Aristolochia (Ma Dou Ling)

Birthwort FruitIn the 1990s, an herbal ingredient known as “aristolochic acid” was reported unsafe because of its association with cancer and kidney failure. Since then, the safety of aristolochia, also known as Ma Dou Ling in Pinyin, has been questioned by more and more medical workers. Unfortunately, this herb has been around for centuries, if not millenniums. From the point of view of traditional Chinese medicine (TCM), most aristolochia species are able to expel wind, remove dampness, activate collaterals to stop pain, and promote qi to activate blood. However, modern research shows that aristolochia plants are toxic and they can result in a series of malignant diseases like kidney disease and urinary tract cancer. In April, 2012, Arthur Grollman, a pharmaceutical scientist from Stony Brook University, published a paper on Proceedings of the National Academy of Sciences and claimed that the culprit for the high prevalence of bladder cancer in Taiwan may be the aristolochia, which has been widely used there.

What is aristolochia?

Medicinally it mainly refers to the dried fruits of Aristolochia contorta Bge. or Aristolochia debilis Sieb. et Zucc., which is a plant in the family Aristolochiaceae. So, other names of it include Birthwort Fruit, Fructus Aristolochiae, Aristolochia fruit, Dutchmanspipe Fruit, and so on. The former is mainly produced in Heilongjiang, Jilin, Hebei and other places and the latter is mainly produced in Shandong, Jiangsu, Anhui, Zhejiang and other provinces. It is usually harvested in autumn when the fruits turn from green to yellow. And then it is dried in the sun and used raw, fried, or processed with honey.

Aristolochia debilis is a perennial twining plant. Alternate leaves has thin and 1 to 1.5cm petiole; blade is triangular oblong-ovate, 3 to 8cm long, 1.8 to 4.5cm wide, attenuate above the middle, and with obtuse or emarginate apex, heart-shape base, and round-ear sides. Large flowers is solitary in leaf axils and with slender and 1 to 1.5cm pedicels; dark purple perianth is from 3 to 5cm; stamens 6; ovary is inferior. Capsule is nearly round or oblong, 4 to 5cm long, and 3 to 4cm in diameter. Flowering time is from July to August and fruit season is in September. Main habitat is slopes of the jungle.

Aristolochia contorta fruit contains aristolochic acid A, C, D, β-sitosterol, and magnoflorine. And aristolochia debilis fruit and seed contain aristolochic acid A and quaternary ammonium alkaloids.

Aristolochia health benefits

Aristolochia fruit is traditionally used for the treatment of cough, bronchial spasm, excessive phlegm, high blood pressure, etc. It is a well-known herb that helps lower blood pressure mildly and steadily. Based on clinical studies, it has better efficacy for the stage 1 and 2 high blood pressure. 37 cases of hypertension patients ever took 15 grams of aristolochia daily in the form of decoction. 15 to 25 days later, diastolic blood pressure significantly decreased in 10 cases, slightly decreased in 9 cases, and remained in 16 cases. The average lowered blood pressure was 28/13 mm Hg. Some patients’ blood pressure went up at one point but returned to normal in the short term. The longest observation had lasted for 278 days and no rising blood pressure was found. In addition, it helped improve most of the symptoms, among which headache and dizziness were the most obvious ones. Main side effects included poor appetite and weakness, which however didn’t affect the treatment.

Modern pharmacological actions

1. It can relieve cough effectively;
2. Its decoction has weak expectorant effect;
3. It can relax bronchial tube and relieve bronchospasm;
4. It has inhibition on a variety of pathogenic fungi.

Selected herbal remedies

The Chinese Pharmacopoeia believes that it is bitter in flavor and slightly cold in nature. And it goes to lung and large intestine. Main functions are clearing away the lung-heat to descend qi, relieving cough and asthma, colon cleanse, and curing hemorrhoid. Major aristolochia uses and indications include lung-heat causing cough and asthma, coughing up bloody sputum, hemorrhoid bleeding due to intestine heat, and hemorrhoid swelling and pain. Recommended dosage is from 3 to 9 grams.

1. Bu Fei E Jiao San from Xiao Er Yao Zheng Zhi Jue (Key to the Therapeutics of Children’s Diseases). It is combined with E Jiao (Donkey-Hide Gelatin), Xing Ren (Apricot Seed), Gan Cao (Licorice Root), Niu Bang Zi (Great Burdock Fruit), and Jing Mi (non-glutinous rice) to treat cough, wheezing, sticky less sputum, blood-stained sputum, dry throat, and so on.

2. Jian Yao Ji Zhong Fang (Brief Prescriptions that Aid All People). It is coupled with Licorice Root to treat lung-qi cough.

3. Qian Jin Fang (Thousand golden essential prescriptions). It is decocted to cure abdominal dropsy.

4. Zhai Yuan Fang. It is charred to treat cardiodynia.

Aristolochia side effects and contraindications

Studies on Aristolochia herbs in western countries can be dated back as early as 1990s. And the medical community’s studies and discuss in 2012 has resulted in the ban on the medicinal uses of aristolochic acid plants in a number of countries. Aristolochic acid causing kidney failure was initially discovered in 1993 by the Belgian scholar Vanhererghem. Then he noticed that more than a hundred women suffered from renal lesions due to taking diet pills containing aristolochia fangchi (Guang Fang Ji). What’s worse, all of them needed a kidney transplant in the end. And later related case studies from around the world also pointed out that this kind of kidney disease was closely related to the use of aristolochic acid-containing drugs. For that reason, this disease is named as aristolochic acid nephropathy (AAN). Though aristolochia can promote diuresis and relieve cough, the long-term use of it can cause kidney poisoning, destruction of the functioning kidney tissue, renal failure, urinary tract cancer, and even death. Hence, in 1994 aristolochic acid-containing Chinese medicine were first banned in France, followed by the United Kingdom, Belgium, Australia, Austria, Spain, the United States, Egypt and other countries.

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