Niu Huang
StarBos taurus domesticus Gmelin
Traditionally used for
- Cough & breathing
- Digestion
- Bowel health
- Menstrual & women's health
- Nerves & recovery
Cautions & contraindications
- Pregnancy
- Young children
- Kidney conditions
☯ TCM Properties
Opens the Heart Orifices; Resolves Phlegm; Cools the Liver and extinguishes Wind; Arrests Convulsions; Clears Heat and Resolves Toxicity
Traditional Chinese Uses
Fu Long Gan (hearth earth, stove center earth) is a warm, astringent substance taken from the center of traditional clay cooking stoves, valued for its ability to warm the middle burner and stop certain types of bleeding and vomiting. It is particularly indicated for vomiting and diarrhea from Spleen-Stomach cold, uterine bleeding and heavy menstruation due to Spleen Qi deficiency, and morning sickness. Its warming, settling quality makes it a classical remedy for cold-type digestive and bleeding disorders.
Relationships
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Botanical Description
Niu Huang (calculus bovis) is not a plant but a zoological product: the dried biliary or gallstone concretion formed in the gallbladder, bile ducts, or occasionally the liver of cattle (Bos taurus domesticus). Naturally occurring stones are irregular, ovoid to spherical, 0.6-4.5 cm across, yellow-brown to reddish-brown, light and friable, with a layered concentric structure and a fine, bitter, slightly sweet, cooling taste. Stones consist largely of bilirubin, cholesterol, bile acids, and calcium salts. Because natural Niu Huang is rare and costly, the great majority of commercial supply is now synthetic Niu Huang, compounded from bovine bile constituents, or in-vitro cultured bezoar (Wikipedia; NCBI).
Active Constituents
Bilirubin
Bile pigment (open-chain tetrapyrrole)Concentration: The Chinese Pharmacopoeia requires not less than 25.0% in natural Calculus Bovis; the biosynthesised drug Calculus Bovis Sativus is specified at not less than 35%
The dominant constituent by mass and the marker on which the drug is assayed and priced. It is a potent chain-breaking antioxidant and has anti-inflammatory and antipyretic activity, and the configuration and amount of bilirubin present is the main determinant of how the four commercial grades of the drug differ pharmacologically. At high concentration it is neurotoxic and has been associated with hearing impairment, which is the basis of the caution in neonates.
Cholic acid
Primary bile acid (C24 steroid)Concentration: Not less than 4.0% in natural Calculus Bovis by the Chinese Pharmacopoeia; Calculus Bovis Sativus is specified at not less than 6.0% total bile acid
The principal bile acid of the drug and the second assay marker. It is choleretic, spasmolytic on smooth muscle, and contributes the anticonvulsant and sedative activity attributed to Niu Huang in animal models.
Deoxycholic acid
Secondary bile acid (C24 steroid)Concentration: Present in all four commercial grades and identified unequivocally by diffusion-ordered NMR
A membrane-active secondary bile acid contributing to the drug's anti-inflammatory and smooth-muscle effects. It is one of the five compound classes used to fingerprint natural against artificial and cultured material.
Taurocholic acid
Taurine-conjugated bile acidConcentration: Detected in both natural and artificial Calculus Bovis, but at different levels, which is why it is used as a discriminating marker rather than a potency marker
A conjugated bile acid contributing to the choleretic and detoxifying actions ascribed to the drug. Its relative abundance against glycocholic and glycodeoxycholic acid is one of the analytical handles for separating genuine bezoar from compounded material.
Hyodeoxycholic acid
Bile acid (C24 steroid)Concentration: Identified alongside cholic and deoxycholic acid in natural, cultured and artificial Calculus Bovis
Chiefly of forensic interest: hyodeoxycholic acid is characteristic of porcine bile, and artificial Calculus Bovis is manufactured using porcine-derived ursodeoxycholic acid alongside bovine bile powder. Its profile therefore helps flag compounded material and matters to patients who avoid porcine-derived products.
Cholesterol
SterolConcentration: A structural component of the gallstone matrix rather than an actively dosed constituent
Part of the stone matrix and one of the components deliberately added when artificial Calculus Bovis is compounded. It is not considered to carry the therapeutic activity.
Taurine
Sulfonic amino acidConcentration: One of the amino acids among the 44-plus compounds isolated from the drug, and an ingredient deliberately added to artificial preparations
Contributes to bile acid conjugation and has independent anticonvulsant and membrane-stabilising activity in animal models, which fits the traditional use of Niu Huang for convulsion.
⚠ Drug Interactions
Artificial and cultured Calculus Bovis substituted for natural bezoar
Genuine ox gallstone is scarce and among the most expensive items in the Chinese materia medica, so the great majority of market material is not natural Calculus Bovis (NCB) but one of three surrogates: Calculus Bovis Sativus (CBS, grown in a live bovine gallbladder), cultured Calculus Bovis (CCB, produced in vitro), or Calculus Bovis Artifactus (CBA), which is simply compounded from bovine bile powder, cholic acid, porcine ursodeoxycholic acid, taurine, bilirubin and cholesterol. The review literature is explicit that the four grades differ in the configuration and concentration of bile acids and bilirubin and therefore differ pharmacologically, with CBS the closest match to natural material. Diffusion-ordered NMR analysis of market samples further identified sugar-adulterated Calculus Bovis, where a bulking agent has simply been added. A prescription written for Niu Huang gives no control over which of these the patient receives.
Clinical note: Require the supplier to state the grade in writing - natural, sativus, cultured or artificial - and treat an unlabelled product as artificial. Do not carry a dose across from one grade to another. Patients avoiding porcine-derived material must be told that artificial Calculus Bovis is made with porcine ursodeoxycholic acid.
Cinnabar- and realgar-containing patent formulas in which Niu Huang is dispensed (An Gong Niu Huang Wan)
In practice Niu Huang is very rarely given alone; it is met inside An Gong Niu Huang Wan and related patents, which also contain cinnabar (mercuric sulfide) and realgar (arsenic disulfide). A systematic review of 49 reported cases across 10 articles concluded that the overall risk of adverse drug reactions from An Gong Niu Huang Wan appears low and that the majority of events were attributable to improper use - overdose, use in children, or combination with incompatible drugs - but the review also found the quality of safety reporting too poor to establish an event rate, and separate toxicology work has been needed to show the formula is less acutely toxic than sodium arsenite or mercuric chloride. The heavy metal load is a property of the formula, not of the bezoar, but it is what the patient is actually swallowing.
Clinical note: Keep courses short and at label dose, avoid repeat or open-ended use, and be particularly careful in children, in renal impairment and in anyone with another source of arsenic or mercury exposure. Cinnabar- and realgar-containing patents are restricted or prohibited in several jurisdictions outside China - check local status before dispensing.
Bilirubin-albumin displacing drugs in neonates (sulfonamides, ceftriaxone)
The drug is by mass at least a quarter bilirubin, and the review literature records that while natural and artificial Calculus Bovis are otherwise of low toxicity, high concentrations of bilirubin cause neurotoxicity and hearing impairment. Sulfonamides and ceftriaxone displace bilirubin from albumin binding sites, and the neonatal blood-brain barrier and conjugating capacity are immature. Giving an exogenous bilirubin load alongside a displacer in a jaundiced neonate is a mechanistically coherent route to kernicterus, although no clinical case series has established that Niu Huang preparations have caused it.
Clinical note: Do not give Niu Huang or Niu Huang-containing patents to neonates, and particularly not to a jaundiced neonate or one receiving ceftriaxone or a sulfonamide. Niu Huang is also contraindicated in pregnancy in the Chinese Pharmacopoeia.
Ursodeoxycholic acid and other bile acid therapies
Calculus Bovis delivers a mixture of cholic, deoxycholic, chenodeoxycholic, ursodeoxycholic and hyodeoxycholic acids, and artificial preparations are explicitly compounded with porcine ursodeoxycholic acid. Co-administration with prescribed bile acid therapy is therefore additive on the same pool. No pharmacokinetic study has been done - the review literature notes that pharmacokinetic data for Calculus bovis are still lacking altogether - so the size of the effect is unknown.
Clinical note: Note it in patients on ursodeoxycholic acid for cholestasis or gallstone dissolution, but do not adjust the prescribed bile acid dose on the strength of it. There is no exposure data to work from.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction, or powder/pills | 0.15–0.35 g | Daily | — | — | 中国药典 2020 【用法与用量】0.15～0.35g，多入丸散用。外用适量，研末敷患处。 【注意】孕妇慎用。 【性味与归经】甘，凉。归心、肝经。 — 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.
Clearing heat, transforming phlegm and resolving toxin combines with aromatic opening of the orifices, so heat-phlegm blocking the pericardium is both cleared and opened.
For high fever with delirium or loss of consciousness from heat entering the pericardium. Contraindicated in pregnancy.
Core pair of a classical formula — An Gong Niu Huang Wan, Wen Bing Tiao Bian (Wu Jutang)
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
0
In vitro / animal
1
0 verified · 1 unverified
Other / unclassified
1
1 verified · 0 unverified
Verified: design read from PubMed for a DOI that resolves to the cited paper Unverified: taken from the study's recorded description
Clinical Studies
Whether Metal Element-Containing Herbal Formula Angong Niuhuang Pill Is Safe for Acute Brain Disorders?
A search of PubMed, Embase, the Cochrane Library, TOXNET, CNKI and Wanfang from 1974 to 2015 retrieved 49 adverse drug reaction or adverse event cases across 10 articles for An Gong Niu Huang Pill, the realgar- and cinnabar-containing patent in which Niu Huang is most often dispensed. The authors estimated the risk of adverse events to be low and attributed the majority to improper use - overdose, use in children, or co-administration with incompatible drugs - but could not calculate a frequency because manufacturers and hospitals did not supply production and market data, and could not reliably distinguish adverse reactions from adverse events because of poor reporting. They call for properly designed randomised trials of the formula's safety.
DOSY‐Assisted Multicomponent Characterization Enables Classification of Precious Chinese Materia Medica and Identification of Adulteration: A Case Study of Calculus Bovis
A diffusion-ordered NMR method was optimised for Calculus Bovis and applied to natural, sativus and artificial material as well as adulterated market samples. Five compound classes - cholic acid, deoxycholic acid, hyodeoxycholic acid, taurine-conjugated bile acids and glycine-conjugated bile acids - were unequivocally identified in all three genuine types and confirmed by carbon-13 NMR, and the signals of added sugar were clearly resolved in sugar-adulterated Calculus Bovis. The paper is direct evidence that bulking adulteration of this drug occurs in the market and can be detected.
Historical Texts
Shen Nong Ben Cao Jing
Han dynasty (compiled by the 2nd century CE)Ben Cao Gang Mu
Ming dynasty (1596)Wen Bing Tiao Bian
Qing dynasty (1798, Wu Jutong)References
- Yu ZJ, Xu Y, Peng W, Liu YJ, Zhang JM, Li JS, Sun T, Wang P. Calculus bovis: A review of the traditional usages, origin, chemistry, pharmacological activities and toxicology . Journal of Ethnopharmacology (2020) [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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