Qing Feng Teng
StarSinomenium acutum (Thunb.) Rehder & E.H.Wilson
Traditionally used for
- Urinary & fluids
- Nerves & recovery
- Pain & joints
Cautions & contraindications
- Pregnancy
☯ TCM Properties
Dispels Wind-Damp Bi , unblocks the channels and collaterals and relieves pain; Facilitates urination
Traditional Chinese Uses
Qing Feng Teng is the woody stem of Sinomenium acutum (Menispermaceae), a bitter, pungent, neutral herb entering the Liver and Spleen channels. Its principal use is to dispel Wind-Dampness, unblock the channels and collaterals, and relieve pain in Wind-Damp painful obstruction—rheumatic and arthritic joint pain, swelling, numbness, and limited movement—for which it is decocted or, traditionally, soaked in wine. By promoting urination it also drains Dampness and reduces edema. Its alkaloid sinomenine is the basis of widely used anti-rheumatic preparations (e.g., zhengqing fengtongning) with anti-inflammatory and immunomodulating effects. Usual dose is 6-12 g. Sinomenine can provoke histamine release causing itching, rash, or flushing, and occasionally GI upset or reduced blood counts, so it is used cautiously and generally avoided in pregnancy.
Western Herbalism Properties
Pharmacological Effects
- Analgesic: Sinomenine analgesic in mice and rabbits at about 1/10-1/2.5 morphine potency, short-lived, with reversible tolerance; no addiction in monkeys; not antagonized by nalorphine and no cross-tolerance with morphine.
- Antiinflammatory and antiallergic: Sinomenine inhibited rat paw edema via the hypothalamic-pituitary-adrenal axis (abolished by adrenalectomy/hypophysectomy) and antagonized allergic shock in rabbits.
- Sedative: Reduced spontaneous activity in mice and caused central inhibition in dogs and monkeys, but lowered strychnine convulsion threshold.
- Antitussive: Sinomenine antitussive in mice, guinea pigs and cats, comparable to codeine in mice and cats.
- Hypotensive: Acute BP fall in several species with tolerance on repetition; no direct vascular action.
- Histamine release: Strong histamine releaser, mainly in skin in dogs.
- Gastrointestinal: Inhibited isolated intestine and antagonized spasmogens; i.v. caused transient histamine-mediated intestinal stimulation.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 288.
Relationships
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Botanical Description
Qing Feng Teng is the dried stem of Sinomenium acutum (Thunb.) Rehder & E.H.Wilson (Menispermaceae), a deciduous twining woody vine of central and southern China, Japan, and Korea reaching 10 to 20 m in length. Stems are cylindrical, longitudinally striated, with a porous yellowish wood whose cross section shows radiating medullary rays; alternate broadly cordate to palmately lobed leaves and small dioecious yellow-green flowers in axillary panicles produce small dark drupes. The chief active constituent, the alkaloid sinomenine, has well-characterized anti-inflammatory, analgesic, and immunomodulatory activity and is the basis of the marketed drug Zheng Qing Feng Tong Ning. In traditional Chinese medicine the stem is bitter, acrid, and neutral, entering the Liver and Spleen channels; it dispels wind-damp, unblocks channels, and promotes urination for rheumatic and arthritic joint pain.
Active Constituents
Sinomenine
Morphinan-type isoquinoline alkaloidConcentration: Mean 24.9 mg/g of dried stem across 35 commercial batches, 76.6 percent of total alkaloid content (UHPLC-QQQ-MS/MS)
The principal active and principal toxic alkaloid of the stem, and the substance licensed in China as sinomenine hydrochloride (Zhengqing Fengtongning) for rheumatoid arthritis, ankylosing spondylitis and knee osteoarthritis. It suppresses TNF-alpha and IL-1beta and inhibits synovial proliferation, but it is also a direct, non-IgE-mediated mast cell degranulator acting through MRGPRX2, which is why rash, flushing, pruritus and occasional anaphylactoid collapse are its characteristic adverse events rather than idiosyncratic rarities.
Magnoflorine
Quaternary aporphine alkaloidConcentration: Mean 6.35 mg/g of dried stem, 19.5 percent of total alkaloid content
The second most abundant alkaloid of the stem and a quaternary ammonium compound with poor oral absorption. It contributes anti-inflammatory and hypotensive activity in preclinical work and is used alongside sinomenine as a quality marker for the crude drug.
Higenamine
Benzylisoquinoline alkaloidConcentration: Mean 288 micrograms/g of dried stem (0.885 percent of total alkaloids); highly variable between batches
A beta-adrenergic receptor agonist with positive chronotropic and inotropic effects. It was added to the WADA Prohibited List as a beta-2 agonist in 2017, and the authors of the quantitative survey of this drug warn that ordinary consumption of Sinomenium acutum stem can push urinary higenamine above anti-doping decision limits.
Coclaurine
Benzylisoquinoline alkaloidConcentration: Mean 435 micrograms/g of dried stem (1.34 percent of total alkaloids)
A biosynthetic precursor of higenamine and magnoflorine that shows vasorelaxant and neuromuscular-blocking activity in isolated tissue. It was proposed together with higenamine as a safety-control marker for the crude drug.
Acutumine
Chlorinated hasubanan alkaloidConcentration: Mean 435 micrograms/g of dried stem (1.34 percent of total alkaloids)
An unusual naturally chlorinated alkaloid essentially characteristic of Sinomenium and Menispermum, useful as an authentication marker. Reported activities are preclinical only, chiefly selective T-cell cytotoxicity and memory-enhancing effects in rodents.
Sinoacutine
Morphinandienone alkaloidConcentration: Mean 44.4 micrograms/g of dried stem
A minor morphinandienone alkaloid of the stem, structurally the enantiomeric series of the salutaridine skeleton. It has no established clinical activity and is used chiefly as a chemotaxonomic marker.
Protoberberine alkaloids (palmatine, jatrorrhizine, columbamine, 8-oxypalmatine)
Protoberberine quaternary alkaloidsConcentration: Low, palmatine mean 22.5, columbamine 15.8, 8-oxypalmatine 9.30 and jatrorrhizine 8.75 micrograms/g of dried stem
Present only at trace levels in the stem, so they are unlikely to contribute meaningfully to the therapeutic effect at ordinary doses. Their presence matters mainly for identification, since these are the dominant alkaloids of several Menispermaceae drugs that share the vernacular name fang ji.
⚠ Drug Interactions
Aristolochia fangchi and other aristolochic acid-containing species sold as fang ji or boi
The vernacular name fang ji (Japanese boi) has been applied to at least four unrelated genera, including Sinomenium acutum, Stephania tetrandra, Cocculus orbiculatus and Aristolochia fangchi. Substitution of the Aristolochia species into fang ji and Kampo boi prescriptions caused the Belgian slimming-clinic epidemic of aristolochic acid nephropathy and subsequent Japanese Fanconi syndrome cases; the injury is progressive interstitial fibrosis with a high rate of upper urinary tract urothelial carcinoma. Sinomenium acutum itself contains no aristolochic acid, so the hazard is one of identity, not of the correct drug.
Clinical note: Dispense only material identified as Sinomenii Caulis and certified aristolochic acid-free. Do not accept a supplier label reading only fang ji, Fang Ji, or boi, and do not treat Japanese and Chinese pharmacopoeial fang ji as interchangeable. Where a patient has taken an unauthenticated fang ji product, screen renal function and consider urothelial surveillance.
Vancomycin, opioids, fluoroquinolones and other MRGPRX2-activating drugs
Sinomenine causes pseudo-allergic reactions by binding MRGPRX2 on mast cells and driving PLC-dependent calcium mobilisation and degranulation, releasing histamine, beta-hexosaminidase and TNF-alpha without IgE involvement; this was demonstrated in MRGPRX2-knockdown cells and Mrgprb2-deficient mice. Its N-demethylsinomenine metabolite acts on the same receptor and aggravates the response. Several conventional drugs, notably vancomycin, opioids such as morphine, fluoroquinolones and neuromuscular blockers, are established MRGPRX2 agonists, so co-exposure is expected to be additive on the same receptor and effector cell.
Clinical note: Because the reaction is receptor-mediated rather than immune, it can occur on the first exposure and there is no useful skin-test or IgE screen. Start low and titrate, warn the patient that flushing, itch, rash or wheeze means stop and seek review, and avoid initiating sinomenine in the same period as a vancomycin or high-dose opioid course. Reported reactions include true anaphylactoid collapse, so this is not merely a nuisance rash.
Simvastatin and lovastatin
In rat liver microsomes the principal enzymes metabolising sinomenine were CYP3A1/2 and CYP2D1 (orthologues of human CYP3A4 and CYP2D6). Simvastatin and lovastatin inhibited that metabolism with Ki values of 13.00 and 25.83 micromolar; a single dose of either raised sinomenine AUC 1.40 to 1.50-fold in rats. Repeated simvastatin dosing reversed the direction by inducing CYP3A1/2, cutting sinomenine AUC to 71.6 percent of control. Atorvastatin, propranolol, verapamil and warfarin did not inhibit in the same screen. The data are rodent, not human.
Clinical note: Relevant because statins are commonly co-prescribed to rheumatoid arthritis patients for cardiovascular risk. Expect a transient rise in sinomenine effect and pseudo-allergic side effects when simvastatin or lovastatin is started, and a possible fall in effect on chronic simvastatin. Review sinomenine tolerance and response at any change in statin therapy.
Methotrexate
Sinomenine 120 mg twice daily was given with methotrexate for 24 weeks in a 120-patient open-label randomised trial against methotrexate plus leflunomide. Efficacy was statistically indistinguishable between arms (ACR50 at week 24 was 65.3 percent with sinomenine against 69.6 percent with leflunomide), while gastrointestinal adverse reactions and hepatotoxicity were significantly lower in the sinomenine arm. No pharmacokinetic interaction was reported.
Clinical note: The combination is the best-evidenced use of this herb and appears well tolerated, but the trial studied a standardised sinomenine hydrochloride tablet, not a crude decoction of Caulis Sinomenii, whose alkaloid content varies several-fold between batches. Continue standard methotrexate monitoring of liver enzymes and blood count.
Beta-2 adrenergic agonists and beta-blockers
The stem carries higenamine, a beta-adrenergic agonist, at a mean 288 micrograms/g with wide batch variation. Pharmacodynamic addition to salbutamol or other beta-2 agonists, and antagonism of beta-blockade, are plausible on that basis although no clinical interaction study exists. The documented and immediate risk is analytical: higenamine has been on the WADA Prohibited List since 2017, and the investigators who quantified it advise athletes to avoid Sinomenium acutum stem because ordinary use can raise urinary higenamine above anti-doping thresholds.
Clinical note: Do not prescribe this herb to a tested athlete. In patients on beta-blockers or beta-2 agonists, monitor heart rate and blood pressure when starting, and prefer a standardised sinomenine preparation over crude stem if higenamine exposure is a concern.
Ciclosporin, tacrolimus, azathioprine and other immunosuppressants
Sinomenine is immunomodulatory, suppressing macrophage and T-cell activation and lowering TNF-alpha and IL-6, which is the basis of its licensed antirheumatic use. Additive suppression with conventional immunosuppressants is expected pharmacodynamically, but no clinical interaction study has been published, so the concern is mechanistic rather than observed.
Clinical note: Where the herb is added to established immunosuppression, treat it as an additional disease-modifying agent rather than a supplement: check full blood count, and counsel the patient on infection symptoms. Reported haematological adverse effects of sinomenine preparations include leucopenia and thrombocytopenia.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 6–12 g | Daily | — | — | 中国药典 2020 monograph 【青风藤】【用法与用量】6～12g。 【性味与归经】苦、辛，平。归肝、脾经。 — Matched to ChP by romanised drug name (pinyin 'Qing Feng Teng' → 青风藤); the romanisation is unique across all 649 ChP monographs, and the match was cross-checked against this record's own TCM temperature. Quoted verbatim. |
Evidence Tier
Moderate evidence · 6 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
1
1 verified · 0 unverified
Other clinical trial
0
Observational / case report
0
In vitro / animal
3
1 verified · 2 unverified
Show 3 studies
- MRGPRX2 is essential for sinomenine hydrochloride induced anaphylactoid reactions
- Discovery of chemical markers for improving the quality and safety control of Sinomenium acutum stem by the simultaneous determination of multiple alkaloids using UHPLC-QQQ-MS/MS
- Co-administration with simvastatin or lovastatin alters the pharmacokinetic profile of sinomenine in rats through cytochrome P450-mediated pathways
Other / unclassified
2
2 verified · 0 unverified
Show 2 studies
Verified: design read from PubMed for a DOI that resolves to the cited paper Unverified: taken from the study's recorded description
Clinical Studies
Comparison of combination therapy with methotrexate and sinomenine or leflunomide for active rheumatoid arthritis: A randomized controlled clinical trial
Open-label 24-week randomised trial in 120 patients with active rheumatoid arthritis, allocated 3:2 to methotrexate plus sinomenine 120 mg twice daily or methotrexate plus leflunomide 20 mg daily; 101 completed. In the intention-to-treat analysis 65.3 percent of the sinomenine arm reached an ACR50 response at week 24 against 69.6 percent on leflunomide, a non-significant difference that was mirrored for ACR20, ACR70, CDAI, EULAR response and remission rates. Gastrointestinal adverse reactions and liver toxicity were significantly lower with sinomenine (p less than 0.05). The trial supports sinomenine as a methotrexate partner of comparable efficacy and better tolerability, though it was open-label and used a purified sinomenine preparation rather than crude stem.
Efficacy and Safety of Sinomenine Preparation for Ankylosing Spondylitis: A Systematic Review and Meta-Analysis of Clinical Randomized Controlled Trials
Meta-analysis of 12 randomised trials and 835 patients in which an oral sinomenine preparation was added to conventional pharmacotherapy for ankylosing spondylitis. Adding sinomenine improved BASDAI (WMD -1.84, 95 percent CI -3.31 to -0.37), morning stiffness (WMD -13.46 minutes, 95 percent CI -16.12 to -10.79), the Schober test (WMD 1.26 cm, 95 percent CI 0.72 to 1.80) and C-reactive protein (WMD -1.84, 95 percent CI -3.24 to -0.45), with no significant difference in adverse events between arms. The authors judged the methodological quality of the included Chinese-language trials to be low, so the effect sizes should be read as provisional.
The Efficacy and Safety of Zhengqing Fengtongning for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
Eighteen randomised trials and 1512 participants comparing the sinomenine sustained-release tablet Zhengqing Fengtongning with control treatment for knee osteoarthritis. Pain fell on the visual analogue scale (SMD -0.87, 95 percent CI -1.08 to -0.66) and on the WOMAC pain, stiffness and function subscales, serum IL-1beta and TNF-alpha fell, and the total effective rate rose (RR 1.15, 95 percent CI 1.07 to 1.23). Adverse reaction rates did not differ (RR 0.96, 95 percent CI 0.69 to 1.35). The reviewers stated that the low methodological quality of the included trials limits the strength of the conclusion.
MRGPRX2 is essential for sinomenine hydrochloride induced anaphylactoid reactions
Mechanistic study of the pseudo-allergic reactions seen with the licensed sinomenine hydrochloride injection. Sinomenine triggered calcium mobilisation and degranulation of mast cells with release of histamine, beta-hexosaminidase and TNF-alpha; the response was abolished by knockdown of the mast cell receptor MRGPRX2 and in Mrgprb2-deficient mice, and depended on phospholipase C signalling. The finding explains why sinomenine reactions are dose-related, can occur on first exposure and are not detectable by IgE-based allergy testing.
Discovery of chemical markers for improving the quality and safety control of Sinomenium acutum stem by the simultaneous determination of multiple alkaloids using UHPLC-QQQ-MS/MS
Quantitative survey of eleven alkaloids across 35 commercial batches of Sinomenium acutum stem. Sinomenine (mean 24.9 mg/g) and magnoflorine (6.35 mg/g) dominated, accounting for 76.6 and 19.5 percent of total alkaloid content, with coclaurine and acutumine each at 435 micrograms/g and higenamine at 288 micrograms/g. Content varied several-fold between batches. The authors proposed higenamine and coclaurine as safety markers and warned explicitly that higenamine, prohibited by WADA since 2017, can reach urinary concentrations above anti-doping limits after ordinary use of the drug.
Co-administration with simvastatin or lovastatin alters the pharmacokinetic profile of sinomenine in rats through cytochrome P450-mediated pathways
Rat microsomal and in vivo study identifying CYP3A1/2 and CYP2D1 as the principal enzymes metabolising sinomenine. Of six cardiovascular drugs screened, simvastatin and lovastatin inhibited that metabolism with Ki values of 13.00 and 25.83 micromolar; single doses raised sinomenine AUC 1.40 and 1.50-fold and reduced clearance to roughly two-thirds. Repeated simvastatin dosing had the opposite effect, inducing CYP3A1/2 and lowering sinomenine AUC to 71.6 percent of control. Propranolol, verapamil, warfarin and atorvastatin showed no inhibition.
⚠ Safety & Contraindications
- Pregnancy
Contraindications
Its use is cautious in patients with deficiency- cold of the spleen and stomach.
Source: Xi S, Gong Y. Essentials of Chinese Materia Medica and Medical Formulas. Academic Press/Elsevier, 2017, pp. 105–112.
Side Effects
- Sinomenine 45 mg/kg (dogs) and 95 mg/kg (monkeys) orally caused mild GI reactions
- i.v. 5–13.5 mg/kg caused severe exhaustion, hypotension, tachycardia and dyspnea with recovery in 1 h
- Rats given 40 and 80 mg/kg/day i.p. for two weeks showed no significant changes
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 288.
Historical Texts
Tu Jing Ben Cao (Illustrated Classic of Materia Medica), Su Song
Northern Song dynasty, 1061Ben Cao Gang Mu (Compendium of Materia Medica), Li Shizhen
Ming dynasty, 1596Zhonghua Renmin Gongheguo Yaodian (Pharmacopoeia of the People's Republic of China)
Modern, 1977 to present editionsReferences
- Zhao XX, Peng C, Zhang H, Qin LP. Sinomenium acutum: A review of chemistry, pharmacology, pharmacokinetics, and clinical use . Pharmaceutical Biology (2012) [DOI]
- Ding C, Li Y, Sun Y, Wu Y, Wang F, Liu C, Zhang H, Jiang Y, Zhang D, Song X. Sinomenium acutum: A Comprehensive Review of its Botany, Phytochemistry, Pharmacology and Clinical Application . The American Journal of Chinese Medicine (2022) [DOI]
- Zhang YS, Han JY, Iqbal O, Liang AH. Research Advances and Prospects on Mechanism of Sinomenin on Histamine Release and the Binding to Histamine Receptors . International Journal of Molecular Sciences (2018) [DOI]
- Debelle FD, Vanherweghem JL, Nortier JL. Aristolochic acid nephropathy: A worldwide problem . Kidney International (2008) [DOI]
- Huang L, Dong Y, Wu J, Wang P, Zhou H, Li T, Liu L. Sinomenine-induced histamine release-like anaphylactoid reactions are blocked by tranilast via inhibiting NF-κB signaling . Pharmacological Research (2017) [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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