Tian Hua Fen
StarTrichosanthes kirilowii Maxim.
Traditionally used for
- Nose & throat
- Cough & breathing
- Digestion
Cautions & contraindications
- Pregnancy
- Allergy risk
☯ TCM Properties
Clears Heat and Drains Fire; Generates Fluids and Relieves Thirst; Clears Heat and Moistens the Lungs; Resolves Toxicity and Reduces Swelling; Expels Pus
Traditional Chinese Uses
Tian Hua Fen (trichosanthes root, snake gourd root) is a cold, bitter-sweet herb that generates Body Fluids, clears Heat and toxin, and reduces swelling. It addresses Heat-induced thirst, dry throat, and wasting-thirst syndrome from Stomach and Lung Heat. Its Heat-toxin-clearing action treats carbuncles, breast abscesses, and inflammatory suppurating conditions in the early-to-suppurative stage. In modern Chinese medicine, it is also used in low doses in protocols for certain reproductive conditions due to its abortifacient properties, requiring strict professional supervision.
Western Herbalism Properties
Pharmacological Effects
- Abortifacient: Single i.p. trichosanthin induced mid-term abortion in mice (effective dose 50 µg) and rabbits (0.5-2.0 mg depending on gestation stage); it selectively damages placental trophoblast cells, lowering chorionic gonadotropin and steroid hormones and leading to fetal death (animal and human placenta pathology).
- Antineoplastic: Trichosanthin 5 mg/kg i.p. inhibited ascites and solid hepatoma in mice; some clinical effect on placental trophoblastic tumour.
- Other effects: Trichosanthin induces passive lung anaphylaxis in rats (proposed antiasthmatic test model); root decoction bacteriostatic in vitro against Streptococcus hemolyticus, Diplococcus pneumoniae and Corynebacterium diphtheriae; no hypoglycemic effect in normal or alloxan-diabetic rabbits.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 114.
Relationships
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Botanical Description
Trichosanthes kirilowii Maxim. (Cucurbitaceae) is the same dioecious perennial climbing vine that yields Gua Lou Ren, native to China with palmately lobed leaves, branched tendrils, and fringed-petaled white flowers. From the underground portion it forms large, fleshy, cylindrical to fusiform tuberous roots up to 30 cm long with white starchy flesh. For Tian Hua Fen, the roots are dug in autumn or winter, peeled, cut into longitudinal pieces or transverse disks, and sun-dried. In TCM, Tian Hua Fen is sweet, slightly bitter, and slightly sour in flavor and cool in nature, entering the Lung and Stomach channels; it clears heat, generates fluids, moistens dryness, reduces swelling, and expels pus. It contains trichosanthin, a ribosome-inactivating protein of significant pharmacological interest.
Active Constituents
Trichosanthin
Type 1 ribosome-inactivating protein (single-chain, about 27 kDa)The defining and the dangerous constituent of the root. It is an rRNA N-glycosylase (EC 3.2.2.22) that hydrolyses and depurinates adenine A-4324 in the sarcin-ricin loop of 28S rRNA, blocking elongation factor binding, halting protein synthesis and triggering apoptosis. It is the active principle of the traditional abortifacient use of Tian Hua Fen powder and the active ingredient of the purified drug GLQ223. It is strongly immunogenic and has caused anaphylaxis. Trichosanthin is a root protein: it does not belong to the fruit drugs Gua Lou, Gua Lou Pi or Gua Lou Ren.
Cucurbitacins (tetracyclic triterpenoids, including cucurbitacin B and cucurbitacin D)
Cucurbitane-type tetracyclic triterpenoidTetracyclic triterpenoids are concentrated in the root and root bark of Trichosanthes kirilowii rather than in the fruit or seed. Cucurbitacins are intensely bitter and are cytotoxic and gastrointestinally irritant as a class; content in this species is low relative to other Trichosanthes such as T. tricuspidata.
Bryonolic acid
Pentacyclic triterpenoidReported from the root of Trichosanthes kirilowii together with stigmast-7-en-3-beta-ol and its glucoside. It is a common triterpene of the Cucurbitaceae and is not linked to a specific action of the drug.
Trichosans A, B, C, D and E
Glycan (polysaccharide)Five glycans obtained from the root by bioactivity-guided fractionation, reported to lower blood glucose in normal mice, with trichosan A also active in alloxan-induced hyperglycaemic mice. They are the usual chemical explanation offered for the classical indication of wasting-thirst.
Free amino acids
Amino acidConcentration: total amino acids averaged 15.39 mg per gram in the main root and 16.38 mg per gram in root bark, higher than in other parts of the plant
The root and root bark are the amino-acid-richest organs of the plant. This fraction is unremarkable pharmacologically but is part of why the fresh root has traditionally been processed into a fine starchy powder for internal use.
Nucleosides
NucleosideConcentration: below 1.5 mg per gram in all parts of the plant
Quantified across nine organs of Trichosanthes kirilowii and present only at low levels everywhere. Included here because nucleoside content is sometimes offered as a quality marker for this drug and the measured values do not support that use.
⚠ Drug Interactions
Pregnancy of any stage
Tian Hua Fen, the crude root powder, was used as an abortifacient in Chinese medicine, and trichosanthin was purified from it in 1972 specifically to make that use more controllable. It was subsequently administered clinically for midterm abortion between 12 and 24 weeks, for termination within the first 12 weeks, and for ectopic pregnancy, hydatidiform mole and choriocarcinoma. Trophoblast is a principal target of the protein. Abortifacient activity is listed among the established pharmacological effects of Trichosanthis Radix in current reviews.
Clinical note: Absolutely contraindicated in pregnancy and in any patient who might be pregnant. Confirm pregnancy status before prescribing to a patient of childbearing potential. This is a hard contraindication and should not be softened into a caution.
Parenteral trichosanthin preparations and repeat exposure (anaphylaxis and immunogenicity)
Trichosanthin is a foreign protein and induces immune responses; inducing immune responses and a short plasma half-life are the two problems that stalled its development as a drug. In a phase I/II study of 51 patients with advanced HIV disease given 10 to 30 micrograms per kilogram, severe reversible fatigue and myalgia were dose-limiting; non-dose-related mental status changes occurred in six patients, usually as dementia, progressing to coma in two, and although this reversed, the sequelae caused the death of one patient. In a later phase II study of 93 patients, mild to moderate anaphylactic reactions occurred and responded to steroids and antihistamine. In the phase I GLQ223 study, one of eighteen subjects had a severe neurological adverse reaction. A flu-like syndrome with raised creatine kinase occurred in all 22 patients in the multiple-dose GLQ223 study.
Clinical note: Injectable trichosanthin is a hospital product, not a dispensary herb, and is not something to administer outside a setting equipped for anaphylaxis. Practitioners should know that the plant their oral decoction comes from is the source of a protein that has killed a patient in a supervised trial, and should treat any systemic reaction to the root drug as potentially serious rather than as a normal detoxification response.
Aconitum species (Chuan Wu, Cao Wu, Fu Zi)
Tian Hua Fen and the other Trichosanthes drugs fall under the eighteen incompatibilities (shi ba fan), the classical prohibition list codified in the mnemonic rhyme transmitted in Ru Men Shi Qin, which places Gua Lou and its root in opposition to Wu Tou. The prohibition is carried into modern Chinese pharmacopoeial and prescribing practice, where Tian Hua Fen is not to be combined with Chuan Wu, Cao Wu or Fu Zi. The modern pharmacological basis is not established; the rule is followed as a formulation constraint.
Clinical note: Do not combine Tian Hua Fen with any aconite drug in the same prescription. If a patient needs both actions, separate them in time and by formula, and document why.
Insulin, sulfonylureas and other glucose-lowering drugs
Trichosans A to E isolated from the root lowered blood glucose in normal mice, and trichosan A was also active in alloxan-induced hyperglycaemic mice; antidiabetic activity is listed among the established effects of Trichosanthis Radix. No controlled human study has quantified the effect of the decoction, so additivity is inference from animal data.
Clinical note: Monitor capillary glucose when starting or stopping the herb in a treated diabetic patient, particularly where it is being used for the classical wasting-thirst indication.
Gua Lou, Gua Lou Pi and Gua Lou Ren (the fruit, peel and seed of the same plant) - part substitution
Trichosanthes kirilowii yields four separately dispensed drugs. Tian Hua Fen is the root, Radix Trichosanthis. Gua Lou is the fruit, Gua Lou Pi the peel and Gua Lou Ren the seed. Trichosanthin is a root protein, so the pregnancy contraindication and the anaphylaxis record attach to Tian Hua Fen and must not be transferred wholesale to the fruit drugs. Conversely the seed's oily, laxative character does not belong to the root. Chemistry supports the split: tetracyclic triterpenoids are concentrated in root and root bark, whereas the pentacyclic triterpenoid 3,29-dibenzoyl rarounitriol is concentrated in the seed kernel and flavonoids in the leaves.
Clinical note: Confirm which of the four Trichosanthes drugs a prescription and a delivery actually name. Do not apply this record's safety statements to Gua Lou, Gua Lou Pi or Gua Lou Ren, and do not assume the fruit's mild profile applies to the root.
Trichosanthes rosthornii Harms (co-official source of Trichosanthis Radix)
Trichosanthis Radix is officially derived from the roots of both Trichosanthes kirilowii Maximowicz and Trichosanthes rosthornii Harms, so a batch meeting the monograph may be either species. This is a legitimate co-official source rather than an adulteration, but the record in this database is grounded on T. kirilowii, which is the species behind the trichosanthin literature.
Clinical note: When a study or a safety statement about Tian Hua Fen matters clinically, check which of the two official species it used.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 10–15 g | Daily | — | — | 中国药典 2020 【用法与用量】10～15g。 【注意】孕妇慎用；不宜与川乌、制川乌、草乌、制草乌、附子同用。 【性味与归经】甘、微苦，微寒。归肺、胃经。 — Chinese Pharmacopoeia 2020, quoted verbatim; route and cautions preserved. Replaces a cleared category-filler value. |
Evidence Tier
Moderate evidence · 4 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
4
4 verified · 0 unverified
Show 4 studies
- A phase I/II study of trichosanthin treatment of HIV disease
- The safety and pharmacokinetics of GLQ223 in subjects with AIDS and AIDS-related complex
- Safety, activity, and pharmacokinetics of GLQ223 in patients with AIDS and AIDS-related complex
- A Phase II Study of Effect of Addition of Trichosanthin to Zidovudine in Patients with HIV Disease and Failing Antiretroviral Agents
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
A phase I/II study of trichosanthin treatment of HIV disease
A dose-escalation study in 51 patients with advanced HIV disease, three injections over 9 to 21 days at 10 to 30 micrograms per kilogram per injection; the maximum tolerated dose was estimated at 30 micrograms per kilogram. Severe but reversible fatigue and myalgia were dose-limiting, with mild leucocytosis and reversible transaminase rises. Non-dose-related reversible mental status changes occurred in six patients, usually presenting as dementia and progressing to coma in two; this reversed, but the sequelae led to the death of one patient. Serum p24 antigen fell at one month in 10 of 18 patients who began with elevated levels, one becoming negative. This is the source of the neurotoxicity signal for trichosanthin, the ribosome-inactivating protein of the Trichosanthes kirilowii root.
The safety and pharmacokinetics of GLQ223 in subjects with AIDS and AIDS-related complex
A phase I dose-escalation study of a single intravenous infusion of GLQ223, whose active ingredient is trichosanthin, in 18 subjects with AIDS or AIDS-related complex. One subject had a severe neurological adverse reaction; otherwise no notable toxicity was recorded at single doses. No consistent change in CD4+ counts or HIV antigen levels occurred, and serum concentrations comparable to in vitro antiviral levels were reached only transiently. The paper is important to a herbal reference because it establishes that the root's protein is systemically active and neurologically hazardous in humans.
Safety, activity, and pharmacokinetics of GLQ223 in patients with AIDS and AIDS-related complex
Multiple intravenous doses of GLQ223 at 8, 16, 24, 36 and 50 micrograms per kilogram were given to 22 patients with AIDS or AIDS-related complex and CD4+ counts between 100 and 350 per cubic millimetre. Every patient reported a flu-like syndrome with muscle and joint aches and rising creatine kinase, controlled easily. At 36 and 50 micrograms per kilogram, target serum concentrations were reached and CD4+ and CD8+ counts rose in a way sustained for at least 28 days after the last infusion. Repeat infusions were tolerated, but the universal flu-like reaction is the clinically relevant point for a herbal reference.
A Phase II Study of Effect of Addition of Trichosanthin to Zidovudine in Patients with HIV Disease and Failing Antiretroviral Agents
Ninety-three patients failing antiretroviral therapy received weekly then monthly intravenous trichosanthin 1.2 mg with zidovudine or didanosine. Side effects were myalgia, fever, mild liver function test elevation, and mild to moderate anaphylactic reactions that responded to steroids or antihistamine; reversible mental status changes occurred in two patients, both on concurrent didanosine. Across 85 patients evaluable for efficacy CD4+ counts rose significantly, with a median gain of 1.2 cells per cubic millimetre per month against a prior median loss of 6.91. This is the clearest published record of anaphylactic reactions to trichosanthin in a supervised setting.
⚠ Safety & Contraindications
- Pregnancy
- Allergy risk
Contraindications
- To prevent allergic reactions to trichosanthin: skin test with 0.1 µg and 2 h observation after the first i.m. dose of 0.2 mg.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 114.
Side Effects
- Daily 9 g of the root for one month caused mild nausea and diarrhea in a few patients.
- Trichosanthin is antigenic: serum antibody/skin test positive in most previously exposed people; in 188 women given it 1-6 years earlier all were antibody-positive, titers higher after i.m. than intra-amniotic use.
- Common reactions to trichosanthin: fever, headache, skin rash, sore throat, stiff neck; leukocytosis over 10 000/mm3 with >90% neutrophils; local painful swelling and tender inguinal lymph nodes after i.m. dose, usually resolving in days to a week.
- Occasional: angioneurotic edema, abnormal ECG or arrhythmia, hypotension, epistaxis or profuse bleeding in abortion, hepatosplenomegaly, abdominal distension, albuminuria.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 114.
⚠ 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.
Incompatibilities (十八反 / 十九畏)
- 十八反: Wu Tou × Gua Lou — avoid combining with Fu Zi / Aconite / Aconitum / Chuan Wu / Cao Wu / Wu Tou / Shu Fu / Hei Shun Pian / Fu Pian / Guan Bai Fu / Xue Shang Yi Zhi Hao / Aconitum brachypodum
Historical Texts
Shen Nong Ben Cao Jing
Han dynastyZheng Lei Ben Cao
Northern Song dynastyBen Cao Gang Mu
Ming dynastyRu Men Shi Qin
Jin dynastyReferences
- Joyce Mudondo; Kenneth Happy; Dennis Okello; Youngmin Kang. Trichosanthis Radix: A comprehensive review on botany, ethnomedicine, phytochemistry, pharmacology, quality control and toxicology . Fitoterapia (2025) [DOI]
- Jia-Qi Lu; Kam-Bo Wong; Pang-Chui Shaw. A Sixty-Year Research and Development of Trichosanthin, a Ribosome-Inactivating Protein . Toxins (2022) [DOI]
- Pang-Chui Shaw; Ka-Ming Lee; Kam-Bo Wong. Recent advances in trichosanthin, a ribosome-inactivating protein with multiple pharmacological properties . Toxicon (2005) [DOI]
- Ying Xu; Gang Chen; Xuan Lu; Zhan-Qiang Li; Shan-Shan Su; Chao Zhou; Yue-Hu Pei. Chemical constituents from Trichosanthes kirilowii Maxim. . Biochemical Systematics and Ecology (2012) [DOI]
- Huang-qin Zhang; Pei Liu; Jin-ao Duan; Ling Dong; Er-xin Shang; Da-wei Qian; Zhen-hua Zhu; Hui-wei Li; Wei-wen Li. Comparative Analysis of Carbohydrates, Nucleosides and Amino Acids in Different Parts of Trichosanthes kirilowii Maxim. by (Ultra) High-Performance Liquid Chromatography Coupled with Tandem Mass Spectrometry and Evaporative Light Scattering Detector Methods . Molecules (2019) [DOI]
- Huang-qin Zhang; Pei Liu; Jin-ao Duan; Ling Dong; Er-xin Shang; Da-wei Qian; Ping Xiao; Ming Zhao; Wei-wen Li. Hierarchical extraction and simultaneous determination of flavones and triterpenes in different parts of Trichosanthes kirilowii Maxim. by ultra-high-performance liquid chromatography coupled with tandem mass spectrometry . Journal of Pharmaceutical and Biomedical Analysis (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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