Chapter 1 Exterior Releasing Herbs

Ma Huang (Herba Ephedrae)

Pinyin Name: Ma Huang

Literal Name: hemp yellow, numb yellow herb
Alternate Chinese Names: Jing Ma Huang, Ma
Huang Rong
Original Source: Shen Nong Ben Cao Jing (Divine
Husbandmans Classic of the Materia Medica) in
the second century
English Name: ephedra
Botanical Name: Ephedra sinica Stapf. (Mu Cao Ma
Huang); Ephedra equisetina Bunge. (Mu Zei Ma
Huang)
Pharmaceutical Name: Herba Ephedrae
Properties: acrid, bitter, warm
Channels Entered: Lung, Urinary Bladder

CHINESE THERAPEUTIC ACTIONS excess perspiration. Exemplar Formula: Ma Xing Gan

1. Releases the Exterior through Diaphoresis Shi Tang (Ephedra, Apricot Kernel, Licorice, and
Exterior-excess, wind-cold condition: Acrid and warm, Gypsum Decoction).
Ma Huang (Herba Ephedrae) ventilates the Lung and is Wheezing or cough from wind-cold attack at the exteri-
commonly used to treat exterior-excess, wind-cold syn- or and cold stagnation in the interior: add it to Gan Jiang
drome characterized by symptoms such as chills, aver- (Rhizoma Zingiberis), Xi Xin (Herba Asari) and Ban Xia
sion to cold, fever, absence of perspiration, headache, (Rhizoma Pinelliae). Exemplar Formula: Xiao Qing Long
body aches and pain, nasal obstruction, and a superficial, Tang (Minor Bluegreen Dragon Decoction).
tight pulse. Its dispersing function also opens peripheral Wheezing and dyspnea caused by stagnation of qi and
channels and collaterals. phlegm: combine it with Xing Ren (Semen Armeniacae
Exterior-excess, wind-cold syndrome: use it with Gui Zhi Amarum), Chen Pi (Pericarpium Citri Reticulatae) and
(Ramulus Cinnamomi) to enhance the diaphoretic action. Hou Po (Cortex Magnoliae Officinalis). Exemplar
Exemplar Formula: Ma Huang Tang (Ephedra Decoction). Formula: Shen Mi Tang (Mysterious Decoction).

2. Relieves Wheezing and Dyspnea, 3. Regulates Water Circulation and

Stops Cough Relieves Edema
Wind-cold constriction of the Lung leading to Lung qi Edema with exterior syndrome: Ma Huang enters the
reversal: Ma Huang ventilates Lung qi and is useful in Lung and Urinary Bladder channels to regulate water circu-
treatment of wheezing, dyspnea and cough characterized lation and eliminate edema. Excess water is generally elim-
by wind-cold attacking the exterior that leads to abnor- inated through perspiration, increased urination, or both.
mal rising of Lung qi. Edema with exterior wind-cold signs or symptoms: use
Cough from wind-cold attacking the exterior and con- Ma Huang with Sheng Jiang (Rhizoma Zingiberis
stricting Lung qi: use it with Xing Ren (Semen Recens), Bai Zhu (Rhizoma Atractylodis Macrocephalae)
Armeniacae Amarum). Ma Huang and Xing Ren work and Gan Cao (Radix Glycyrrhizae) to dispel the exterior
synergistically to treat cough, as the former herb dispers- condition and eliminate water accumulation. Exemplar
es Lung qi and relieves stagnation while the latter herb Formula: Yue Bi Jia Zhu Tang (Maidservant from Yue
sends qi downward. Decoction plus Atractylodes).
Wheezing or cough caused by Lung heat: combine it
with Shi Gao (Gypsum Fibrosum) and Xing Ren (Semen 4. Disperses Cold
Armeniacae Amarum). Ma Huang and Xing Ren have Bi zheng (painful obstruction syndrome): Warm and
synergistic functions in treating wheezing and dyspnea. dispersing in nature, Ma Huang disperses and eliminates
Shi Gao clears Lung heat and neutralizes the warm prop- cold and damp from the exterior parts of the body.
erty of Ma Huang to prevent the possible side effect of Bi zheng caused by wind-damp: use it with Yi Yi Ren

Copyright 2004 Chinese Medical Herbology and Pharmacology by John Chen & Tina Chen. Art of Medicine Press. www.AOMpress.com
 Chinese Medical Herbology and Pharmacology

Ma Huang (Herba Ephedrae)

(Semen Coicis), Xing Ren (Semen Armeniacae Amarum) Lung qi and lead to further complications. Other herbs
and Gan Cao (Radix Glycyrrhizae) to treat muscle aches must be added to harmonize its strong effects.
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and pain of the extremities caused by wind-damp. Ingesting Ma Huang is not recommended in patients

EXTERIOR-RELEASING HERBS
with Liver yang rising or yin-deficient fire, as its use may
Yin sores: This condition is characterized by localized, lead to vertigo, epistaxis, or hematemesis.
painful swellings without heads, that blend into the sur- Ma Huang has a stimulating effect on the sympathetic
rounding tissues. They often appear to be the same color nervous system. Thus, it should be used with caution in
as the skin and are not hot to the touch. The underlying patients with such medical conditions as convulsions,
cause of this problem is blood deficiency with stagnation epilepsy and seizure disorders, diabetes mellitus, hyper-
of cold and phlegm. tension, hyperthyroidism and prostatic enlargement.
Yin sores: use Ma Huang with Shu Di Huang (Radix Use Ma Huang with caution during pregnancy because
Rehmanniae Preparata), Bai Jie Zi (Semen Sinapis) or Lu of its stimulating effect on the uterus.1
Jiao Jiao (Gelatinum Cornu Cervi).
Arteritis obliterans, obliterating phlebitis or Raynauds OVERDOSAGE
disease: use it with Shu Di Huang (Radix Rehmanniae Overdose of Ma Huang is characterized by stimulation of
Preparata), Bai Jie Zi (Semen Sinapis), Lu Jiao Jiao the sympathetic nervous system by the numerous
(Gelatinum Cornu Cervi), Rou Gui (Cortex ephedrine alkaloids in the herb. Symptoms include exci-
Cinnamomi) and Gan Cao (Radix Glycyrrhizae). tation, irritability, restlessness, hypersensitivity, tinnitus,
insomnia, nausea, vomiting, red face, upper abdominal
DOSAGE discomfort, poor appetite, thirst, perspiration, increased
1.5 to 10 grams in decoction. The maximum dosage of blood pressure, dizziness, elevated blood glucose levels,
Ma Huang is 20 to 25 grams. Use of Ma Huang in treat- chest pain, and tremor. In severe cases, there may be car-
ing edema requires dosage between 10 and 15 grams. diac arrhythmia, increased blood pressure, and possibly
The proper method for preparing Ma Huang is to pre- epilepsy and convulsions. Adverse reactions generally
decoct it and remove the resultant foam from the solu- occur between one-half and two hours following inges-
tion prior to the addition of other herbs. Classic texts tion of an excessive quantity of the herb.2
state that the foam is the component more likely to cause TREATMENT OF OVERDOSAGE
irritability. To minimize diaphoresis and neutralize the Overdose of Ma Huang may be treated with either of two
warm nature of Ma Huang, Shi Gao (Gypsum Fibrosum) herbal formulas:
is frequently used with Ma Huang in a three-to-one ratio Formula one contains Da Huang (Radix et Rhizoma
(Shi Gao 3 : Ma Huang 1). Rhei) 9g, Hou Po (Cortex Magnoliae Officinalis) 9g, Mu
Different types of Ma Huang have slightly different Xiang (Radix Aucklandiae) 9g, Mang Xiao (Natrii Sulfas)
therapeutic functions: unprocessed Ma Huang has a 15g, and Gan Cao (Radix Glycyrrhizae) 6g. The decoc-
stronger function to induce perspiration and is com- tion is to be taken once every four hours until toxic
monly used to treat wind-cold conditions; honey-fried symptoms are alleviated.
Ma Huang is weaker in inducing perspiration but more Formula two contains Lu Dou (Semen Phaseoli Radiati)
strongly moistens the Lung and relieves wheezing, dysp- 15g and Gan Cao (Radix Glycyrrhizae) 30g cooked in
nea and cough; and crushed Ma Huang Rong is milder in water to yield 300 ml of decoction. Patients are instructed
inducing perspiration and is generally used in pediatric to take 150 ml per dose, every two hours, for 3 to 5 doses.2,3
medicine to relieve exterior syndromes.
CHEMICAL COMPOSITION
CAUTIONS / CONTRAINDICATIONS Ephedrine alkaloids 0.481-2.47% (l-ephedrine, d-pseu-
Because Ma Huang strongly functions to induce diaphore- doephedrine, l-norephedrine, d-norpseudoephedrine, l-
sis and ventilate the lungs, inappropriate use may damage methylephedrine, d-methylpseudoephedrine), ephedrox-
qi, yin and body fluids. It should be used with caution in ane, 2,3,4-trimethyl-5-phenyloxazolidine benzylmethy-
patients with weak constitutions, spontaneous perspira- lamine, 2,3,5,6-tetramethylpyrazine, essential oil 0.25%
tion arising from qi deficiency, night perspiration due to (l--terpineol).4,5
yin deficiency, wheezing or dyspnea caused by Kidney
deficiency (manifesting in long exhalation and short
inhalation), or edema due to Spleen deficiency.
Chronic or repetitive use of Ma Huang to treat wheez-
ing/dyspnea is not recommended, as it may damage Ephedrine

Copyright 2004 Chinese Medical Herbology and Pharmacology by John Chen & Tina Chen. Art of Medicine Press. www.AOMpress.com
 Chapter 1 Section 1 Wind-Cold Releasing Herbs

Ma Huang (Herba Ephedrae)

PHARMACOLOGICAL EFFECTS mental formula included Ma Huang 10g, Pi Pa Ye
Diaphoresis: In humans, administration of ephedrine (Folium Eriobotryae) 10g, Zi Wan (Radix Asteris) 15g,
alkaloids is associated with increased perspiration, but Kuan Dong Hua (Flos Farfarae) 15g, Bai Qian (Rhizoma
only in subjects with elevated body temperature.6 Cynanchi Stauntonii) 15g, Sang Bai Pi (Cortex Mori)
Antipyretic: Essential oil of Ma Huang is associated with 15g, Ting Li Zi (Semen Descurainiae seu Lepidii) 10g, Bai
antipyretic action in rabbits with artificially-induced Jie Zi (Semen Sinapis) 10g, Su Zi (Fructus Perillae) 10g,
fever. It also reduces temperature in mice with normal Lai Fu Zi (Semen Raphani) 10g, Wu Wei Zi (Fructus
body temperature. However, it has no effect on cats with Schisandrae Chinensis) 10g, Tu Si Zi (Semen Cuscutae)
normal body temperature.7 10g, Bei Mu (Bulbus Fritillaria) 10g, Ban Xia (Rhizoma
Respiratory: Both ephedrine and pseudoephedrine have Pinelliae) 10g, Chen Pi (Pericarpium Citri Reticulatae)
mild, prolonged bronchodilating effects. Ephedrine has a 10g, Xing Ren (Semen Armeniacae Amarum) 15g, and Jie
more rapid onset of action, but its effectiveness may Geng (Radix Platycodonis) 15g. Modifications to the
decrease if it is used repeatedly in a short period of time.8 fundamental formula included Gan Jiang (Rhizoma
Water extract of Ma Huang administered via oral or Zingiberis) for cold; Huang Qin (Radix Scutellariae) and
intraperitoneal injection is also associated with an anti- Huang Lian (Rhizoma Coptidis) for heat; Dang Shen
tussive effect.9 (Radix Codonopsis) and Huang Qi (Radix Astragali) for
Diuresis: Pseudoephedrine has a diuretic function.10 deficiency; and Da Huang (Radix et Rhizoma Rhei) and
Cardiovascular: Use of Ma Huang is associated with an Mang Xiao (Natrii Sulfas) for excess.17
increase in both systolic and diastolic blood pressures. Asthma: An herbal formula containing Ma Huang, Di
Ephedrine has a mild but prolonged effect to constrict Long (Pheretima), Chuan Bei Mu (Bulbus Fritillariae
blood vessels and raise blood pressure.11 Cirrhosae), Chan Tui (Periostracum Cicadae) and Gan
CNS stimulant: Ephedrine has a marked stimulating Cao (Radix Glycyrrhizae) was used to treat asthma
influence on the central nervous system (CNS), cardiovas- patients. Minor modifications to the formula were made,
cular system, and respiratory system. It may cause such side depending on the condition of each individual patient, if
effects as irritability, insomnia, restlessness and tremor.12,13 deemed necessary by the doctors. Out of 55 patients, 28
Antibiotic: Decoction of Ma Huang has varying degrees showed marked improvement, 15 showed moderate
of inhibitory effect in vitro against Staphylococcus aureus, improvement, and 2 showed no response.18
-streptococcus, -streptococcus, Bacillus anthracis,
Corynebacterium diphtheriae, Pseudomonas aeruginosa, HERB-DRUG INTERACTION
Bacillus dysenteriae, and Salmonella typhi.14 The essential General effect: Ma Huang contains ephedrine alkaloids
oil of Ma Huang has an inhibitory effect against E. coli, that stimulate the central nervous system and the cardio-
Candida albicans, and various types of influenza virus.15 vascular system. Combining Ma Huang with cardiac gly-
cosides may lead to cardiac arrhythmia. Ma Huang
CLINICAL STUDIES AND RESEARCH should not be combined with other sympathomimetic
Infantile diarrhea: According to one report, 138 patients drugs, such as ephedrine, pseudoephedrine, theo-
with infantile diarrhea were treated with Ma Huang (2 to phylline, caffeine, monoamine oxidase inhibitors
4 grams) and Qian Hu (Radix Peucedani) (4 to 8 grams). (MAOI), or substances with similar properties.19
The herbs were given once daily as an herbal decoction Beta blockers: The effect of beta blockers may be
with the addition of a small amount of sugar. Out of 138 reduced when combined with Ma Huang because of
patients, 126 (91.3%) showed significant improvement, increased levels of norepinephrine caused by the herb.20
and 124 (90%) responded within 1 to 2 doses. This study [Note: Examples of beta blockers include atenolol
demonstrates the zang fu relationship between the Lung (Tenormin), metoprolol (Lopressor/Toprol), sotalol
and Large Intestine, in that ventilation of the Lung helps (Betapace), propranolol (Inderal), and labetalol
with water retention of the Large Intestine.16 (Normodyne/Trandate).]
Coughing and wheezing: In a clinical trial, 260 patients Diuretics: Ma Huang has a diuretic effect. Though this
with coughing, wheezing and asthma from various caus- potential interaction has not been documented, concur-
es were treated with Chinese herbal formulas, with com- rent use with diuretic drugs may lead to increased elimi-
plete recovery in 148 patients, marked improvement in nation of water and/or electrolytes.21 [Note: Examples of
107 patients, and no response in 5 patients. The formu- diuretics include chlorothiazide, hydrochlorothiazide,
las were given as decoctions, six to eight times daily for furosemide (Lasix), bumetanide (Bumex), and
children, and three times daily for adults. The funda- torsemide (Demadex).]

Copyright 2004 Chinese Medical Herbology and Pharmacology by John Chen & Tina Chen. Art of Medicine Press. www.AOMpress.com
 Chinese Medical Herbology and Pharmacology

Ma Huang (Herba Ephedrae)

TOXICOLOGY Lung qi. Honey-fried Ma Huang should be used instead
Ephedrine and pseudoephedrine are well-absorbed. Peak of unprocessed Ma Huang when treating respiratory dis-
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plasma concentration is reached 1 to 2 hours after oral orders not caused by exterior wind-cold invasion mani-

EXTERIOR-RELEASING HERBS
ingestion of the herb. Ephedrine and pseudoephedrine are festing in cough, dyspnea or wheezing.
distributed throughout the body, with higher concentra- According to the clinical experience of Dr. Chen Shu-
tions found in the liver and kidneys, followed by the brain, Sheng, Ma Huang constricts blood vessels and should be
spleen, fatty tissues, and saliva. The half-lives of these com- used with caution for hypertensive patients. The strong
pounds range from 4.73 to 7.1 or 13.4 hours (when the uri- diaphoretic effect contraindicates its use for weak
nary pH is 5.2, 6, and 7, respectively). Up to 75% of these patients or those experiencing excessive sweating.
compounds can be recovered unchanged in the urine.4 However, Ma Huang Gen (Radix Ephedrae) has the exact
The LD50 for water-extracted Ma Huang in mice via opposite effect. It dilates the blood vessels to lower blood
intraperitoneal injection is 650 mg/kg. The LD50 for essen- pressure and consolidates the wei (defensive) level and
tial oil of Ma Huang in mice is 1.35 ml/kg via intraperi- stops perspiration. When used together, the herb and
toneal injection, and 2.79 ml/kg via oral ingestion.22 root regulate respiration and increase the physiological
efficiency of the lung without causing the side effects of
AUTHORS COMMENTS hyperactivity or increased blood pressure.
Ma Huang is one of the most extensively studied Chinese
herbs. Several ephedrine alkaloids, such as ephedrine and References
1. Brinker, Francis. The Toxicology of Botanical Medicines, rev.
pseudoephedrine, have been isolated and used as phar-
2nd ed., 1996
maceutical drugs. Though the herb is not as potent as its 2. Zhong Yao Bu Liang Fan Ying Yu Zhi Liao (Adverse Reactions and
drug counterpart, the herb still possesses strong medici- Treatment of Chinese Herbal Medicine), 1996; 158:159
nal properties and stimulates both the central nervous 3. Ibid.
system and the cardiovascular system. 4. Xian Dai Zhong Yao Yao Li Xue (Contemporary Pharmacology of
Chinese Herbs), 1997; 32-33
Ma Huang must be prescribed carefully and its use
5. The Merck Index 12th edition, Chapman & Hall/CRCnetBASE/Merck,
supervised. Respectful attention to dosages and the clear 2000
guidelines for use of this herb will result in safe applica- 6. Zhong Xi Yi Jie He Za Zhi (Journal of Integrated Chinese and
tions in the majority of cases. Inappropriate or prolonged Western Medicine), 1989; 9(4):255
use, or high dosages, may lead to adverse reactions and 7. Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of
Chinese Herbs), 1983; 1082
unwanted side effects. While taking this herb, patient
8. Zhong Yao Xue (Chinese Herbology), 1998; 63:65
symptoms and progress must be closely monitored, as 9. Yao Xue Tong Bao (Report of Herbology), 1986; 21(4):235
adverse reactions and side effects may occur in individu- 10. Zhong Yao Xue (Chinese Herbology), 1998; 63:65
als with pre-existing medical conditions. 11. Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of
Traditionally, Ma Huang is pre-decocted and the Chinese Herbs), 1983: 1082
12. Ibid.
resultant foam removed, prior to addition of the other
13. Neuropharmacology, 1984; 23:1241
herbs. Various sources offer several reasons for this. 14. Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of
Some indicate that the foam may cause irritability. Chinese Herbs), 1983; 1082
Others state that the foam is representative of the 15. Zhong Xi Yi Jie He Za Zhi (Journal of Integrated Chinese and
diaphoretic function of Ma Huang and is strongest in Western Medicine), 1989; 9(4):255
16. Ibid., 1988; 6:351
inducing perspiration. Therefore, the foam is best
17. Shan Xi Zhong Yi (Shanxi Chinese Medicine), 1991; 12(7):320
removed to prevent irritability and excessive diaphoresis. 18. Hu Bei Zhong Yi Za Zhi (Hubei Journal of Chinese Medicine), 1990;
Patients with initial wind-cold invasion may require (4):43
the use of unprocessed Ma Huang, as it is strongest in 19. Brinker, Francis. Herb Contraindications and Drug Interactions,
inducing perspiration and driving out external pathogen- 1997; 63
20. The IBIS Guide to Drug-Herb and Drug-Nutrient Interactions, 1999
ic factors lingering in the wei (defense) level. However, if
21. Chen, J. Recognition & prevention of Herb-drug interactions,
the patient has overcome the exterior condition but still is Medical Acupuncture, Fall/Winter 1998/1999; volume 10/number 2;
experiencing coughing, dyspnea or wheezing, then it is 9-13
best to choose honey-fried Ma Huang, as it has a weaker 22. Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of
diaphoretic function but is stronger to relieve rebellious Chinese Herbs), 1983; 1082

Copyright 2004. Chinese Medical Herbology and Pharmacology by John K Chen and Tina T Chen.
Art of Medicine Press, Inc. Tel: 626-333-1430 Fax: 626-609-2844 www.AOMpress.com

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