Xian He Cao
StarAgrimonia pilosa Ledeb.
Traditionally used for
- Nose & throat
- Bowel health
- Menstrual & women's health
- Energy & fatigue
Cautions & contraindications
- Bleeding disorders
☯ TCM Properties
Astringes and Stops Bleeding; Tonifies Deficiency and Strengthens the Body; Stops Dysentery; Checks Malaria; Resolves Toxicity; Expels Parasites
Traditional Chinese Uses
Xian He Cao (agrimony herb) is a neutral, astringent herb used in Chinese medicine as one of the most versatile hemostatic herbs — effective for a broad range of bleeding conditions including nosebleeds, hemoptysis, heavy menstruation, and gastrointestinal bleeding. Its neutral temperature makes it appropriate for both hot and cold bleeding patterns. A secondary traditional role as a "fatigue-relieving herb" reflects its supplementing quality for debility and post-illness weakness, and it is also used for intestinal parasites.
Western Herbalism Properties
Pharmacological Effects
- Teniacidal: Winter sprout expels tapeworm; active principle agrimophol acts directly, inhibiting glycogenolysis and aerobic/anaerobic metabolism; also lethal to Trichomonas vaginalis, blood fluke and roundworm.
- Antibacterial: Six isolated phenolics active against bacillary dysentery; certain pair combinations more effective than single compounds.
- Antitumor: Agrimoniin single dose 10-30 mg/kg IV or oral prolonged survival or cured mice with MM2 tumors, inhibited MH-134 and Meth-A tumors; activity appears immune-mediated (raised WBC and monocytes).
- Cardiovascular: IV alcoholic extract raised blood pressure and stimulated respiration in rabbits and dogs; alcohol-soluble fraction of aqueous extract lowered it and inhibited isolated frog heart; extract/agrimoniin raised heart rate and contractility in frogs/toads.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 419.
Relationships
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Botanical Description
Agrimonia pilosa, hairy agrimony, is a perennial herb of the family Rosaceae widely distributed across East Asia, the Russian Far East, and central Europe, in meadows, forest margins, roadsides, and grassy slopes. It grows 30 to 100 cm tall from a short woody rhizome, with erect, ribbed stems clothed in spreading and appressed hairs. The interruptedly pinnate leaves bear 3 to 9 larger leaflets with smaller leaflets interposed; all leaflets are coarsely serrate and softly hairy beneath, with glandular dots. Small bright yellow five-petalled flowers are borne in slender, elongated terminal racemes in summer, each subtended by tiny bracts; the cup-shaped hypanthium develops hooked bristles at maturity, forming bur-like fruits that cling to fur and clothing. The entire aerial herb is harvested in flower for medicinal use.
Active Constituents
Agrimonolide
IsocoumarinConcentration: principal isocoumarin of the aerial part; no consensus content figure published
The most studied single compound of the herb. It is highly lipophilic and crosses the blood-brain barrier, inhibits alpha-glucosidase with an IC50 of about 24 micromolar, and in preclinical models is hepatoprotective, anti-inflammatory and cardioprotective, acting largely by damping NF-kappaB signalling and pro-inflammatory cytokine output. It has shown no cytotoxicity across a range of concentrations in several cell types.
Desmethylagrimonolide
IsocoumarinConcentration: accompanies agrimonolide in the aerial part; no content figure published
Inhibits alpha-glucosidase with an IC50 of about 37 micromolar, somewhat weaker than agrimonolide. Agrimonolide-6-O-beta-D-glucopyranoside is the third member of this isocoumarin group in the herb.
Agrimoniin
Dimeric ellagitanninConcentration: a tannin of the roots and rhizome in particular; no consensus content figure published
Isolated from Agrimonia pilosa roots and characterised as an antitumour constituent. As an ellagitannin it precipitates proteins, which is the conventional explanation for the local astringent, wound-sealing effect of the herb; more recent work describes mitochondrial targets for its anticancer and antioxidant activity.
Condensed and hydrolysable tannins
Polyphenolic tanninsConcentration: Chinese materia medica sources give roughly 16% in the leaf, 9% in the root and 7% in the stem of the dried plant
The astringent fraction responsible for the classical shou lian zhi xue (astringe and stop bleeding) action when the herb is applied locally or taken as a strong decoction. Note that this local astringency does not predict what a systemic dose does to coagulation, which is the opposite (see interactions).
Agrimols A to G
Phloroglucinol derivativesConcentration: the trial extract used in the 2025 human study was standardised to 0.2 mg agrimols in a 50 mg extract dose
The phloroglucinol group of the plant. These are the compounds behind the recent interest in Agrimonia pilosa extract as a senolytic, i.e. as an agent that clears senescent immune cells.
Agrimophol
Phloroglucinol derivativeConcentration: concentrated in the fresh rhizome winter bud (He Cao Ya), not the aerial part that constitutes Herba Agrimoniae
The taeniacidal principle. It acts by direct contact on the tapeworm scolex, neck and segments, inhibiting glycogen breakdown and both aerobic and anaerobic metabolism of the worm rather than acting through its nervous system. Because it sits in the winter bud rather than the herb, a Xian He Cao (aerial part) prescription should not be expected to deworm.
⚠ Drug Interactions
Warfarin, heparins, direct oral anticoagulants, aspirin and clopidogrel
An aqueous extract of Agrimonia pilosa was tested on human blood across 0 to 80 g/L. From 4 g/L upward it significantly prolonged whole blood clotting time and activated partial thromboplastin time, reduced the activities of coagulation factors VIII, IX and XI, and reduced platelet aggregation and fibrinogen receptor expression. It simultaneously shortened prothrombin time and raised factor VII activity, so the effect is genuinely two-directional, but the authors concluded that the net effect is anticoagulant, with anticoagulant activity exceeding pro-coagulant activity and both intensifying with dose. The work is ex vivo on blood samples, not a clinical bleeding study.
Clinical note: Do not assume Xian He Cao is a safe add-on for a patient on an anticoagulant just because it is classified as a Blood-stopping herb. Keep to conventional decoction doses, monitor INR more frequently in the first weeks, and be alert for bruising or gum bleeding.
He Cao Ya (Agrimoniae Gemma, the winter bud of the same plant)
Agrimonia pilosa yields two distinct Chinese drugs. Xian He Cao / Herba Agrimoniae is the dried aerial part, used to astringe bleeding and to tonify deficiency. He Cao Ya is the winter bud dug from the rhizome before spring regrowth, and it is this bud, not the herb, that contains agrimophol, the compound with the demonstrated taeniacidal effect (adult powder dose of the bud is on the order of 30-50 g). The tcm_functions field for this record includes expelling parasites, and that function belongs to the bud.
Clinical note: If the intent is to treat taeniasis, prescribe He Cao Ya specifically and check that the supplier has sent buds and not chopped aerial herb. Modern practice would in any case use praziquantel or niclosamide first line.
Agrimonia eupatoria L. (European agrimony) supplied as agrimony
Xian He Cao is specifically Agrimonia pilosa, while the Western herbal drug sold as agrimony is normally Agrimonia eupatoria, which has its own separate literature (for example on wound healing). The two share the tannin and isocoumarin classes but the agrimol and agrimonolide data that support A. pilosa claims were generated on A. pilosa.
Clinical note: Check the binomial on the certificate of analysis when sourcing from a Western herbal supplier rather than a Chinese one.
Oral iron salts, and alkaloid-containing or protein-based oral drugs
The herb is tannin-rich (roughly 16% in the leaf by Chinese materia medica figures). Tannins chelate iron and precipitate alkaloids and proteins in the gut lumen. No specific interaction study exists for Agrimonia pilosa, so this is a class inference from its tannin content.
Clinical note: Separate the decoction from iron supplements and from narrow-therapeutic-index oral drugs by two hours.
Metformin, sulfonylureas, acarbose and other glucose-lowering drugs
Agrimonolide and desmethylagrimonolide are alpha-glucosidase inhibitors in vitro (IC50 about 24 and 37 micromolar) and the isocoumarin fraction is reported to improve insulin resistance in preclinical models, which is the same target class as acarbose. There is no human glycaemic trial of the herb.
Clinical note: In a diabetic patient starting a Xian He Cao formula, ask for a few days of extra glucose monitoring rather than adjusting hypoglycaemic doses pre-emptively.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 6–12 g | Daily | — | — | 中国药典 2020 【用法与用量】6～12g。外用适量。 【性味与归经】苦、涩，平。归心、肝经。 — Chinese Pharmacopoeia 2020, quoted verbatim; route and cautions preserved. Replaces a cleared category-filler value. |
Evidence Tier
Moderate evidence · 3 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
2
0 verified · 2 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
Preliminary Data on the Senolytic Effects of Agrimonia pilosa Ledeb. Extract Containing Agrimols for Immunosenescence in Middle-Aged Humans: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Comparison Study
110 Japanese adults aged 40 to 59 with a high proportion of senescence-associated beta-galactosidase-high CD8+ T cells took 50 mg of Agrimonia pilosa extract standardised to 0.2 mg agrimols, or placebo, for eight weeks. The primary endpoint, change in the proportion of SA-betaGal-high CD8+ T cells, was not met in the whole group; a reduction was seen in the male subgroup only. The authors describe the senolytic signal as preliminary. This appears to be the first properly controlled human trial of the herb; earlier clinical use was reported only as case series, so nothing in this record should be read as established clinical efficacy for a TCM indication.
Opposite effects of Agrimonia pilosa Ledeb aqueous extracts on blood coagulation function
Aqueous extract at 0, 4, 20 and 80 g/L was applied to human blood. Clotting time and APTT were prolonged, factors VIII, IX and XI fell, and platelet aggregation and fibrinogen receptor expression fell, all dose-dependently; at the same time prothrombin time shortened, factor VII activity rose and blood viscosity increased. The conclusion was that the extract has opposing actions with a net anticoagulant effect, the anticoagulant component being the stronger. This is the key safety finding for a herb prescribed to stop bleeding.
Promising Antiviral Activity of Agrimonia pilosa Phytochemicals against Severe Acute Respiratory Syndrome Coronavirus 2 Supported with In Vivo Mice Study
An ethanol extract of Agrimonia pilosa inhibited SARS-CoV-2 in cell culture with an IC50 of about 1.1 micrograms/mL, acting virucidally and by blocking viral adsorption, and reduced inflammatory gene expression. In mice it protected against lipopolysaccharide-induced acute lung injury. LC-MS profiling annotated 81 compounds, with isoflavonoids, procyanidins and anthocyanins reported in the species for the first time. These are laboratory findings only, with no clinical data in humans.
⚠ Safety & Contraindications
- Bleeding disorders
Side Effects
- Agrimoniin occasionally caused palpitation, facial hyperemia and flushing.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 419.
Historical Texts
Ben Cao Tu Jing
Song dynastyBen Cao Gang Mu Shi Yi
Qing dynastyWei Yao Tiao Bian
Qing dynastyReferences
- Sihua Wen, Xiaofei Zhang, Yanan Wu, Shangshang Yu, Wei Zhang, Ding Liu, Kai Yang, Jing Sun. Agrimonia pilosa Ledeb.: A review of its traditional uses, botany, phytochemistry, pharmacology, and toxicology . Heliyon (2022) [DOI]
- Xianming Fei, Wufeng Yuan, Lei Jiang, Huan Wang. Opposite effects of Agrimonia pilosa Ledeb aqueous extracts on blood coagulation function . Annals of Translational Medicine (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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