Kǔ Lián Pí (苦楝皮) — Chinaberry bark / Persian lilac bark

On this page

1. Overview
2. Properties
3. Actions and indications
4. Key formulas
5. Modern research
6. Incompatibilities
7. Cautions and toxicity
8. Treatment at my clinic

1. Overview

Kǔ Lián Pí (苦楝皮) — the bark of Melia azedarach, the chinaberry tree or Persian lilac — is one of the strongest anti-parasitic herbs in the Chinese Materia Medica. It belongs to the “Herbs that expel parasites” (Sha Chong Yao) category and has a documented broad-spectrum action against roundworm, hookworm and pinworm. The bark is also used topically for fungal skin infections and scabies. Ku Lian Pi carries significant hepatotoxicity risk — multiple case reports of acute liver injury are documented in the literature, and the therapeutic dose sits relatively close to the toxic dose. The herb is prescribed only short-term, in carefully controlled doses, by experienced practitioners, for clearly indicated conditions where safer alternatives have been considered and ruled out. It is used in Chinese herbal medicine as a component of classical formulas and in tailored prescriptions.

I prescribe Kǔ Lián Pí only when clinically necessary, in short courses, with full informed consent regarding the safety profile, and as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan. Patients on the herb are monitored for liver-related symptoms throughout the course.

Important species note. Ku Lian Pi refers to the bark of Melia azedarach (chinaberry). It should not be confused with Chuan Lian Zi — the fruit of the related but distinct species Melia toosendan, which is also used in Chinese herbal medicine for Liver Qi stagnation and parasites but has a substantially different (and lower) toxicity profile. The two are sometimes confused in older texts; modern Chinese pharmacology distinguishes them clearly.

2. Properties

3. Actions and indications

Principal actions

1. Kills parasites — broad spectrum, particularly active against roundworm and hookworm
2. Topical antifungal and anti-parasitic action — for scabies, ringworm and other skin parasitic conditions

Indications

1. Roundworm infection — the principal classical indication
2. Hookworm and pinworm infections
3. Scabies (topical use)
4. Fungal skin infections including tinea (topical use)

4. Key formulas containing Kǔ Lián Pí

Ku Lian Pi is most often used as a single herb decoction for parasitic clearance or topical preparation rather than in named multi-herb formulas, given its strong action and toxicity profile. It is included in some classical broad-spectrum anti-parasitic combinations such as Hua Chong Wan, used short-term and under qualified supervision.

See the full Chinese herbal medicine formula directory for detailed information on related classical formulas.

5. Modern research

Melia azedarach contains meliatoxins (a group of triterpenoid limonoids) as the principal active and toxic constituents. The anti-parasitic activity is well-documented against multiple intestinal helminths. The principal active anti-parasitic compound, toosendanin, is the same as the principal active constituent of the related species Melia toosendan. Modern pharmacological research has confirmed hepatotoxic effects at higher doses, with reported case series of acute hepatitis following overdose or prolonged use. The herb is the subject of pharmacovigilance attention in mainland China and is restricted in some regions.

6. Incompatibilities

Kǔ Lián Pí is not listed in either of the two classical incompatibility texts — Shi Ba Fan (Eighteen Antagonisms) or Shi Jiu Wei (Nineteen Mutual Inhibitions). As with every Chinese herb, and particularly for a herb with toxicity considerations, it should be prescribed only as part of a balanced formula by a registered Chinese herbalist (RCHM), and only when safer alternatives have been considered.

7. Cautions and toxicity

Hepatotoxicity is the principal safety concern. Documented adverse events include acute hepatitis, raised liver enzymes, jaundice and (in severe cases) acute liver failure. The therapeutic dose for parasitic clearance sits relatively close to the toxic dose, so dosing must be precise and the course brief.

• Use short-term only — typically a few days for the parasitic course, never as a sustained treatment
• Do not exceed the prescribed dose. Overdose causes nausea, vomiting, abdominal pain, jaundice and, in severe cases, hepatic failure and death
• Avoid in pregnancy — absolute contraindication
• Avoid in liver disease — any pre-existing hepatic impairment is a contraindication
• Avoid in children below 12 (or use extreme caution under specialist supervision)
• Avoid in patients with significant weakness, debility or recent illness
• Monitor liver function — baseline and post-treatment LFTs are reasonable for any course beyond a few days

Pattern contraindications

Contraindicated in Spleen and Stomach Yang deficiency, in any pattern characterised by Cold or weakness, and in patients with established Liver Qi stagnation with Liver Yin deficiency.

Modern drug interactions

Avoid combination with paracetamol (acetaminophen), other hepatotoxic medications including methotrexate, isoniazid and ketoconazole, and alcohol. Coordinate any course with the patient’s prescriber. Tell your GP and your herbalist about all medications.

Important: Chinese herbs — and particularly Chinese herbs with toxicity considerations such as Ku Lian Pi — should always be prescribed by a fully qualified herbalist who is a member of the Register of Chinese Herbal Medicine (RCHM). Never self-prescribe or self-administer this herb. Dr (TCM) Attilio D’Alberto is a member of the RCHM with over 25 years of clinical experience.

8. Treatment at my clinic

I prescribe Kǔ Lián Pí only when clinically necessary, in short courses, for confirmed parasitic infections (see my intestinal parasites article) and with full discussion of the safety profile. Safer alternatives (Shi Jun Zi, Fei Zi, Bing Lang) are considered first where appropriate.

I see patients in person at my clinic in Wokingham, Berkshire. Online Chinese herbal medicine consultations are available throughout the UK and internationally. Visit the prices page for consultation fees.

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