Cyathula

Other Names

Achyranthes alternifolia L.f.Achyranthes prostrata L.bhuiaghadacerukadalaadiChuan Niu XiChuanniuxichuvannakadaladicivappu nayuruviCyathula capitataCyathula capitata Moq.Cyathula geniculata Lour.Cyathula globosa Moq.Cyathula lancifolia Merr.Cyathula officinalisCyathula officinalis K.C. KuanCyathula prostrataCyathula prostrata (L.) BlumeCyathula repens Moq.Cyathula rootCyathulae RadixDesmochaeta globosa Schult.Desmochaeta micrantha DC.Desmochaeta prostrata (L.) DC.Desmochaeta repens Schult.dhakto mogrokempu uttharaanikempu uttharanelal chirchitaMedicinal Cyathula Rootnela uttharaaniNiuxiOx kneeProstrate pastureweedPupalia prostrata (L.) Mart.Radix CyathulaeRadix Cyathulae Officinalisrakta apaamargaraktapamargaSheng Chuan Niu XiSzechuan Ox Knee川牛膝

Synopsis

Cyathula: A Comprehensive Reference

1. Identity and Botanical Classification

Cyathula is a genus of flowering plants in the family Amaranthaceae, encompassing approximately 30 species distributed across tropical and subtropical regions of the world. Within the context of traditional medicine and dietary supplementation, two species are of particular importance: Cyathula officinalis Kuan and Cyathula prostrata (L.) Blume. These two species occupy distinct niches in global ethnomedicine — the former principally in East Asian medical traditions, and the latter across a wide swath of African, South Asian, and Southeast Asian folk medicine.

1.1 Cyathula officinalis Kuan (Sichuan Cyathula; Chuan Niu Xi)

Cyathula officinalis Kuan, known as "Chuanniuxi" in Chinese, was first recorded in Xian Shou Li Shang Xu Duan Mi Fang (仙授理伤续断秘方, A.D. 841–846). According to the Chinese Pharmacopoeia (2025 edition), the drug Cyathulae Radix (CR) is the dried root of Cyathula officinalis Kuan, a plant belonging to the Amaranthaceae family and Cyathula genus. The species name honors the Chinese botanist K.C. Kuan, who formally described it. Its common English names include Sichuan cyathula root, medicinal cyathula root, and hookweed.

Cyathulae Radix is a perennial herbaceous plant distributed in Sichuan, Guizhou, and Yunnan provinces in China. Its root is commonly used as a traditional Chinese herbal medicine called "Chuanniux," and it is traditionally believed to have the effects of removing "blood stasis," antifertility, anti-inflammation, stimulating menstruation, and curing orthopedic diseases including bone injury.

Morphologically, Cyathulae Radix is a herbaceous perennial plant reaching approximately 50–100 cm in height with many branches. The stems are erect and four-prismatic but circular at the bottom, exhibiting green color sometimes mixed with purple, and are covered with sparse coarse hairs. The leaves are elliptic to narrowly elliptic, opposite, and petiolate, with entire margins. The most valuable part of the plant for medicinal purposes is its root, which is slender, cylindrical, and often twisted, ranging in color from brown to dark purple. The roots are cylindrical, and the surface is near white, gray-brown, or brown-yellow, with a sweet and sticky taste. The aftertaste is slightly bitter.

1.2 Cyathula prostrata (L.) Blume (Prostrate Pastureweed)

Cyathula prostrata, the prostrate pastureweed, is a perennial, prostrate, herbaceous plant distributed throughout the tropical and subtropical world. It is an annual to perennial branched herb/shrub reaching an approximate length of about 1 metre, rooting at the nodes, with an obtusely quadrangular stem, thickened above the nodes, and young foliage often coloured red. Its synonym Achyranthes prostrata L. reflects its original placement in a related genus before reclassification.

The species bears a wide range of local names. In Nigeria it is called Shawere Pepe (Yoruba) or K'arangiya Kusu (Hausa); in India it is known as Civappu Nayuruvi (Tamil) and Cherukataladi (Malayalam); in Ghana it is called Ninsala (Dagbani). C. prostrata is widespread in the tropics, through many parts of Africa, through Asia to New Guinea, northern Australia, and into the western Pacific.

1.3 Common Forms and Preparations

For C. officinalis, the root (Cyathulae Radix) is the sole pharmacopoeial part used medicinally. CR is harvested in autumn and winter. It is dried or sun-dried after removing the reed head, root, and sediment, stacked back to moisten, and then again dried or sun-dried. Currently, the root of CR is commonly used as an important TCM for the treatment of various orthopedic, gynecological, and urologic diseases in decoction form and as proprietary Chinese medicine. It is additionally processed with wine or salt: wine-processing is traditionally considered to enhance blood-activating properties, while salt-processing is used to direct the herb's actions toward the kidney meridian.

For C. prostrata, the plant is often harvested from the wild for local use, especially for medicinal purposes but also as a food source. Preparations include aqueous decoctions of leaves, stems, or roots, fresh leaf pastes for topical wound application, and ethanolic extracts used in research settings.

2. Traditional and Historical Use

2.1 Traditional Chinese Medicine (TCM)

Cyathulae Radix, also known as "Chuanniux," is a well-known traditional Chinese herbal medicine that has been used in China for thousands of years. Its earliest formal documentation dates to the Tang Dynasty text Xian Shou Li Shang Xu Duan Mi Fang (A.D. 841–846). Cyathulae Radix has been listed in the Pharmacopoeia of the People's Republic of China, and since 1953, over 100 prescriptions containing CR have been utilized to treat gynecological diseases, orthopedic diseases, blood stasis diseases, stroke, and deficiency of the liver and kidney.

In the classical TCM framework, CR is neutral in nature and enters the liver and kidney meridians. It promotes blood circulation to remove blood stasis, unblocks the meridians, relieves joint pain, promotes diuresis, and treats dysuria. It is used to treat amenorrhea with masses, retained placenta, contusions and injuries, rheumatic arthralgia, foot weakness and muscle cramps, hematuria, and bloody dysuria.

TCM distinguishes Cyathula officinalis (Chuan Niu Xi, or Sichuan ox-knee) from the closely related species Achyranthes bidentata (Huai Niu Xi), even though both are sometimes sold as "Niu Xi." Sichuan Cyathula Root is considered more effective in removing blood stasis and promoting menstruation, promoting joint mobility, reducing swelling, and relieving pain, with its primary action being to promote blood circulation and remove stasis. Achyranthes-derived Niu Xi root is considered more effective in tonifying the liver and kidney and strengthening tendons and bones.

C. officinalis (Amaranthaceae family) plays an important role in the clinical treatment of TCM with functions of strengthening bones and muscles and activating blood and removing blood stasis. It is described as a safe and effective herb widely used for the treatment of lower extremity joint pain, joint flexion and extension difficulties, inducing urination and relieving stranguria, with a medicinal history of more than 1000 years. It can be mainly used to activate blood and remove blood stasis in clinical application, such as treatment of cardiovascular and cerebrovascular diseases, arthritis, and dysmenorrhea.

In TCM formulation practice, the root of CR is commonly used as an important TCM for the treatment of various orthopedic diseases (e.g., bone injury, osteoarthritis, rheumatic arthritis, and arthralgia), gynecological disease, and urologic diseases. In the 2015 edition of the Pharmacopoeia of the People's Republic of China, the root of CR was recorded as a traditional Chinese medicinal material and contained in over 30 prescriptions. Classical multi-herb formulas in which it appears include Sanbi Decoction and Duhuo Jisheng Decoction, where CR is often used in combination with other traditional Chinese medicines in clinical practice.

2.2 African Ethnomedicine

Cyathula prostrata has a broad and well-documented role in African traditional medicine. C. prostrata, which belongs to the plant family Amaranthaceae, is one of the wild plants with vast medicinal applications throughout its distribution range in Africa. Its medicinal properties include anti-inflammatory and analgesic properties, antibacterial and antifungal activities, antidiabetes effects, and it has been used to treat rheumatism, eye problems, dysentery, otitis, and wound healing.

Specific documented uses from individual countries include: in Nigeria, C. prostrata is an annual herb widely used traditionally in the treatment of various inflammatory and pain-related health disorders. Among the Mitsogho people in Gabon, C. prostrata was documented as one of the most frequently cited plants in ethnobotanical surveys on plants used to treat infant diarrhea. In Kenya, stems are used for pain relief, and extracts have been reported to reduce writhing in mice (60% at 200 mg/kg).

2.3 Ayurvedic and South Asian Traditions

Cyathula prostrata is used in Ayurveda, known as Kshudra Apamarga, for inflammation, piles, skin ailments, and more. In Ayurveda and African folk medicine, Cyathula has been employed to treat ailments such as rheumatism, menstrual disorders, and wound healing.

3. Key Constituents and Active Compounds

3.1 Phytochemistry of Cyathula officinalis

Previous phytochemical studies on C. officinalis led to the isolation of 59 compounds, including steroids, triterpenoid saponins, flavonoids, and phenolic glycosides. More recent comprehensive reviews have extended this. To date, there are about 70 compounds isolated from the roots of C. officinalis, including steroids, saponins, flavonoids, phenolic glycosides, alkaloids, and organic acids. Over 59 compounds have been identified and isolated from this herb, including alkaloids, flavonoids, tannins, triterpenes, and fatty acids.

Steroids (Phytoecdysteroids): These constitute the primary and most pharmacologically studied class of constituents. Steroids are the representative components of C. officinalis, and they exhibit significant anti-inflammatory, antibacterial, antiviral, antidiabetic, and antiosteoporosis activities. In the Chinese Pharmacopoeia 2020 edition, cyasterone is selected as the only marker for the quality control of C. officinalis. Among the steroids, cyasterone has been studied most extensively. Novel ecdysteroid compounds have also been identified; six undescribed compounds including four undescribed ecdysteroids (cyathsterones A–D) and two undescribed phenolic glycosides (cyathglucosides A–B) have been isolated from the roots of Cyathula officinalis Kuan.

Triterpenoid Saponins: One new oleanane-type triterpenoid saponin, 28-O-[α-L-rhamnopyranosyl-(1→3)-β-D-glucuronopyranosyl-(1→3)-β-D-glucopyranosyl] hederagenin, has been isolated from the roots of Cyathula officinalis. Chikusetsusaponin IV is among the most pharmacologically examined saponins. Forty compounds were identified from the active fraction of C. officinalis, mainly phytoecdysteroids and saponins.

Polysaccharides: A water-soluble polysaccharide (PSRC) was extracted and purified from the roots of Radix Cyathulae officinalis Kuan. Its average molecular weight was 182 kDa. The majority of monosaccharide components were glucose (relative mass 48.8%) with lower levels of mannose, rhamnose, galactose, fructose, and arabinose. In vitro assays revealed that PSRC possessed potent scavenging activities against DPPH, hydroxyl, and superoxide anion radicals.

In sum, C. officinalis phytochemical studies have revealed the primary chemical components as steroids, saponins, flavonoids, alkaloids, and organic acids. Among these, steroids and saponins are its main active components.

3.2 Phytochemistry of Cyathula prostrata

Phytochemical screening of aqueous and ethanolic extracts of Cyathula prostrata reveals the presence of flavonoids, saponins, steroids, terpenoids, alkaloids, tannins, and phytosterols. It is one of the highly exploited tropical herbal plants, with important phytochemical content such as terpenoids, flavonols, phenols, and tannins, steroids, and carbohydrates. Ecdysterone has been found to be the major phytoecdysone in Cyathula prostrata and is present to an extent of 0.05% of the dry plant.

4. Established and Proposed Mechanisms of Action

4.1 Anti-inflammatory and Analgesic Mechanisms

Research on the anti-inflammatory activity of Cyathula species has identified several molecular mechanisms. For C. officinalis, all isolated ecdysteroid and phenolic glycoside compounds inhibited nitric oxide (NO) release in lipopolysaccharide (LPS)-induced RAW 264.7 macrophages in vitro. Among them, cyathsterone A showed the strongest inhibitory effects. Moreover, cyathsterone A has been shown to inhibit the release of the proinflammatory cytokines TNF-α, IL-6, and IL-1β in LPS-induced RAW 264.7 macrophages in vitro.

A proposed NF-κB pathway mechanism has also been identified: one compound from C. officinalis exerted anti-inflammatory activity via the NF-κB signalling pathway.

Cyasterone and chikusetsusaponin IV, two representative components of the active fraction, exert effects on vascular inflammation: cyasterone and chikusetsusaponin IV could significantly inhibit levels of TXA2, ET, MDA, and COX-2 and promote the activities of eNOS and SOD in vitro.

For C. prostrata, studies suggest that the antibacterial, analgesic, and anti-inflammatory activity demonstrated by C. prostrata was due to the inhibition of prostaglandin biosynthesis.

4.2 Hemorheological and Anticoagulant Mechanisms

One of the central pharmacological concepts underlying the TCM use of Cyathulae Radix is its ability to modify blood rheology. CO (Cyathula officinalis extract) and ACO (active fraction) significantly reduced whole blood viscosity, plasma viscosity, and levels of IL-6, NO, TNF-α, and COX-2 in vivo. This directly supports the TCM concept of "removing blood stasis" through measurable hemorheological parameters.

4.3 Antihypertensive Mechanisms

C. officinalis Kuan significantly improved arterial remodeling in spontaneously hypertensive rats (SHR) through decreasing ET-1 and AT1R expression and increasing eNOS and NO expression. The proposed mechanism involves modulation of the endothelin system: different doses of C. officinalis Kuan or enalapril treatment significantly decreased the transcriptional level of ET-1 and AT1R, while increasing the transcriptional level of eNOS in the aorta of SHR.

4.4 Rheumatoid Arthritis Mechanisms

Regarding the ecdysteroid-enriched fraction's mechanism in rheumatoid arthritis, CES (ecdysteroid-enriched fraction of C. officinalis) is involved in the PI3K/AKT/mTOR/SREBP1/SCD-1/GPX4 axis-mediated ferroptosis and anti-inflammation, exerting protective effects against the progression of RA.

A 2025 review of metabolite mechanisms identified: of the 185 metabolites contained in COK (C. officinalis Kuan), 22 metabolites (including Chikusetsusaponin V and chikusetsusaponin IVa) showed multiple anti-RA activities. The mechanisms underlying the effects of COK with respect to the occurrence and development of RA, including inflammatory processes, immunoregulation, fibroblast-like synoviocytes, angiogenesis, oxidative stress, cartilage degradation, and bone destruction, were evaluated.

5. Scientific Evidence by Area of Use

5.1 Musculoskeletal and Arthritic Conditions

Evidence grade: Predominantly preclinical (in vitro and animal); no large-scale human clinical trials identified.

The roots of C. officinalis are still commonly used for the treatment of bone injury, osteoarthritis, and rheumatic arthritis. Modern pharmacological investigations have also revealed that C. officinalis has many activities, such as immune-enhancing, antihypertensive, antiviral, and anti-inflammatory activities. Among these, anti-inflammation has been the focus of research because the inflammatory response has great effects on the progression of osteoarthritis and rheumatic arthritis.

A preclinical study on rheumatoid arthritis published in 2025 (PubMed PMID: 40257367) investigated the ecdysteroid-enriched fraction of C. officinalis: in vitro results revealed that CES suppressed interleukin (IL)-1β-stimulated proliferation, migration, and invasion of MH7A cells in a concentration-dependent manner. In vivo results indicated that CES could reduce the arthritis score, paw swelling, and improve histopathological deterioration. The levels of inflammatory factors, matrix metalloproteinases, and proteins expressed in rat synovial tissue were suppressed after treatment with CES. These findings are limited to cell culture and animal models; no published human clinical trials could be identified for this application.

For C. prostrata, a PubMed-indexed study (Ibrahim et al., 2012, Journal of Ethnopharmacology) examined anti-inflammatory and analgesic activities: the anti-inflammatory (phorbol 12-myristate 13-acetate (PMA)-induced reactive oxygen species, LPS-induced nitric oxide production in U937 macrophages, LPS-induced COX-2 expression, carrageenan-induced rat paw oedema, arachidonic acid-induced ear oedema, and xylene-induced ear oedema) and analgesic activities of the plant extract were investigated. The methanolic extract of C. prostrata did not show inhibitory activity in the in vitro PMA-induced reactive oxygen species, LPS-induced nitric oxide production, and LPS-induced COX-2 expression assays. In the in vivo anti-inflammatory assays, the extract (50, 100, and 200 mg/kg) showed a significant (P<0.05) dose-dependent inhibition in the carrageenan, arachidonic acid, and xylene-induced tests. The results suggest that the methanolic extract of C. prostrata possesses anti-inflammatory and analgesic activities and authenticates the use of the plant in the traditional treatment of ailments associated with inflammation and pain. This is an animal study; no human trials were conducted.

5.2 Blood Stasis and Hemorheology

Evidence grade: Animal models only; no human trials identified.

The hemorheological effects of C. officinalis were studied in an acute blood stasis rat model (PMC5701413). This study evaluated the improving blood rheology and anti-inflammatory properties of C. officinalis Kuan extract (CO) and its active fraction (ACO) on acute blood stasis model Wistar rats, and characterized the correlative constituents. CO at 0.26, 0.53, and 1.04 g/kg and ACO at 0.38, 0.75, and 1.5 g/kg were administered to acute blood stasis model Wistar rats for 3 days. Whole blood viscosity, plasma viscosity, and the levels of interleukin-6 (IL-6), nitric oxide (NO), tumor necrosis factor alpha (TNF-α), and cyclooxygenase-2 (COX-2) in the plasma were measured. Results showed significant reductions in all measured parameters. These findings are relevant to the traditional TCM indication of "blood stasis" but are restricted to animal models.

5.3 Cardiovascular and Antihypertensive Effects

Evidence grade: Animal models only; no human clinical trials identified.

A study published in Experimental and Therapeutic Medicine (Zhao et al., 2017; PMC5740529) examined the effects of C. officinalis Kuan root on arterial remodeling. The study aimed at investigating the prevention of C. officinalis Kuan's roots against arterial remodeling. Spontaneously hypertensive rats (SHRs) were intragastrically administered 3, 6, or 12 g/kg C. officinalis Kuan or normal saline or enalapril (2.5 mg/kg) once a day for 8 weeks. This study was the first to demonstrate that C. officinalis Kuan significantly improved arterial remodeling in SHR through decreasing ET-1 and AT1R expression and increasing eNOS and NO expression. While these mechanistic findings are notable, translation to human cardiovascular disease has not yet been demonstrated in clinical trials.

Separately, a study using C. prostrata extracts in adrenaline-induced hypertensive rats (Ojekale et al., Lagos State University) found that a total of 13 plant secondary metabolites were identified by GC-MS, and C. prostrata extracts effected a marked decrease in the measured blood pressure parameters of adrenaline-induced hypertensive rats evaluated in the study. This, too, is an animal model.

5.4 Antimicrobial Activity

Evidence grade: In vitro only; no human trials identified.

The antimicrobial activities of aqueous (cold and hot) and ethanolic extracts of leaf, stem bark, and root of Cyathula prostrata were investigated against human clinical isolates of Staphylococcus aureus, Streptococcus mutans, Escherichia coli, Bacillus cereus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Proteus mirabilis, Salmonella typhi, and Candida albicans using the agar well diffusion method at extract concentration of 25 mg/ml, with ciprofloxacin (5 μg/ml) and fluconazole (20 μg/ml) as positive reference standards. Results showed that all test isolates were inhibited by various fractions of the leaf, root, and stem bark extracts. The greatest activities were observed with the ethanolic fractions (14.0–25.5 mm), followed by hot water (12.0–24.2 mm) and cold extracts (13.0–18.5 mm). These are in vitro inhibition zone measurements and do not establish clinical efficacy.

5.5 Antidiarrheal Effects

Evidence grade: Animal models only; no human trials identified.

In the castor oil-induced diarrhoea model, the extract produced a significant effect on all parameters measured: onset of diarrhoea, the number of stools, number of wet stools, and weight of wet stools. The antidiarrheal action exerted by aqueous extract of C. prostrata may also be associated with the inhibition of prostaglandin formation.

5.6 Immunomodulatory Activity

Evidence grade: In vitro and animal models only.

Its complex chemical composition endows CR with a wide range of pharmacological activities: it regulates hemorheology and exerts anticoagulant, antihypertensive, estrogen-like, anti-inflammatory, antioxidative, immunomodulatory, and antitumor effects. Regarding the polysaccharide fraction specifically, immunomodulatory activity in murine models has been reported in the literature, with polysaccharides from Radix Cyathulae shown to improve immune response to ovalbumin in mice.

5.7 Antioxidant Activity

Evidence grade: In vitro; no human trials identified.

The majority of monosaccharide components of the purified polysaccharide PSRC was glucose (relative mass 48.8%) with lower levels of mannose, rhamnose, galactose, fructose, and arabinose. In vitro assays revealed that PSRC possessed potent scavenging activities against DPPH, hydroxyl, and superoxide anion radicals.

5.8 Summary of Evidence Strength

The extracts and compounds from CR have many pharmacological activities both in vivo and in vitro, providing beneficial effects on the hematological system and anti-inflammatory properties. However, few studies have investigated the pharmacokinetics and toxicity of CR. Further studies should be undertaken to investigate the clinical effects, toxic constituents, and pharmacokinetics of CR; perform quality evaluation; and establish quality criteria for processed C. officinalis. Taken together, all identified efficacy evidence for Cyathula species is preclinical — derived from cell culture systems and animal models. No adequately powered, peer-reviewed randomized controlled trials in human subjects were identified in this literature review for any indication, for either C. officinalis or C. prostrata.

6. Body Systems Associated with Cyathula

Based on both traditional indications and preclinical pharmacological research, Cyathula species are associated with the following body systems and health areas:

Musculoskeletal System: Cyathula, particularly C. officinalis, is an herb widely used in TCM. Historically, it has been employed to invigorate blood circulation, remove blood stasis, and strengthen muscles and bones. Its traditional indications include the treatment of weakness and pain in the lower back and knees. The root is commonly included in formulas intended for musculoskeletal complaints such as muscle soreness, joint pain, and restricted movement.
Cardiovascular and Hematological System: CR regulates hemorheology and exerts anticoagulant and antihypertensive effects.
Gynecological System: Indications include amenorrhea and abdominal masses, retention of placenta, and hematuria and strangury with blood.
Urological System: CR promotes diuresis and treats dysuria.
Immune System: CR can act on multiple systems, including the immune system and endocrine system.
Gastrointestinal System (C. prostrata): The leaf of C. prostrata is traditionally used for the treatment of diarrhoea.
Integumentary System (C. prostrata): Traditional wound-healing use documented across multiple African ethnomedicinal surveys.

7. Dosage Forms and Reported Dosages

The following dosage information is reported directly from sourced documents. None of these dosages should be interpreted as clinical recommendations; they are presented solely as documented figures from the literature.

7.1 Traditional TCM Dosage (Cyathula officinalis)

A decoction of 6–10 g or it can be made into pills or powder, or soaked in wine. It is contraindicated for menorrhagia, pregnancy, and spermatorrhea.

In compiled TCM sources, the dosage range for Cyathula officinalis Kuan (Chuan Niuxi) is listed as 5–10 g, with indications including rheumatism, hematuria, amenorrhea, and abdominal masses, and it is classified as "cautiously used" in pregnancy.

7.2 Dosages Used in Identified Animal Studies

Hemorheology study (rat model; PMC5701413): C. officinalis extract (CO) at 0.26, 0.53, and 1.04 g/kg and active fraction (ACO) at 0.38, 0.75, and 1.5 g/kg were administered to acute blood stasis model Wistar rats for 3 days.
Antihypertensive/arterial remodeling study (SHR rat model; PMC5740529): Spontaneously hypertensive rats (SHRs) were intragastrically administered 3, 6, or 12 g/kg C. officinalis Kuan or normal saline, or enalapril (2.5 mg/kg), once a day for 8 weeks.
Anti-inflammatory study of C. prostrata (rat model; Ibrahim et al., 2012): The extract (50, 100, and 200 mg/kg) showed a significant (P<0.05) dose-dependent inhibition in the carrageenan, arachidonic acid, and xylene-induced tests.
Hypertension study of C. prostrata (rat model; Ojekale et al.): C. prostrata extracts were administered in graded doses of 50, 100, and 150 mg/kg body weight to the different groups of animals.

7.3 Dosage Forms

The root of CR is currently used in TCM for treatment of various orthopedic, gynecological, and urologic diseases in decoction form and as proprietary Chinese medicine. Other preparation forms documented include wine-soaked preparations, pills, powder, and standardized extracts in research settings. C. officinalis Kuan has been listed in Chinese Pharmacopoeia as a blood-activating herb and is a health product approved by the Ministry of Health of the People's Republic of China.

8. Safety Considerations and Known Interactions

8.1 Pregnancy and Reproductive Cautions

Cyathula root is contraindicated for menorrhagia, pregnancy, and spermatorrhea according to TCM practice. In compiled TCM pregnancy safety resources, Cyathula officinalis Kuan (Chuan Niuxi) is classified as "cautiously used" in pregnancy, with its indications including conditions related to blood stasis such as amenorrhea and abdominal masses. The caution in pregnancy is consistent with its traditional property of promoting blood circulation and stimulating menstruation, which carries a theoretical risk of uterine stimulation.

8.2 Known Pharmacological Safety Profile (Preclinical)

Despite advances made in the research on the phytochemical components and pharmacological effects of CR, its pharmacological mechanism remains unclear. Moreover, the investigation on the pharmacokinetics of CR needs to be promoted to guide its clinical application. For C. prostrata, one published source reports that no significant toxicity has been reported, with LD₅₀ >5,000 mg/kg in rats (safe at therapeutic doses). Excessive use may cause mild gastrointestinal irritation due to saponin content.

8.3 Antifertility Considerations

The traditional TCM description of Cyathulae Radix includes antifertility effects. The root is traditionally believed to have the effects of removing "blood stasis," antifertility, anti-inflammation, stimulating menstruation, and curing orthopedic diseases including bone injury. Experimental work in mice has examined this: a study referenced in the published review literature (Song, 1994, as cited in the Huang et al. 2019 review, Springer) investigated the effects of Radix Cyathulae decoction on pregnancy in mice. The significance of these findings for human fertility at traditional doses has not been established by clinical evidence.

8.4 Drug Interactions and Pharmacokinetics

Cyathulae Radix has been studied as a "guiding herb" (引经药) in TCM formulations. CR exerts anticoagulant effects, which represents a theoretical interaction concern with pharmaceutical anticoagulant or antiplatelet drugs, though no clinical pharmacokinetic interaction studies were identified in the reviewed literature. Few studies have investigated the pharmacokinetics and toxicity of CR. Further studies should be undertaken to investigate the clinical effects, toxic constituents, and pharmacokinetics of CR.

8.5 Quality Control and Adulteration

A documented concern in the commercial supply of Cyathulae Radix is adulteration and substitution with related species. According to nucleotide diversity analysis and sequence alignment, DNA barcoding and allele-specific PCR primers were designed to identify and distinguish Cyathula officinalis from its fake drugs, which has effective practical significance for the authentication of "Chuan Niuxi" crude drug in the market. CR remains a traditional Chinese medicine listed in the Chinese Pharmacopoeia, and cyasterone is used as the indicator agent to characterize its quality.

9. Regulatory and Pharmacopoeial Status

Cyathulae Radix has been listed in the Pharmacopoeia of the People's Republic of China, and since 1953, over 100 prescriptions containing CR have been utilized. In the 2015 edition of the Pharmacopoeia of the People's Republic of China, the root of CR was recorded as a traditional Chinese medicinal material and contained in over 30 prescriptions. CR not only is highly regarded for its medicinal value but has also been approved by the National Health Commission of the People's Republic of China for inclusion in health food products.

No entries for Cyathula species were identified in the European Pharmacopoeia, United States Pharmacopeia (USP), WHO monographs, ESCOP monographs, German Commission E, or European Medicines Agency (EMA) monograph databases. Cyathula is therefore not formally regulated as a medicinal plant in Western jurisdictions, though it may be sold as a dietary supplement or ingredient in traditional formulas in those markets.

10. Research Gaps and Future Directions

The existing body of evidence on Cyathula is heavily weighted toward preclinical investigation. Despite advances in the research on the phytochemical components and pharmacological effects of CR, its pharmacological mechanism remains unclear. Moreover, the investigation on the pharmacokinetics of CR needs to be promoted to guide its clinical application. In addition, scientific and reliable quality control standards should be established based on the correlation between active components and pharmacological effects to effectively develop and use CR.

Key gaps identified in the literature include: the complete absence of randomized controlled trials in human subjects for any indication; limited pharmacokinetic data in humans or animals; insufficient characterization of the toxic constituents and maximum safe doses; lack of standardized extract definitions that would enable inter-study comparisons; and an incomplete mechanistic understanding of the "guiding herb" function attributed to CR in multi-herb TCM formulas.

References

Health Conditions

Health conditions that Cyathula may help support.

No conditions available.

Body Systems

Body systems that Cyathula may help support.

No body systems available.