Ying Su Ke
StarPapaver somniferum L.
Traditionally used for
- Cough & breathing
- Bowel health
- Pain & joints
Cautions & contraindications
- Pregnancy
- Breastfeeding
- Young children
- Toxic — professional use only
☯ TCM Properties
Astringes the Lungs and Stops Cough; Astringes the Intestines and Stops Diarrhea; Alleviates Pain; Secures the Lower Burner
Traditional Chinese Uses
Ying Su Ke (opium poppy husk) is a powerful astringent herb used to stop chronic cough, bind the intestines for long-standing diarrhea, and relieve severe pain. Due to its content of morphine and related alkaloids, it has significant narcotic potential and is classified as a controlled substance in most countries. It is only used for serious, unremitting conditions under close medical supervision, never for short-term acute illness, and with strict attention to dose and duration of treatment.
Western Herbalism Properties
Relationships
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Botanical Description
Papaver somniferum, the opium poppy, is an erect glaucous annual herb in the family Papaveraceae, cultivated worldwide and naturalized from its probable Mediterranean origin. Plants grow 60–150 cm tall with lobed, clasping bluish-green leaves and large solitary flowers 5–10 cm across in shades of white, pink, red, or purple, often with a dark basal blotch. The fruit is a subglobose to ovoid capsule 3–9 cm in diameter, glaucous-green ripening to brown, crowned by a persistent disc of 8–15 radiating stigmas; the capsule wall yields a milky latex containing morphine, codeine, thebaine, and other opium alkaloids. Ying Su Ke is the dried mature empty capsule (after removal of seeds) collected in summer. In TCM it is sour, astringent, and neutral with toxicity, binding the lung to stop chronic cough, astringing the intestines for chronic diarrhea, and relieving pain. It is a strictly controlled narcotic substance in most jurisdictions.
Active Constituents
Morphine
Phenanthrene (morphinan) opiate alkaloidConcentration: dried poppy capsules averaged 362 mg/100 g (about 0.36% of the dried capsule) by capillary electrophoresis, with an HPLC range of 152-676 mg/100 g across cultivars
A full mu-opioid receptor agonist, and the reason this drug works and the reason it is dangerous. It produces analgesia, cough suppression, marked slowing of gut transit, sedation and dose-dependent respiratory depression, and it produces physical dependence with repeated use. The morphine content of a batch of pericarp is not standardised in the way a pharmaceutical opioid dose is, so the delivered opioid dose varies several-fold between batches.
Codeine
Phenanthrene (morphinan) opiate alkaloidConcentration: about 25 mg/100 g of dried capsule by capillary electrophoresis
A prodrug that is O-demethylated by CYP2D6 to morphine, which carries most of the analgesic and respiratory-depressant effect. CYP2D6 ultrarapid metabolisers convert an unusually large fraction to morphine, which is the mechanism behind the paediatric deaths that led regulators to contraindicate codeine in children.
Papaverine
Benzylisoquinoline alkaloidConcentration: about 29 mg/100 g of dried capsule by capillary electrophoresis
A non-narcotic smooth-muscle relaxant with no opioid receptor activity; it acts as a phosphodiesterase inhibitor and vasodilator. It contributes to the antispasmodic effect of the drug but not to its analgesia or its abuse liability.
Thebaine
Morphinan alkaloidPresent in the capsule as a minor alkaloid. It is a poor analgesic and is convulsant rather than narcotic at high dose; industrially it is the starting material for oxycodone, buprenorphine and naloxone.
Noscapine
Phthalideisoquinoline alkaloidA non-opioid antitussive with no dependence liability. It is one of the five alkaloids routinely quantified together with morphine, codeine, thebaine and papaverine when laboratories test food or herbal material for the illegal presence of poppy pericarp.
⚠ Drug Interactions
Opioid analgesics (morphine, oxycodone, fentanyl, methadone, tramadol, codeine)
Ying Su Ke is not an opioid-like herb, it is an opioid. The pericarp is poppy straw and carries morphine at roughly 0.15-0.68% of dry weight plus codeine and thebaine, so co-administration with any opioid is simply an unmeasured dose increase of the same drug class at the same mu-opioid receptor. It is a controlled substance on this basis: in the United States the opium poppy, poppy straw (all parts of the plant except the seeds) and concentrate of poppy straw are Schedule II under the Controlled Substances Act, and the plant is controlled internationally under the 1961 Single Convention on Narcotic Drugs, so the herb is not lawfully available as a herbal ingredient in most jurisdictions. China retains it as a Pharmacopoeia drug but administers it under narcotic-drug controls, and its addition to food is prohibited and is nonetheless documented in commercial hot-pot broth.
Clinical note: Do not combine with any opioid. Where the herb is legally available at all it is prescription-only, short-course and low-dose; treat any concurrent opioid as an absolute contraindication and count the herb toward the total opioid burden.
Benzodiazepines, z-drugs, gabapentinoids, sedating antihistamines and alcohol
Morphine-induced respiratory depression is potentiated by any other CNS depressant, and the herb delivers a variable, unlabelled morphine dose. US poison-centre and FDA adverse-event data through 2018 record 591 poppy exposures, 18 overdoses and at least 19 poppy-associated deaths in the literature, most involving home-prepared poppy preparations. A four-year-old who ingested raw poppy plant material developed shallow respiration, needed a two-day naloxone infusion after a delayed respiratory arrest at ten hours, and died on day twelve, which shows both the paediatric respiratory risk and the delayed, biphasic course that makes plant-source opioid poisoning harder to treat than a known pharmaceutical dose.
Clinical note: Contraindicated with any sedative-hypnotic or alcohol. Do not use in children at all, and do not use in anyone with sleep apnoea, COPD or reduced respiratory reserve. Onset can be delayed by hours, so a well-looking patient early on does not exclude serious poisoning.
Naltrexone, naloxone and buprenorphine (including opioid use disorder maintenance)
These agents are competitive mu-opioid antagonists or partial agonists, so they block the herb's morphine and can precipitate withdrawal in a patient who has been taking it regularly. The reverse hazard also matters: poison-centre reviewers specifically recommend that clinicians in opioid treatment and recovery ask about poppy use, because patients use poppy preparations to self-treat pain and withdrawal symptoms, which both destabilises maintenance treatment and defeats the point of it.
Clinical note: Absolutely contraindicated in anyone on naltrexone or buprenorphine maintenance, and in anyone in opioid recovery. Ask directly about poppy pericarp, poppy tea and poppy-containing cough syrups, because patients do not classify them as opioids.
Monoamine oxidase inhibitors (phenelzine, tranylcypromine, selegiline, linezolid)
The opioid-MAOI interaction is best documented for pethidine but is a standing contraindication for opioids as a class, and the herb delivers morphine and codeine. Because the alkaloid dose in the pericarp is not standardised, the exposure cannot be titrated cautiously the way a pharmaceutical opioid can.
Clinical note: Avoid within 14 days of any MAOI, including linezolid and transdermal selegiline.
CYP2D6 inhibitors (paroxetine, fluoxetine, bupropion, quinidine) and CYP2D6 phenotype
The codeine fraction depends on CYP2D6 for conversion to morphine. Strong CYP2D6 inhibitors block that conversion, while CYP2D6 ultrarapid metabolisers generate more morphine than expected from the same material. This is the established mechanism behind codeine's regulatory contraindication in children and in breastfeeding, and it applies to the herb's codeine content as well; the morphine already present in the pericarp is not affected, so only part of the exposure shifts.
Clinical note: Do not rely on dose experience carried over from another patient or another batch. In practice this is another reason the drug is unsuitable outside a controlled prescription setting.
Loperamide, diphenoxylate and anticholinergic antidiarrhoeals
Morphine slows gut transit through peripheral mu-opioid receptors in the enteric nervous system, which is exactly the mechanism the antidiarrhoeals use, so the effects add. The traditional indication overlaps precisely with the drugs that share the mechanism, so the combination is easy to reach for.
Clinical note: Avoid stacking with antidiarrhoeals. Do not use where diarrhoea is infective or where there is an inflammatory colitis, since arresting transit in those settings is itself the hazard.
Urine opiate immunoassay screening (workplace, forensic or clinical drug testing)
This is a true positive, not a cross-reaction: the patient really has ingested morphine and codeine. A human pharmacokinetic study of a Chinese Papaveris pericarpium cough syrup found urinary morphine and codeine above the 300 ng/mL opiate cut-off for 6-14 hours depending on dose, and repeated dosing raised AUC in a way the authors flagged as a risk of cumulative toxicity. Poppy-containing foods and herbal cough preparations are a recognised explanation for unexpected opiate-positive screens.
Clinical note: Warn any patient subject to drug testing, on an opioid pain agreement, or in a treatment programme. Record the exposure contemporaneously in the notes; a retrospective claim after a positive result carries much less weight.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 3–6 g | Daily | — | — | 中国药典 2020 【用法与用量】3～6g。 【注意】本品易成瘾，不宜常服；孕妇及儿童禁用；运动员慎用。 【性味与归经】酸、涩，平；有毒。归肺、大肠、肾经。 — 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.
Two strongly astringent herbs reinforce each other to bind the intestines and stop intractable chronic diarrhea and dysentery.
Only for chronic cases without residual pathogen; contraindicated in early-stage diarrhea or dysentery. Ying Su Ke is addictive and legally controlled in many jurisdictions.
Core pair of a classical formula — Zhen Ren Yang Zang Tang, Tai Ping Hui Min He Ji Ju Fang
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
0
Other clinical trial
0
Observational / case report
1
1 verified · 0 unverified
In vitro / animal
0
Other / unclassified
2
0 verified · 2 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
The Pharmacokinetics of Morphine and Codeine in Human Plasma and Urine after Oral Administration of Qiangli Pipa Syrup
The first human pharmacokinetic study of Papaveris pericarpium as delivered in a marketed Chinese antitussive syrup, given as single 15, 30 and 60 mL doses and as multiple 15 mL doses and measured by HPLC-MS/MS. Morphine and codeine showed linear kinetics, but AUC rose markedly on repeated dosing, which the authors read as a risk of accumulative toxicity, and urinary concentrations exceeded the 300 ng/mL opiate cut-off for 6-14 hours depending on dose. It is the best direct evidence that an ordinary therapeutic course of this drug produces measurable systemic opioid exposure and positive opiate drug tests.
A Fatal Case of Opioid Intoxication After Raw Poppy Plant Ingestion
A four-year-old girl admitted to paediatric intensive care after eating raw poppy plant material presented with shallow respiration, tachycardia, hypertension and muscle cramps, and a high plasma opioid level. Bolus naloxone briefly restored consciousness, but she suffered sudden respiratory depression and loss of consciousness ten hours later, required intubation and a two-day naloxone infusion, developed disseminated intravascular coagulation and died on day twelve. The authors emphasise that plant-source opioid poisoning is harder to treat than a known pharmaceutical exposure because the ingested alkaloid content is unknown and naloxone dosing has no consensus.
Opioid exposure associated with poppy consumption reported to poison control centers and the U.S. Food and Drug Administration
Cross-sectional analysis of the US National Poison Data System (2000-2018) plus FDA adverse-event systems. There were 591 poppy exposure cases, 392 of them in people aged 13 and over, with intentional exposures rising over the period and concentrated in males in their teens and twenties. The datasets contained 18 overdoses and three deaths likely attributable to poppy, mostly poppy seed tea, plus five further poppy-opioid deaths, bringing the published US total to at least 19. The authors recommend that clinicians in opioid treatment and recovery specifically ask about poppy use for pain and withdrawal.
⚠ Safety & Contraindications
- Pregnancy
- Breastfeeding
- Young children
- Toxic — professional use only
Contraindications
Contraindicated in pregnancy, in breastfeeding, in children, and in any patient with a history of substance dependence.
Safety Warnings
- Addictive. Short-term use only, and not as a first-line antitussive or antidiarrhoeal.
- Additive respiratory depression with opioids, benzodiazepines and alcohol.
- Will produce a positive opiate result on drug screening.
Regulatory Status
- A controlled substance in most jurisdictions. Import, supply and possession of poppy pericarp are restricted or prohibited in the US, the UK, the EU and Australia.
- In China, supply is restricted to licensed channels.
⚠ Toxicity Information
Sedation, constipation, respiratory depression in overdose, and physical dependence on repeated use.
Historical Texts
Kai Bao Ben Cao
Northern Song dynasty (973)Ben Cao Gang Mu
Ming dynasty (1596)References
- Meos A, Saks L, Raal A. Content of alkaloids in ornamental Papaver somniferum L. cultivars growing in Estonia; pp. 34–39 . Proceedings of the Estonian Academy of Sciences (2017) [DOI]
- Guo Q, Zhang J, Zhao S, Shao B. Determination of Five Alkaloids of Pericarpium Papaveris in Hot Pot Broth Using Ultra-Performance Liquid Chromatography Coupled to Triple Quadruple Mass Spectrometry . Food Analytical Methods (2012) [DOI]
- Canton-Alvarez JA. A Gift from the Buddhist Monastery: The Role of Buddhist Medical Practices in the Assimilation of the Opium Poppy in Chinese Medicine during the Song Dynasty (960–1279) . Medical History (2019) [DOI]
- Wang S, Shou D. Determination of alkaloids in Pericarpium papaveris (Yingsuqiao) by high performance capillary electrophoresis . Se Pu (Chinese Journal of Chromatography) (1997)
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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