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Traditional Chinese medicine

CoptisCoptis chinensis

Coptis (huang lian) is the rhizome that supplies berberine; berberine hydrochloride cut diarrhea and pain frequency in a 132-person IBS-D trial (p = 0.032 and p < 0.01).

Botanical name
Coptis chinensis
Part used
rhizome, dried; used raw or fried with wine, ginger or evodia
Also called
pinyin Huang lian (黄连); Chinese goldthread, Coptidis rhizoma, Rhizoma coptidis, Oren (Japanese)
Used in
Traditional Chinese medicine
Taken for
Loose stools and diarrhea, Antimicrobial use, Cramping and pain
Sold as
decoction, granule extract, patent medicine, capsules, powder

What coptis is

Coptis, or huang lian, is the dried rhizome of Coptis chinensis and related species of the buttercup family. The cut root is bright yellow, a color that comes from its alkaloids, chiefly berberine, with palmatine and coptisine. Coptis is not the same plant as goldenseal or barberry, though all three supply berberine.

The tradition prepares the rhizome in several ways: raw, or fried with wine (jiu huang lian), with ginger (jiang huang lian) or with the fruit of evodia (yu huang lian), each with its own purpose in the texts. It is taken as a decoction, as granules and in patent medicines. In the digestive formulas it is the lead herb of Ban Xia Xie Xin Tang, where it is paired with pinellia, scutellaria, dried ginger, ginseng, licorice and jujube. Berberine hydrochloride, the isolated alkaloid, is a separate product with its own trials and has its own page.

What the traditions use it for

Traditional Chinese medicine (about TCM)

Huang lian is entered in the materia medica as bitter and cold, entering the heart, spleen, stomach, liver, gallbladder and large intestine channels, with the actions of clearing heat, drying dampness, draining fire and resolving toxicity. For the gut the tradition uses it for what it calls damp-heat in the intestines: urgent, foul, burning diarrhea or dysentery with abdominal pain, and for stomach heat with a bitter taste and acid regurgitation. In Ban Xia Xie Xin Tang it is used against the “heat” half of a cold-and-heat mixture while dried ginger works on the “cold” half. The same texts caution that a bitter, cold herb can damage a spleen and stomach that are already weak or cold. Heat and dampness here are pattern names from the texts, not measurements.

The constituents

Berberine, palmatine and coptisine are the main alkaloids, and berberine is the one studied most often. A mouse and cell study of Ban Xia Xie Xin Tang identified 11 bitter compounds in the formula, including berberine, coptisine and palmatine; docking work gave berberine the strongest score at the bitter-taste receptor TAS2R38, and in mice with induced dyspepsia the formula reduced eosinophil infiltration and inflammatory markers in the duodenum. Berberine is also reported to inhibit the liver and intestinal enzyme CYP3A4. These are laboratory and animal findings, not trial results.

The human evidence

We could not find a placebo-controlled trial of coptis rhizome on its own for a gut outcome. The human data are on the isolated alkaloid, berberine, and on formulas that contain coptis.

Berberine has the clearest trial in diarrhea-predominant IBS. In a Chinese double-blind, placebo-controlled trial, 196 patients were recruited and 132 randomized to berberine hydrochloride 400 mg (given twice daily, per the abstract) or placebo for 8 weeks. The berberine group had a lower frequency of diarrhea (p = 0.032), abdominal pain (p < 0.01) and urgent need to defecate (p < 0.01), and trends of improvement in the IBS symptom score, anxiety and depression scores. In acute watery diarrhea the older trials disagree. In 165 adults, a single 400 mg dose of berberine sulfate cut stool volume in E. coli enterotoxin diarrhea, with 42 percent stopping diarrhea at 24 hours against 20 percent of controls. In a 400-adult trial, berberine had no antisecretory effect on its own in cholera, although a factorial analysis suggested about a liter fewer diarrheal stools in the berberine groups, and neither it nor tetracycline beat placebo in 215 people with non-cholera diarrhea.

For Helicobacter pylori, a meta-analysis found berberine added to triple therapy raised the eradication rate (RR 1.18, 95% CI 1.12 to 1.24 by breath test) and lowered adverse effects (OR 0.59). For the whole formula Ban Xia Xie Xin Tang, see the pinellia page; 57 trials with 5,525 people with dyspepsia favored the formula over Western medicine, but not over placebo on a visual scale.

Not tested: coptis rhizome alone for IBS or dyspepsia, and berberine against standard IBS-D drugs.

StudyDoseWhat it found
Double-blind placebo-controlled RCT, 132 randomized people with IBS-D (berberine hydrochloride) PMID 26400188400 mg of berberine hydrochloride, given twice daily per the abstract, for 8 weeksLower frequency of diarrhea (p = 0.032), abdominal pain (p < 0.01) and urgent need to defecate (p < 0.01) than placebo
Randomized trial, 165 adults with E. coli or cholera diarrhea (berberine sulfate) PMID 3549923400 mg onceE. coli group: 42% vs 20% stopped diarrhea at 24 h (p < 0.05); cholera: stool volume 2.22 vs 2.79 L in one 8-h period
Double-blind placebo-controlled trial, 400 adults with acute watery diarrhea (berberine, tetracycline, both) PMID 3935203Berberine alone or with tetracyclineNo antisecretory effect of berberine alone in cholera; no benefit over placebo in 215 non-cholera cases
Meta-analysis of RCTs, berberine plus triple therapy vs triple therapy for H. pylori PMID 30410559Berberine added to standard regimenEradication RR 1.18 (1.12 to 1.24) by breath test; adverse effects OR 0.59 (0.46 to 0.75)
Umbrella review of 11 meta-analyses of berberine RCTs PMID 36999891VariousEffect reported on H. pylori infection; common side effects were constipation and diarrhea

Doses, in trials and in practice

In the IBS-D trial the abstract reports berberine hydrochloride 400 mg delivered twice daily for 8 weeks; the early diarrhea trial used single oral doses of 400 mg of berberine sulfate, and 1,200 mg with tetracycline in one arm. In the cyclosporine interaction study, 0.2 g was taken three times a day. Coptis rhizome itself is dosed in the tradition in grams in a water decoction, simmered with the other herbs; the grams differ by formula and none are tied to a gut trial. Berberine hydrochloride, the isolated alkaloid, and coptis powder are different products.

The amounts above are what trials and pharmacopoeias record, not a dose for you; your medicines and conditions change the answer, and a clinician or pharmacist who knows them is the person to ask.

What is known about safety

The umbrella review lists constipation and diarrhea as the common side effects of berberine. Newborns are the group of concern: coptis and phellodendron had been banned in Singapore for about three decades when one study was done, because berberine was implicated in jaundice and kernicterus in newborns with G6PD deficiency. That phase I/II study followed 20 patients who took coptis for 1,055 patient-days and found no organ toxicity or electrolyte imbalance; three patients with thalassemia had a transient rise in bilirubin, and the authors found conflicting evidence in the literature. Pregnancy and breastfeeding have no controlled safety data in what we read. On product quality, a New York screen of 90 Chinese herbal and patent medicine samples found nine different Western drugs across five samples, among them diclofenac, hydrochlorothiazide and sildenafil, and one sample held two drugs contraindicated for its intended users; it did not concern coptis products specifically.

Where it meets prescription medicines

In a randomized trial of 104 kidney-transplant recipients on cyclosporine, 52 added berberine 0.2 g three times a day for 3 months. Their cyclosporine trough levels and concentration-to-dose ratios were 29.3 percent and 27.8 percent higher than the 52 who did not take it. In a small pharmacokinetic study of 6 patients, the cyclosporine exposure (AUC) rose 34.5 percent; the authors attribute this to CYP3A4 inhibition. Other medicines cleared by CYP3A4 may be affected in the same way, though we could find no controlled study of coptis rhizome itself.

Medicines the site’s own interaction rules flag with coptis

The quiz applies these rules when someone names a medicine. They come from published interaction references and are a reason to ask a pharmacist, not a diagnosis:

Catalog entries that list coptis

If you want coptis in a product rather than as a loose herb, these are the entries that carry it, with the label amounts and the reviews read.

Emma Relief Daily Digestive Supplement 4 out of 5 from 11,119 ratings from Amazon · $2.00 a day Gundry MD Total Restore 4.1 out of 5 from 9,333 ratings from Amazon · $2.33 a day Thorne Berberine 4.4 out of 5 from 6,514 ratings from Amazon · ~$2.93 a day at the full label dose, about $1.47 at the lowest Omyo GLP-1 Digestive Support 4.8 out of 5 from 2,814 ratings from omyohealth.com · $2.00 a day ActivatedYou Morning Complete 3.9 out of 5 from 1,503 ratings from Trustpilot · $2.08 a day Snap Supplements Gut Health 4.5 out of 5 from 410 ratings from Amazon · $1.20 a day Nuora Gut Ritual 2.2 out of 5 from 39 ratings from Amazon · $1.30 a day

From the herb to a product that fits you

The quiz takes about three minutes, asks what you have tried and which medicines you take, and shows the products whose trials and labels fit, with the reasons.

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Herbs that sit beside it

TCM / Western Berberine Berberis, Hydrastis, Coptis and Mahonia species (source plants) Western Goldenseal Hydrastis canadensis TCM Pinellia Pinellia ternata TCM Ginseng Panax ginseng TCM Evodia (wu zhu yu) Tetradium ruticarpum (syn. Evodia rutaecarpa)

Common questions

Is coptis the same as berberine?

No. Berberine is one alkaloid in coptis, and berberine supplements are the purified compound, not the rhizome. Coptis also contains palmatine and coptisine.

Does coptis work for IBS diarrhea?

Berberine hydrochloride, the isolated alkaloid, reduced diarrhea frequency (p = 0.032) and pain frequency (p < 0.01) versus placebo in a 132-person trial over 8 weeks. We could not find a trial of the whole rhizome.

Why is it bitter and cold in Chinese medicine?

The tradition classes huang lian as bitter and cold and uses it for what it calls heat and dampness in the intestines. It also warns that a bitter cold herb can damage a cold or weak stomach and spleen.

Is coptis safe for infants?

Singapore had banned coptis and phellodendron for about three decades over a suspected link to jaundice in G6PD-deficient newborns. A small study in adult patients found no organ toxicity, and the authors found the evidence conflicting.

Does coptis interact with cyclosporine?

Berberine raised cyclosporine levels in a trial of kidney-transplant recipients, and the authors attribute the rise to CYP3A4 inhibition, an enzyme that also handles many other medicines.

Sources