Anemarrhena
AsparagaceaeAnemarrhena asphodeloides
Also known as: Zhi Mu, Anemarrhena Rhizome, Know-Mother Root
clinical_notes Clinical Summary
Zhi Mu (Anemarrhena asphodeloides) is a cornerstone Chinese yin-nourishing and heat-clearing herb, classified in the 'clears heat and purges fire' category.
Its rhizome contains steroidal saponins (timosaponins, sarsasapogenin) and the xanthone mangiferin, with documented antipyretic, antidiabetic, anti-inflammatory, neuroprotective, and anti-osteoporotic activity.
Best known for treating yang-ming high fever (in Bai Hu Tang) and menopausal yin-deficient heat (in Zhi Bai Di Huang Wan); contraindicated in cold-deficient digestive patterns.
Pregnancy Safety
Classical TCM contraindication during pregnancy due to cold nature and downward-moving effect. Insufficient modern safety data. Avoid unless directed by a qualified TCM practitioner.
Lactation Safety
Insufficient safety data in lactation. Cold nature may affect milk supply and infant digestion (cold and damp). Use with caution.
warning Contraindications
- Spleen Yang deficiency / Cold in the Middle Jiao (contraindicated)Theoretical
- Pregnancy (caution)Theoretical
- Chronic diarrhea (avoid)Theoretical
- Concurrent anticoagulant or antiplatelet therapy (caution)Theoretical
- Hypoglycemia / concurrent antidiabetic drugs (caution)Theoretical
vital_signs Clinical Profile
Primary Indications
- check_circle high fever with thirst
- check_circle yin deficiency with night sweats
- check_circle menopausal hot flashes
- check_circle diabetes mellitus (consumptive thirst / xiaoke)
- check_circle irritability and insomnia from yin deficiency
- check_circle dry cough
- check_circle lower back pain (kidney yin deficiency)
- check_circle steaming bone fever (tuberculosis convalescence)
- check_circle urinary tract infection with heat
Therapeutic Actions
System Affinities
- check_circle Lung
- check_circle Stomach
- check_circle Kidney
- check_circle endocrine
- check_circle central nervous system
- check_circle skeletal
labs Active Constituents
timosaponin A-III
timosaponin B-II
sarsasapogenin
anemarsaponin IA
mangiferin
neomangiferin
isomangiferin
polysaccharides
broussonin A and B
phenolic compounds
asphonin
choline
tannins
history_edu Traditional Use
Traditional Chinese Medicine (TCM)
知母 (Zhi Mu)
Nature: cold
- High fever (Yang Ming heat)
- consumptive thirst (Xiao Ke)
- Yin deficiency with night sweats and steaming bone fever
- irritability and insomnia from yin deficiency
- dry cough from Lung heat
- menopausal heat
- lower back pain (Kidney yin deficiency)
Zhi Mu is one of the most important Yin-tonifying and Heat-draining herbs in Chinese Materia Medica. Used 'unprepared' (Sheng Zhi Mu) for clearing excess Yang Ming heat; salt-prepared (Yan Zhi Mu) is preferred for nourishing Kidney yin and clearing deficient heat. Frequently paired with Huang Bai (phellodendron) for yin-deficient heat in lower body and with Shi Gao (gypsum) for Yang Ming fever.
Traditional Uses Across Healing Systems
While many herbs lack controlled clinical trials, centuries of traditional practice across cultures provide valuable insight into their therapeutic applications.
Clears heat, drains fire, nourishes yin, moistens dryness; for high fever, irritability, thirst, hot flashes, night sweats, diabetes-related thirst, and dry cough.
Key herb in Bai Hu Tang (White Tiger Decoction) by Zhang Zhongjing (Han dynasty, 200 CE) for Yang Ming heat patterns.
Classical formula Zhi Bai Di Huang Wan combines Zhi Mu, Phellodendron, and six Rehmannia herbs to treat Kidney yin deficiency with empty fire — menopausal heat, night sweats, hot flushes, low-back pain.
Modern clinical trials of Zhi Bai Di Huang Wan demonstrate significant reduction in vasomotor symptoms in menopausal women.
Used in Japanese Kampo formulas adapted from Chinese tradition, often for febrile illness and yin-deficiency patterns.
spa Parts Used
rhizome
- fever
- thirst
- diabetes
- yin deficiency heat
- night sweats
- menopausal symptoms
- dry cough
- low back pain
Harvested in spring or autumn from 3-4 year old plants. Two main preparations: (1) Sheng Zhi Mu (unprepared) — sliced and dried; cooling, clears excess Yang Ming heat. (2) Yan Zhi Mu (salt-prepared) — stir-fried with salt water; directed to the Kidney to nourish yin and clear deficient heat. Best quality has yellow-white cross-section with sticky mucilage; the 'gold-wrapped head' (jin bao tou) crown is prized.
shield Safety
Contraindications — Evidence Basis
Spleen Yang deficiency / Cold in the Middle Jiao
Zhi Mu is cold and moistening; will worsen loose stools, poor appetite, and cold-deficient digestive patterns.
Pregnancy
Use with caution. Classical TCM texts caution use in pregnancy due to cold nature; modern data limited.
Chronic diarrhea
Cold and moistening nature exacerbates loose stools and damp-cold patterns.
Concurrent anticoagulant or antiplatelet therapy
Timosaponin B-II inhibits blood coagulation and platelet aggregation in animal studies; theoretical additive bleeding risk.
Hypoglycemia / concurrent antidiabetic drugs
Mangiferin significantly lowers blood glucose in type 2 diabetic models; additive hypoglycemia possible.
Monitoring Parameters
Monitor during use, especially with prolonged or high-dose therapy.
Fasting blood glucose and HbA1c (if diabetic)
Baseline and every 4-12 weeksMangiferin lowers blood glucose; may potentiate antidiabetic therapy.
flagThreshold: FBG <70 mg/dL or symptomatic hypoglycemia: reduce dose.
INR (if on warfarin)
More frequent monitoring after initiationTimosaponin B-II inhibits coagulation and may potentiate warfarin.
flagThreshold: INR >3.5 or supratherapeutic: reduce warfarin dose.
Toxicity
Generally well tolerated within therapeutic dose (6-12 g/day decoction). High doses may cause GI upset.
Loose stools, abdominal cramping, nausea at high doses or in cold-deficient individuals.
Discontinue or reduce dose; combine with warming digestive herbs (ginger, dried ginger) to offset cold nature.
Adverse Effects
CYP Metabolism
Mangiferin inhibits CYP3A4 and CYP2C9 in vitro at micromolar concentrations — theoretical interactions with substrates including warfarin, statins, midazolam. Timosaponin B-II modulates intestinal P-gp efflux.
swap_horiz Interactions
Insulin / Sulfonylureas / Metformin
Class: Antidiabetic
Total saponins, mangiferin, anemarans, and timosaponin B-II from A. asphodeloides have documented hypoglycemic activity through enhanced insulin sensitivity, GLP-1 secretion, and AMPK activation. Additive glucose lowering with antidiabetic agents may cause hypoglycemia.
Monitor fasting and postprandial blood glucose. Consider downward titration of antidiabetic drugs. Educate patients on hypoglycemia recognition and management.
Warfarin
Class: Anticoagulant
Mangiferin inhibits CYP3A4 (IC50 8.7 μM) and CYP2C9 in vitro; CYP2C9 is the primary metabolic pathway for warfarin (S-enantiomer). Inhibition raises plasma warfarin levels and elevates INR. Timosaponin AIII also has documented anti-platelet aggregation activity.
Monitor INR closely if co-administered. Be prepared to reduce warfarin dose. Counsel patients on bleeding signs. Discontinue Anemarrhena 1-2 weeks before elective surgery.
Tamoxifen
Class: Selective estrogen receptor modulator
Mangiferin and the Baihe Zhimu formula (containing A. asphodeloides) significantly inhibit CYP450 enzymes responsible for bioactivation of tamoxifen to endoxifen and 4-hydroxytamoxifen (CYP2D6, CYP3A4/5). In mouse xenograft models, Baihe Zhimu reduced tumor-tissue concentrations of active tamoxifen metabolites and attenuated anticancer efficacy.
Avoid co-administration in breast cancer patients on tamoxifen. The clinical risk is reduced efficacy of endocrine therapy. Use alternative herbs without CYP2D6/3A4 inhibition.
CYP3A4 substrates (statins, midazolam, calcium channel blockers, cyclosporine)
Class: CYP3A4 substrates
Mangiferin inhibits CYP3A4 (IC50 8.7 μM, Ki 10.8 μM) non-competitively. Anemarsaponin BII inhibits CYP3A4 (IC50 13.7 μM). Inhibition may elevate plasma levels of simvastatin, atorvastatin, midazolam, amlodipine, nifedipine, tacrolimus, and cyclosporine.
Monitor for substrate toxicity. Consider therapeutic drug monitoring (cyclosporine, tacrolimus) or alternative agents. Watch for myopathy with statins.
CYP2D6 substrates (codeine, tramadol, metoprolol, fluoxetine, paroxetine)
Class: CYP2D6 substrates
Mangiferin inhibits CYP2D6 (IC50 9.2 μM, Ki 3.8 μM). For prodrugs requiring CYP2D6 bioactivation (codeine→morphine, tramadol→O-desmethyltramadol), inhibition reduces analgesic efficacy. For metoprolol, inhibition raises plasma levels and may cause bradycardia/hypotension.
Monitor analgesic response with codeine/tramadol. Consider alternative analgesics. For metoprolol and other CYP2D6 substrates, monitor for substrate toxicity.
P-glycoprotein substrates (digoxin, fexofenadine, dabigatran)
Class: P-gp substrates
Timosaponin B-II from A. asphodeloides modulates intestinal P-glycoprotein efflux. Inhibition of P-gp increases bioavailability and plasma levels of digoxin, dabigatran, and fexofenadine.
Monitor digoxin levels (target 0.5-1.0 ng/mL). For dabigatran, watch for bleeding. Consider dose adjustment.
hub Combinations
Synergistic pairings can enhance therapeutic outcomes, while knowing suitable substitutes helps when specific herbs are unavailable or contraindicated.
Classical Formulas
2Rehmannia
Strong EvidenceRehmannia (Shu Di Huang or Sheng Di Huang) is the chief yin-nourishing herb; pairs with Zhi Mu for Kidney yin deficiency and empty heat. Core of Zhi Bai Di Huang Wan.
Modern clinical use for menopausal syndrome, diabetic complications, autoimmune conditions with yin deficiency.
Sour Jujube Seed
Strong EvidenceIn Suan Zao Ren Tang, Zhi Mu nourishes yin and clears empty heat while suan zao ren nourishes Heart yin and calms shen. Together used for yin-deficient insomnia and anxiety.
Classical Han Dynasty formula (Jin Gui Yao Lue); modern clinical use for insomnia, anxiety, and menopausal sleep disturbance.
Synergistic Combinations
3Chinese Skullcap
Traditional UseHuang Qin (Chinese skullcap) clears Lung and upper jiao heat; combined with Zhi Mu treats febrile illness and lung heat patterns.
Common pairing in modern Chinese pharmacology for respiratory infections with high fever.
Phellodendron
Strong EvidenceClassic 'Yin tonic / drain deficient fire' pair. Zhi Mu clears heat in upper and middle burner while Huang Bai (Phellodendron) drains heat from the lower burner. Foundational duo in Zhi Bai Di Huang Wan.
Zhi Bai Di Huang Wan formulation showed significant reduction in menopausal vasomotor symptoms in clinical trials.
White Peony
Traditional UseWhite peony nourishes Liver Yin and softens; combined with Zhi Mu addresses Liver-Kidney yin deficiency with heat, insomnia, and irritability.
Traditional pairing for menopausal women with irritability and dryness.
science Studies
No studies match your criteria.
medication Dosing
decoction
6-12 g dried rhizome
1-2x/day
Standard TCM dose. Boil for 20-30 minutes with other herbs in formula. Often combined with Huang Bai (phellodendron) for yin-deficient heat or Shi Gao (gypsum) for Yang Ming excess heat.
capsule
500 mg dried powder, 3-6 capsules
2-3x/day
Commercial Western formulation. Always take with formula partners — rarely used as monotherapy in TCM.
tincture
2-4 mL of 1:5 tincture in 45% ethanol
TID
Less common but used in Western herbal practice. Adjust based on formula partners.
powder
1-3 g granular extract (5:1 concentration)
2-3x/day
Granular extracts (e.g., Sun Ten, KPC) standardized to 5:1. Use within formula structure.
Disclaimer: This information is largely AI-generated and reviewed by human experts at Evara Health. It is intended for educational and clinical reference purposes only and should not replace professional medical advice.
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