Contraindicated / High risk. Use only under practitioner supervision.
TCM Properties
- Taste
- bitter
- Temperature
- cold
- Channels
- Liver, Spleen, Stomach
Traditional Use
Primary Actions
- Strongly expels intestinal parasites - classically used for roundworm, pinworm, hookworm, and mixed helminth patterns when abdominal pain, irritability, anal itching, or worm expulsion indicate a significant parasitic burden.
- Kills parasites and relieves itching externally - powdered or decocted topical use addresses tinea, scabies, eczema, and vulvovaginal itching when damp-heat and parasites combine at the skin surface.
- Clears damp-heat from localized toxic lesions - its bitter coldness helps dry dampness and reduce inflammatory itching when hot, weeping, or foul lesions accompany fungal or parasitic skin disease.
- Acts as a harsh short-course eliminant rather than a daily tonic herb - traditionally reserved for defined excess conditions and usually combined with supportive or harmonizing herbs to reduce the burden of its toxicity.
Secondary Actions
- Traditional internal use may extend to trichomonas-type vaginal itching and damp-heat leukorrhea, especially when combined with external washing methods.
- Because Ku Lian Pi is cold and toxic, classical practice often limits the treatment course and balances it with digestive support rather than prescribing it as a long-term single herb.
Classic Formulas
- Hua Chong Wan (化虫丸) - traditional worm-expelling pill in which Ku Lian Pi is combined with Shi Jun Zi, Bing Lang, and other antiparasitic herbs for stubborn intestinal parasite accumulation.
- Lian Liu Er Pi Yin (楝榴二皮饮) - a regional decoction pairing Ku Lian Pi with Shi Liu Gen Pi for hookworm and related intestinal parasite presentations.
- External Ku Lian Pi powder or wash preparations mixed with vinegar, oil, or fat are repeatedly recorded in materia medica practice for scabies, tinea, and itching skin lesions.
Classical References
- Ming Yi Bie Lu and later materia medica list Ku Lian Pi as a cold, bitter, toxic bark that powerfully expels worms and should not be overused because of its harsh nature.
- TCM Wiki and related educational materia medica emphasize its dual internal-external role: strong antiparasitic action internally and damp-heat itching relief externally.
- The classical cautions to decoct thoroughly and avoid prolonged or excessive dosing reflect longstanding recognition that therapeutic value and toxicity sit close together in this herb.
Modern Research
Active Compounds
- Toosendanin (trichilin-class limonoid) - the best-known bioactive marker in medicinal Melia species and a major driver of both pharmacologic activity and toxicity concern
- Meliatoxins A and B (limonoid toxins) - mammalian toxic constituents important for quality control and overdose risk assessment
- Melianone and related limonoids (tetranortriterpenoids) - contribute antiparasitic, cytotoxic, and metabolic research interest
- Cedrelone-class limonoids (limonoids) - associated with anti-inflammatory and antiproliferative activity in genus-level Melia research
- Sterols and triterpenoids from bark extracts - minor constituents that broaden the phytochemical profile beyond the limonoid fraction
Studied Effects
- A recent review of Melia limonoids highlights anti-cancer, insecticidal, antiparasitic, and anti-botulism activities while also stressing non-negligible toxic effects, especially around toosendanin-class constituents (PMID 35140606)
- Human poisoning has been documented after Melia azedarach exposure, with neurologic and systemic symptoms occurring after medicinal use, confirming that clinical toxicity is not merely theoretical (PMID 18763152)
- Chemical analysis of bark isolates identified multiple constituents with protein tyrosine phosphatase 1B inhibitory activity, showing that the bark remains pharmacologically active beyond its classical antiparasitic role (PMID 32081038)
- A bark hexane fraction showed experimental anticancer activity but required parallel toxicity evaluation, illustrating the narrow therapeutic window that complicates modern development (PMID 24278590)
PubMed References
Safety & Interactions
Contraindications
- Pregnancy
- Children or frail patients without direct practitioner supervision
- Spleen and Stomach deficiency-cold, chronic diarrhea, or non-parasitic itching disorders
Cautions
- Ku Lian Pi is a toxic herb with limonoid constituents close to the edge of therapeutic and overdose ranges; prolonged, excessive, or unsupervised internal use is inappropriate
- Human poisoning reports describe neurologic and systemic symptoms after exposure, and classical texts likewise warn against large doses or long courses
- Use topically with care on broken or highly inflamed skin, and avoid treating it as a general wellness antifungal or parasite cleanse
- MSK page not found - drug interaction data not available from Memorial Sloan Kettering integrative medicine database