Chuan Xiong
ApiaceaeLigusticum chuanxiong
Also known as: Sichuan Lovage, Chuanxiong Rhizome, Cnidium officinale (former synonym)
clinical_notes Clinical Summary
Ligusticum chuanxiong (Chuan Xiong) is a premier TCM blood-moving herb prized for over 1800 years for headache, migraine, dysmenorrhea, and cardiovascular disease.
Its principal alkaloid, tetramethylpyrazine (ligustrazine), has been used as a pharmaceutical in China for decades for ischemic stroke and cardiovascular conditions.
RCT meta-analyses support Chuanxiong-based formulas for migraine prevention.
Pregnancy Safety
Classical TCM contraindication in pregnancy due to strong blood-moving action; risk of miscarriage.
Lactation Safety
Limited data; avoid unless under qualified TCM supervision.
warning Contraindications
- Bleeding disorders / Anticoagulant use (avoid)Clinically Proven
- Pregnancy (contraindicated)Theoretical
- Heavy menstrual bleeding / menorrhagia (avoid)Theoretical
vital_signs Clinical Profile
Primary Indications
- check_circle Migraine
- check_circle Tension headache
- check_circle Dysmenorrhea
- check_circle Blood stasis
- check_circle Angina
- check_circle Ischemic stroke
- check_circle Cerebral vascular disease
Therapeutic Actions
System Affinities
- check_circle Cardiovascular
- check_circle Nervous
- check_circle Musculoskeletal
- check_circle Reproductive
labs Active Constituents
Tetramethylpyrazine
Ligustilide
Senkyunolide A
Ferulic acid
Butylidenephthalide
Chuanxiong polysaccharides
history_edu Traditional Use
Traditional Chinese Medicine (TCM)
川芎 (Chuan Xiong)
Nature: warm
- Blood stasis
- Qi stagnation
- Wind invasion headache
- Dysmenorrhea
- Painful obstruction (Bi syndrome)
Described as 'Qi medicine within the blood' — moves Qi while invigorating Blood. Ascends to the head, making it the premier TCM herb for headache.
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.
Invigorates Blood, moves Qi, dispels Wind, relieves pain; premier herb for headache and gynecological blood stasis.
Top-ranked herb for headache in Chinese pharmacopoeia.
Senkyu — used in Kampo medicine for blood stasis, dysmenorrhea, cerebrovascular conditions.
Sourced from Cnidium officinale in Japan; genetically equivalent to L. chuanxiong.
spa Parts Used
rhizome
- Headache
- Blood stasis
- Cardiovascular disease
Dried rhizome is the pharmacopoeial part; wine-fried (jiu chuan xiong) enhances blood-moving action and ascending effect for headache.
shield Safety
Contraindications — Evidence Basis
Bleeding disorders / Anticoagulant use
Tetramethylpyrazine is clinically used IV as an antiplatelet agent; additive bleeding risk with warfarin, aspirin, NSAIDs.
Pregnancy
Strong blood-moving action traditionally contraindicated in pregnancy due to risk of miscarriage.
Heavy menstrual bleeding / menorrhagia
May worsen heavy bleeding due to blood-activating action.
Monitoring Parameters
Monitor during use, especially with prolonged or high-dose therapy.
INR / PT (if on warfarin)
Baseline and every 2 weeks during initiationTetramethylpyrazine has clinically demonstrated antiplatelet activity and may potentiate anticoagulants.
flagThreshold: INR >3.5: hold herb, consult prescriber
Toxicity
Low toxicity in crude herb form at standard doses (3-10 g/day).
Rare: nausea, dizziness, headache (paradoxically at high doses).
Dose reduction; supportive care.
Adverse Effects
CYP Metabolism
Tetramethylpyrazine has been shown to inhibit P-gp and MRP2/3/5 in vitro; may increase bioavailability of co-administered drugs.
swap_horiz Interactions
Warfarin
Class: Vitamin K Antagonist Anticoagulant
Chuan Xiong (Ligusticum chuanxiong) extract inhibits CYP2C9 and CYP1A2 and competitively inhibits metabolic enzymes, increasing free warfarin concentrations. In addition, tetramethylpyrazine (TMP) and ferulic acid produce antiplatelet effects via nitric oxide synthase activation. The Shunaoxin Dripping Pill (Chuan Xiong + Angelica sinensis) has been shown to increase warfarin peak concentrations and significantly raise PT/INR.
Avoid Chuan Xiong in patients on warfarin unless under close clinician supervision. If used, monitor INR at baseline, 3-7 days after starting/stopping, and then weekly until stable. Counsel patients on signs of bleeding (bruising, epistaxis, hematuria, melena). Warfarin dose reduction may be needed.
Aspirin / Clopidogrel / Ticagrelor
Class: Antiplatelet
Tetramethylpyrazine (TMP), ligustilide, and ferulic acid from Chuan Xiong inhibit platelet aggregation via nitric oxide synthase activation, inhibition of thromboxane A2 generation, and direct effects on the cAMP pathway. Combined with pharmaceutical antiplatelets, the additive effect substantially increases bleeding risk.
Do not combine therapeutic Chuan Xiong doses with antiplatelet drugs outside of carefully controlled TCM-integrative protocols. Discontinue Chuan Xiong at least 1-2 weeks before elective surgery. Monitor for signs of bleeding (epistaxis, gum bleeding, easy bruising, hematuria).
Direct Oral Anticoagulants (apixaban, rivaroxaban, dabigatran)
Class: DOAC Anticoagulant
Tetramethylpyrazine inhibits P-glycoprotein (P-gp) and MRP2/3/5 transporters in vitro — all DOACs are P-gp substrates. Additionally, Chuan Xiong's inhibition of CYP3A4 is relevant for apixaban and rivaroxaban metabolism. The combined pharmacokinetic effect (increased DOAC plasma concentration) plus pharmacodynamic antiplatelet effect raises major bleeding risk.
Avoid concurrent use of Chuan Xiong with DOACs. If unavoidable, consider DOAC dose reduction, monitor clinical signs of bleeding, obtain baseline CBC, and consider anti-Xa or dilute thrombin time testing if clinically indicated.
Valsartan / Angiotensin Receptor Blockers
Class: ARB Antihypertensive
A rat pharmacokinetic study of ligustrazine (TMP) with valsartan found significant alteration of valsartan AUC and Cmax, suggesting P-gp/OATP-mediated transport interference. Chuan Xiong itself has vasodilatory and mild antihypertensive effects. Combined administration can produce additive blood pressure lowering.
Monitor blood pressure in patients initiating Chuan Xiong while on valsartan or other ARBs. Watch for orthostatic hypotension, especially with initiation and dose changes. Consider staggered dosing times if co-use is necessary.
Antihypertensives (CCBs, ACE-inhibitors, beta-blockers)
Class: Antihypertensive (general)
Chuan Xiong has documented vasodilator, endothelial-protective, and mild blood-pressure-lowering effects (shown in Chinese clinical studies for hypertension). Concomitant use with antihypertensives can produce additive hypotension.
Advise patients on antihypertensive medication to monitor home blood pressure when adding Chuan Xiong-containing formulas. Patients should report symptoms of hypotension (dizziness, syncope, fatigue). Antihypertensive dose reduction may be required.
hub Combinations
Synergistic pairings can enhance therapeutic outcomes, while knowing suitable substitutes helps when specific herbs are unavailable or contraindicated.
Classical Formulas
2Dong Quai
Traditional UseClassic pairing in Si Wu Tang (Four Substances Decoction); foundational TCM blood-nourishing and blood-moving formula for gynecological disorders.
2000+ year use; widely used for menstrual disorders and post-partum recovery.
White Peony
Traditional UsePaired in Si Wu Tang; white peony nourishes blood and softens liver, balancing chuan xiong's warm moving nature.
Classical formula component; well-documented traditional use.
Possible Substitutes
1Feverfew
Moderate EvidenceIn Western herbal practice, feverfew is primary migraine prophylactic; Chuan Xiong provides a TCM alternative with blood-moving mechanism.
Both have RCT evidence for migraine prophylaxis.
Synergistic Combinations
1Dan Shen
Moderate EvidenceBoth are blood-moving cardiovascular herbs; combined in modern Chinese patent formulas for ischemic heart disease and stroke.
Used in contemporary Chinese cardiology; supportive clinical data for combined therapy.
science Studies
A systematic review on the rhizome of Ligusticum chuanxiong Hort. (Chuanxiong)
Systematic ReviewThis comprehensive systematic review consolidates ethnobotanical, phytochemical, pharmacological, and toxicological research on Ligusticum chuanxiong (Chuanxiong), an extensively used TCM herb for cardiovascular and cerebrovascular diseases. Key bioactive compounds include phthalides (ligustilide, butylidenephthalide), alkaloids (tetramethylpyrazine), and phenolic acids (ferulic acid), each with documented cardiovascular, neuroprotective, and anti-inflammatory activities. Clinical applications span cardiocerebrovascular disease, menstrual disorders, headaches, and pain management. The review summarizes safety data, noting dose-dependent toxicity concerns and potential herb-drug interactions at high doses. This reference provides the evidence base for Chuanxiong therapeutic indications.
Chuanxiong Formulae for Migraine: A Systematic Review and Meta-Analysis of High-Quality Randomized Controlled Trials
Meta-AnalysisThis systematic review and meta-analysis identified 19 high-quality RCTs involving 1,832 participants evaluating Chuanxiong (Ligusticum chuanxiong) formulae for migraine treatment. Analyses showed that Chuanxiong formulae significantly reduced migraine frequency, duration, pain severity, and the number of migraine days compared to placebo or conventional pharmacotherapy. Adverse event rates were low across the 16 studies that monitored safety. Both monotherapy and adjunctive use with conventional treatments showed benefit. These findings provide meaningful clinical evidence supporting the use of Chuanxiong-based preparations for migraine prophylaxis and treatment.
medication Dosing
decoction
3-10 g
1-2x/day
Standard TCM dose; often in multi-herb formulas.
powder
1.5-3 g
2-3x/day
Used in Chuan Xiong Cha Tiao San for headache.
tincture
2-4 mL (1:5, 45% ethanol)
2-3x/day
Western herbal preparation.
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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