical consequence is that myrrh does not dissolve cleanly in water, which is why the classical preparations are pills and powders rather than decoctions.
⚠ Drug Interactions
Warfarin
A published case report describes a patient stabilised on warfarin whose anticoagulant effect was antagonised after taking Commiphora molmol (a myrrh species dispensed interchangeably with C. myrrha as Mo Yao). Enzyme induction with accelerated warfarin clearance is the proposed mechanism, but it was not measured. Note that the documented direction of this interaction is a LOSS of warfarin effect, not bleeding - the popular assumption that a blood-invigorating resin must add to anticoagulation is not what the single human report shows.
Clinical note: Do not add or stop myrrh in a warfarin-stabilised patient without INR monitoring. Check the INR within 3-7 days of any change and again at 2 weeks.
Boswellia species (Ru Xiang, frankincense), the routine co-prescribed pair herb
Mo Yao is almost never dispensed alone; the classical pairing with Ru Xiang means the two resins are taken together in formulas such as Huo Luo Xiao Ling Dan. Boswellia resin has been reported to inhibit CYP2C9, CYP2C19 and CYP3A4 in vitro, the isoenzymes that clear warfarin, which would push the INR up, while the one human report on myrrh pushed it down. The net effect of the pair in an anticoagulated patient has never been studied and cannot be predicted from either herb alone.
Clinical note: Treat the pair as a single unquantified variable. Avoid starting it in patients on warfarin, DOACs or dual antiplatelet therapy; if it is already in the formula, do not change the dose without repeat coagulation monitoring.
Pregnancy (uterine-stimulant and abortifacient risk)
Myrrh has a real, not merely traditional, abortifacient signal. A randomised double-blind placebo-controlled trial gave 500 mg of myrrh oleo-gum-resin three times daily to 80 women with ultrasound-documented retained products of conception and achieved complete expulsion in 82.9 percent versus 54.3 percent on placebo - that is, myrrh measurably assists uterine evacuation in humans. Persian and Chinese sources independently record it as a uterine stimulant, and a case report attributes acute abdominal pain in a pregnant woman to myrrh, resolving on withdrawal.
Clinical note: Contraindicated in pregnancy at any dose and in any formula. Ask directly about pregnancy and about attempts to conceive before dispensing Mo Yao.
Praziquantel (and antischistosomal therapy generally)
Myrrh was commercialised in Egypt from 2001 as the antischistosomal product Mirazid on the strength of uncontrolled reports. Two randomised comparisons against praziquantel then found cure rates of 8.9-15.6 percent and 9.1 percent for myrrh against 62.5-79.7 percent for praziquantel, and most myrrh failures cleared when subsequently given praziquantel. This is a substitution hazard rather than a pharmacokinetic interaction: the harm is the parasitic disease left in place.
Clinical note: Myrrh is not an antiparasitic substitute. A patient with confirmed or suspected schistosomiasis needs praziquantel; do not let a myrrh-containing formula defer that referral.
CYP3A4 substrates (e.g. midazolam, ciclosporin, statins)
This entry exists to stop a cross-species inference. Guggulsterone, a potent pregnane X receptor agonist that induces CYP3A in rodent and human hepatocytes, comes from guggul, Commiphora mukul / C. wightii, an Ayurvedic drug from the same genus but not the source of Mo Yao. No comparable CYP3A data exist for Commiphora myrrha, and guggul's profile must not be transferred to it. The one clinical myrrh report (warfarin antagonism) is consistent with induction but does not identify an enzyme.
Clinical note: Do not quote guggul data as myrrh data. In practice, monitor rather than predict when myrrh is added to a narrow-therapeutic-index CYP3A4 substrate.
Adulterated or misidentified Commiphora oleo-gum-resin
Commiphora oleo-gum-resins are hard to tell apart morphologically and adulteration is documented in this trade: chemical profiling of a commercial guggul (C. wightii) sample found Mangifera indica gum markers in it. The Chinese Pharmacopoeia itself admits two botanical sources for Mo Yao - Commiphora myrrha and C. molmol - sold as natural myrrh and gum myrrh, and the warfarin case report was on C. molmol, so the two are not cleanly separated in the evidence either.
Clinical note: Buy from suppliers who state the binomial and the grade (natural versus gum myrrh). Treat furanoeudesma-1,3-diene / curzerene GC-MS profiles as the authenticity check for a batch.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction, or powder/pills | 3–5 g | Daily | — | — | 中国药典 2020 【用法与用量】3～5g，炮制去油，多入丸散用。 【注意】孕妇及胃弱者慎用。 【性味与归经】辛、苦，平。归心、肝、脾经。 — Chinese Pharmacopoeia 2020, quoted verbatim; route and cautions preserved. Replaces a cleared category-filler value. |
Dui Yao — Herb Pairs
The classical two-herb combinations this herb appears in, each with an action neither herb has alone.
Together they move blood and qi more strongly than either alone, dispersing stasis, reducing swelling and relieving pain; one leans to moving qi, the other to breaking blood stasis.
Classic for traumatic injury, painful swellings and stasis pain of the chest, abdomen and limbs; both are also core to Huo Luo Xiao Ling Dan (Zhang Xichun). Hard on the stomach; avoid in pregnancy.
Named pairing — Lü Jingshan, Shi Jinmo Dui Yao
Evidence Tier
Strong evidence · 5 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
4
3 verified · 1 unverified
Show 4 studies
- EFFICACY OF MYRRH IN THE TREATMENT OF HUMAN SCHISTOSOMIASIS MANSONI
- Efficacy and safety of myrrh in patients with incomplete abortion: a randomized, double-blind, placebo-controlled clinical study
- A Pilot Study on Bioactive Constituents and Analgesic Effects of MyrLiq®, a Commiphora myrrha Extract with a High Furanodiene Content
- Clinical efficacy of new aloe vera- and myrrh-based oral mucoadhesive gels in the management of minor recurrent aphthous stomatitis: a randomized, double-blind, vehicle-controlled study
Other clinical trial
0
Observational / case report
0
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
EFFICACY OF MYRRH IN THE TREATMENT OF HUMAN SCHISTOSOMIASIS MANSONI
104 people infected with Schistosoma mansoni were randomised to myrrh (Mirazid) or praziquantel, each given twice three weeks apart. Myrrh cured 15.6 percent after the first course and 8.9 percent after the second, with egg reduction of only 17-28 percent; praziquantel cured 73.7 and 76.3 percent. Of 34 people uncured by two myrrh courses, 32 stopped passing eggs after praziquantel. The authors concluded the antischistosomal claims for Mirazid are doubtful.
Efficacy and safety of myrrh in patients with incomplete abortion: a randomized, double-blind, placebo-controlled clinical study
80 women with ultrasound-confirmed retained products of conception received 500 mg myrrh oleo-gum-resin or placebo three times daily for two weeks. Complete abortion occurred in 82.9 percent of the myrrh group versus 54.3 percent on placebo, a significant difference. Read from a safety angle, this is direct human evidence that myrrh assists uterine evacuation, and therefore the strongest argument against giving it in a wanted pregnancy.
A Pilot Study on Bioactive Constituents and Analgesic Effects of MyrLiq®, a Commiphora myrrha Extract with a High Furanodiene Content
A small placebo-controlled pilot of a standardised high-furanodiene Commiphora myrrha extract in people with various pain syndromes reported reduced pain scores, with women responding more than men. It is a pilot with a proprietary extract, not the crude resin, and the sample is too small to establish an effect size.
Clinical efficacy of new aloe vera- and myrrh-based oral mucoadhesive gels in the management of minor recurrent aphthous stomatitis: a randomized, double-blind, vehicle-controlled study
90 patients with minor recurrent aphthous ulcers applied a 0.5 percent aloe vera gel, a 0.5 percent myrrh gel or a plain vehicle four times daily for five days. By day 6, 76.7 percent of the myrrh group reported near-absence of pain, while aloe performed better on ulcer healing, erythema and exudation. No side effects were reported. This supports the topical, analgesic use of myrrh on mucosal sores rather than any systemic claim.
An Unprecedented 4,8-Cycloeudesmane, Further New Sesquiterpenoids, a Triterpene, Steroids, and a Lignan from the Resin of Commiphora myrrha and Their Anti-Inflammatory Activity In Vitro
43 compounds were isolated from Commiphora myrrha resin, 21 of them new natural products, including the first 4,8-cycloeudesmane skeleton. Eight of eleven compounds tested produced concentration-dependent but small reductions in nitric oxide release from LPS-stimulated RAW 264.7 macrophages, up to 40 percent; the reference compound furanoeudesma-1,3-diene had an IC50 of 46.0 microM, which the authors class as moderate.
⚠ Safety & Contraindications
- Pregnancy
- Bleeding disorders
Contraindications
Its use is cautious in patients with weak stomach, and prohibited in pregnant women and patients without blood stasis.
Source: Xi S, Gong Y. Essentials of Chinese Materia Medica and Medical Formulas. Academic Press/Elsevier, 2017, pp. 230–235.
Historical Texts
Kai Bao Ben Cao
Northern Song dynastyBen Cao Gang Mu
Ming dynastyReferences
- Al Faraj S. Antagonism of the anticoagulant effect of warfarin caused by the use of Commiphora molmol as a herbal medication: a case report . Annals of Tropical Medicine & Parasitology (2005) [DOI]
- Tsai HH, Lin HW, Lu YH, Chen YL, Mahady GB. A Review of Potential Harmful Interactions between Anticoagulant/Antiplatelet Agents and Chinese Herbal Medicines . PLoS ONE (2013) [DOI]
- Botros S, Sayed H, El-Dusoki H, Sabry H, Rabie I, El-Ghannam M, Hassanein M, El-Wahab YA. EFFICACY OF MIRAZID IN COMPARISON WITH PRAZIQUANTEL IN EGYPTIAN SCHISTOSOMA MANSONI–INFECTED SCHOOL CHILDREN AND HOUSEHOLDS . The American Journal of Tropical Medicine and Hygiene (2005) [DOI]
- Latha S, Selvamani P, Prabha T. Pharmacological Uses of the Plants Belonging to the Genus Commiphora . Cardiovascular & Hematological Agents in Medicinal Chemistry (2021) [DOI]
- Ahmed R, Ali Z, Wu Y, Kulkarni S, Avery MA, Choudhary MI, Khan IA. Chemical Characterization of a Commercial Commiphora wightii Resin Sample and Chemical Profiling to Assess for Authenticity . Planta Medica (2011) [DOI]
- Brobst DE, Ding X, Creech KL, Goodwin B, Kelley B, Staudinger JL. Guggulsterone Activates Multiple Nuclear Receptors and Induces CYP3A Gene Expression through the Pregnane X Receptor . The Journal of Pharmacology and Experimental Therapeutics (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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