Su He Xiang
StarLiquidambar orientalis Mill.
Traditionally used for
- Cough & breathing
- Digestion
- Heart & circulation
Cautions & contraindications
- Liver conditions
☯ TCM Properties
Opens the Orifices and Revives Consciousness; Dispels Turbidity and Filth; Dispels Cold and Alleviates Pain; Scours Phlegm and Opens the Orifices
Traditional Chinese Uses
Su He Xiang (styrax resin) is a warm, aromatic substance that opens the orifices and revives consciousness in cases of collapse, coma, or sudden loss of consciousness from cold-Phlegm obstructing the Heart orifices. It also moves Qi and disperses cold to relieve chest pain, angina, and abdominal pain from cold Qi stagnation. As a powerful aromatic opener, it is typically used in prepared pill or capsule form rather than in decoctions.
Western Herbalism Properties
Relationships
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Botanical Description
Liquidambar orientalis Mill. (Altingiaceae) is a medium-sized deciduous tree native to southwestern Anatolia (Turkey), reaching 10-20 m with palmately five-lobed leaves resembling those of maple. The medicinal substance Su He Xiang (storax, styrax) is a balsamic oleoresin obtained by bruising the inner bark and collecting the exuded gum, which is then purified. The crude balsam is a viscous, grey-brown, semi-fluid mass with a sweet, aromatic, vanilla-like odor due to cinnamic acid esters, styrene, and triterpenoids. In traditional Chinese medicine it is classified as an aromatic substance that opens the orifices, awakens the spirit, and dispels turbidity, used in formulas for stroke, sudden loss of consciousness, and cold-phlegm patterns. It has a long parallel history in European pharmacopoeias as an expectorant and antiseptic.
Active Constituents
Cinnamyl cinnamate (styracin)
Cinnamic acid esterConcentration: roughly 5-15% of purified storax; identified as one of the two predominant components in a 2024 GC analysis
One of the two compounds that dominate the balsam. Huang and colleagues resolved 59 components in styrax from this tree and found twelve of them accounted for about 94% of the material, with cinnamyl cinnamate and 3-phenylpropyl cinnamate predominant. It is also a shared allergen with balsam of Peru.
3-Phenylpropyl cinnamate
Cinnamic acid esterConcentration: around 10% of purified storax; the other predominant component in the 2024 GC analysis
Co-dominant ester of the balsam and, with cinnamyl cinnamate, the practical chemical signature that separates storax from benzoin.
Cinnamic acid (free)
Aromatic carboxylic acidConcentration: roughly 5-15% of purified storax
Free cinnamic acid is the defining acid of storax, exactly as free benzoic acid is the defining acid of benzoin. It contributes antiseptic and irritant properties and is a fragrance sensitiser.
Storesin
Resin alcohol (partly esterified)Concentration: roughly 33-50% of purified storax
The bulk resinous alcohol fraction, largely inert pharmacologically but responsible for the viscid consistency of the balsam and for the fact that so much of the drug's weight is not volatile.
Benzyl cinnamate and ethyl cinnamate
Aromatic estersConcentration: small fractions of the balsam
Minor cinnamate esters. Benzyl cinnamate is one of the constituents shared with balsam of Peru, benzoin and balsam of Tolu, and part of the reason patch-test reactions to these materials travel together.
Styrene
Vinyl aromatic hydrocarbonConcentration: traces
Present only in traces, but historically important: the hydrocarbon takes its name from this balsam. At trace level in the crude drug it is not a meaningful exposure, though it is a reason not to concentrate or distil the balsam casually.
Oleanolic acid and 3-epioleanolic acid
Oleanane triterpene acidsConcentration: minor constituents
The triterpenic acid fraction of the balsam. Their presence, alongside the absence of siaresinolic acid, helps distinguish storax from Siam benzoin analytically.
⚠ Drug Interactions
Topical and inhaled preparations in patients patch-test positive to balsam of Peru (Myroxylon pereirae) or fragrance mix
Storax is one of the classic cross-reactants of balsam of Peru. In de Groot's review of the patch-test literature, 43% of balsam of Peru-positive patients co-reacted to styrax/storax, alongside balsam of Tolu at 47% and compound benzoin tincture at 90%. The shared cinnamates and benzoates account for it. Balsam of Peru is positive in roughly half of all fragrance-allergic patients, so this is a common allergy, not a rare one.
Clinical note: Take a fragrance and balsam allergy history before any external or inhaled use of Su He Xiang, including medicated plasters. A balsam of Peru positive should also raise caution about An Xi Xiang, balsam of Tolu and colophony, which cross-react with it.
Warfarin, direct oral anticoagulants and antiplatelet agents
Huang and colleagues showed that both commercial and graft-derived styrax from this tree significantly reduced thrombosis and increased blood flow velocity in adrenaline-induced zebrafish models, and reduced apoptosis and infarct area in myocardial injury models. This is a consistent antithrombotic signal, but it is in zebrafish and rodent models at experimental doses, with no pharmacokinetic or clinical bleeding data in humans.
Clinical note: No dose change is indicated on present evidence. Where Su He Xiang or a storax-containing patent such as Shexiang Baoxin Pill is added to full anticoagulation, review bleeding symptoms at the next visit rather than assuming no effect.
Hepatotoxic and enterotoxic drugs (e.g. methotrexate, high-dose paracetamol, NSAIDs)
In the same 2024 study, long-term zebrafish exposure at 1.95 micrograms/mL indicated that the toxic target organs of both graft-derived and commercial styrax may be the liver and intestine, although no significant organ damage occurred at therapeutic doses. That is a signal from a screening model at supratherapeutic exposure, not a demonstrated clinical hepatotoxicity, and it should not be reported to patients as one.
Clinical note: Relevant mainly to prolonged or high-dose use. Keep courses of aromatic orifice-opening drugs short, which is in any case the classical usage, and avoid open-ended daily dosing alongside known hepatotoxic drugs.
Benzoin / Benzoinum (An Xi Xiang, from Styrax tonkinensis)
The two drugs are routinely confused because the pharmacy name for this record, Styrax or Styrax liquidus, is also the name of the botanical genus that yields the other one. This record is storax, the viscid balsam obtained from the wounded trunk of Liquidambar orientalis, an Altingiaceae tree of southwest Türkiye and Rhodes; An Xi Xiang is the solid resin of Styrax tonkinensis, a Styracaceae tree of Southeast Asia. Chemically they separate cleanly: storax is a cinnamic-acid balsam built on cinnamyl cinnamate and 3-phenylpropyl cinnamate, while Siam benzoin is a benzoic-acid resin built on coniferyl benzoate with siaresinolic acid as its triterpene marker. Both are orifice-opening aromatics that appear in resuscitation formulas, so the substitution is not self-announcing.
Clinical note: Order by binomial. A label reading only Styrax is ambiguous and should be clarified before dispensing. Note also that Liquidambar orientalis is an IUCN-assessed threatened relict endemic with a very restricted natural range, which is what motivated the grafted-styrax work; supply pressure is a live reason to check what is actually in the jar, though the species is not CITES-listed.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction, or powder/pills | 0.3–1 g | Daily | — | — | 中国药典 2020 【用法与用量】0.3～1g，宜入丸散服。 【性味与归经】辛，温。归心、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.
Both warm aromatic resins open the orifices and expel turbid filth, together reviving consciousness from cold-phlegm obstruction.
Core pair of a classical formula — Su He Xiang Wan, Tai Ping Hui Min He Ji Ju Fang
Warm aromatic opening of the orifices combined, dispelling cold and turbidity to revive consciousness in cold closed patterns.
Cold closed pattern; not for hot closed patterns or collapse.
Core pair of a classical formula — Su He Xiang Wan, Tai Ping Hui Min He Ji Ju Fang
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
0
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
Effects of grafting on chemical constituents, toxicological properties, antithrombotic activity, and myocardial infarction protection of styrax secreted from the trunk of Liquidambar orientalis Mill
Styrax obtained from grafted trees was compared with commercial styrax. GC analysis resolved 59 components, twelve of which made up about 94% of the balsam, with cinnamyl cinnamate and 3-phenylpropyl cinnamate predominant, and the two materials gave nearly identical chromatograms. In zebrafish, acute toxicity was comparable, and long-term exposure at 1.95 micrograms/mL suggested liver and intestine as the toxic target organs, with no significant organ damage at therapeutic doses. Both preparations significantly reduced thrombosis and increased blood flow velocity in adrenaline-induced models, and reduced apoptosis and infarct area in myocardial injury models, the grafted material giving somewhat better cardiac output. The authors conclude grafted styrax can substitute for commercial styrax while relieving pressure on endangered wild trees.
Efficacy and safety of Shexiang Baoxin Pill for stable coronary artery disease: A systematic review and meta-analysis of 42 randomized controlled trials
A meta-analysis of 42 randomised controlled trials, 6694 patients, of Shexiang Baoxin Pill added to conventional therapy in stable coronary artery disease. The formula derives from the Song-dynasty Suhexiang Pill and contains Liquidambar orientalis balsam alongside Moschus, Panax ginseng, Bovis Calculus, Cinnamomum, toad venom and borneol. This is the largest body of controlled human evidence touching Su He Xiang, and it must be read for what it is: a seven-ingredient patent medicine. Nothing in it isolates the contribution of storax, and none of its efficacy can properly be attributed to this herb alone.
Historical Texts
Ming Yi Bie Lu (Miscellaneous Records of Famous Physicians)
Southern and Northern dynasties, c. 500 CEReferences
- Anton C. de Groot. Myroxylon pereirae resin (balsam of Peru) – A critical review of the literature and assessment of the significance of positive patch test reactions and the usefulness of restrictive diets . Contact Dermatitis (2019) [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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