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Herbal Monograph

Horny goat weed

Epimedium brevicornu Maxim.

Berberidaceae (Barberry family)

Class 2c Nervine Anti-inflammatory Cardiotonic Nootropic

Premier TCM kidney-yang tonic — natural PDE5 inhibitor with evidence for bone health, sexual function, and neuroprotection.

Overview

Plant Description

Low-growing, rhizomatous, deciduous or semi-evergreen perennial herb, 20-60 cm tall. Rhizome creeping, slender, irregularly branched, with wiry rootlets. Stems slender, erect, glabrous. Leaves compound: basal leaves biternate (twice-divided into three), with 9 leaflets; stem leaves similar but smaller. Leaflets ovate to heart-shaped, 3-8 cm long, acuminate at apex, cordate or rounded at base, margins finely spinulose-serrate (with spine-tipped teeth), glabrous above, slightly pubescent beneath. Flowers in loose, few-flowered racemes; individual flowers distinctive with 4 inner sepals (petaloid, colored), 4 petals with elongated spurs (the 'horns' — hence 'brevicornu' meaning 'short-horned'), white, yellow, pink, or purple depending on species/variety; 4 stamens. Fruit a capsule containing several seeds with a fleshy aril. The Chinese Pharmacopoeia specifies four species for the drug Epimedii Folium (Yin Yang Huo): E. brevicornu, E. sagittatum, E. pubescens, and E. koreanum.

Habitat

Shady, moist forest understory, mountain slopes, ravines, and thickets. Prefers dappled shade in rich, humus-filled, well-drained soil. Found at altitudes of 200-3,000 m depending on species. E. brevicornu is typical of temperate mountain forests of northwestern China (Shaanxi, Gansu, Sichuan, Shanxi, Henan).

Distribution

The genus Epimedium is native to temperate East Asia and parts of the Mediterranean. The four medicinal species are primarily found in China: E. brevicornu in northwestern and central China; E. sagittatum in central and southern China; E. pubescens in western China (Sichuan, Guizhou); E. koreanum in northeastern China and Korea. Commercially cultivated in China (Sichuan, Guizhou, Hubei, Shaanxi provinces). Some wild harvesting continues but cultivation is increasing to meet demand.

Parts Used

Leaf (aerial herb) — Epimedii Folium (淫羊藿)

Preferred: Standardized extract (10-20% icariin) for modern clinical use; dried herb decoction or fat-processed herb for traditional TCM formulations

The dried leaf (including stems) is the official medicinal part in the Chinese Pharmacopoeia and in international herbal commerce. The leaf contains the highest concentration of prenylated flavonoids (icariin, epimedin A/B/C). In TCM practice, the herb may be used either raw (sheng) or processed (zhi — stir-fried with sheep fat). The processed form is considered more warming and kidney-yang-tonifying. Modern standardized extracts are typically from the leaf.

Key Constituents

Prenylated flavonol glycosides

Icariin 0.5-5% in dried leaf depending on species and growing conditions; E. koreanum and E. brevicornu tend to have higher content; Chinese Pharmacopoeia requires ≥0.5% icariin
Icariside II (baohuoside I) Present in leaf; also a major gut metabolite of icariin
Icaritin Minor amounts in leaf; primary aglycone metabolite
Epimedin A Present in leaf
Epimedin B Present in leaf
Epimedin C Present in leaf (often the most abundant flavonoid glycoside in some species, sometimes exceeding icariin)

The prenylated flavonol glycosides, particularly icariin and its metabolites, are the primary bioactive constituents. The therapeutic relevance centers on three key pharmacological mechanisms: (1) PDE5 inhibition — icariin and more potently icariside II and icaritin inhibit phosphodiesterase type 5, the same target as sildenafil (Viagra), increasing cGMP levels in smooth muscle and promoting vasodilation in erectile tissue. The PDE5 inhibitory potency of icaritin approaches that of sildenafil in vitro, though bioavailability and clinical efficacy differ. (2) Osteogenic activity — icariin stimulates osteoblast proliferation and differentiation, inhibits osteoclast-mediated bone resorption, and has shown bone-protective effects in animal models of osteoporosis. (3) Neuroprotection and cognitive effects — prenylated flavonoids show antioxidant and anti-inflammatory activity in neural tissue, inhibit acetylcholinesterase, and promote nerve growth factor secretion in preclinical models.

Other flavonoids

Quercetin and kaempferol glycosides Present in leaf
Hyperoside (quercetin-3-O-galactoside) Present in leaf

Non-prenylated flavonoids provide broad-spectrum antioxidant and anti-inflammatory activity, complementing the specific pharmacological effects of the prenylated flavonoids.

Lignans and polysaccharides

Epimedium polysaccharides Present in leaf and rhizome
Lignans (various) Minor amounts

Polysaccharides and lignans are secondary bioactive compounds. The polysaccharides may contribute to immunomodulating and adaptogenic-type effects. The lignans add to the overall phytoestrogenic profile.

Sterols and terpenoids

Beta-sitosterol Present in leaf
Campesterol Present in leaf

Phytosterols contribute to anti-inflammatory effects and may have minor relevance to prostatic and cardiovascular health.

Herbal Actions

Nervine (primary)

Supports and calms the nervous system

In TCM, Yin Yang Huo is classified as a kidney-yang tonic with secondary effects on the nervous system — improving vitality, dispelling fatigue, and enhancing mental function. Modern pharmacology supports nervine/nootropic activity through multiple mechanisms: PDE5 inhibition increases cerebral blood flow; icariin shows neuroprotective effects against oxidative stress and beta-amyloid toxicity; acetylcholinesterase inhibition; promotion of nerve growth factor secretion. The nervine effect is more tonic/restorative than sedative.

[1, 4]
Anti-inflammatory (primary)

Reduces inflammation

Demonstrated anti-inflammatory activity through NF-kB pathway inhibition, COX-2 suppression, and reduction of pro-inflammatory cytokines (TNF-alpha, IL-1beta, IL-6). Icariin suppresses osteoclast-mediated bone resorption through RANKL/OPG modulation, which is both an anti-inflammatory and bone-protective mechanism. Clinically relevant for inflammatory joint conditions and osteoarthritis.

[4]
Cardiotonic (secondary)

Strengthens and tones the heart muscle

Cardiovascular effects include PDE5-mediated vasodilation (increasing cGMP in vascular smooth muscle), improved endothelial function, nitric oxide production enhancement, and mild blood pressure-lowering effects. Icariin has shown cardioprotective activity in animal models of ischemia-reperfusion injury.

[4]
Antioxidant (secondary)

Prevents or slows oxidative damage to cells

The flavonoid content (both prenylated and non-prenylated) provides significant antioxidant capacity. Icariin and icariside II scavenge free radicals and upregulate endogenous antioxidant enzymes (SOD, glutathione peroxidase). The antioxidant activity is particularly relevant to the neuroprotective and cardioprotective effects.

[4]
Nootropic (secondary)

Enhances cognitive function, memory, and mental performance

Cognitive-enhancing effects demonstrated in animal models: improved spatial learning and memory, acetylcholinesterase inhibition, increased hippocampal brain-derived neurotrophic factor (BDNF), and protection against neuronal apoptosis. These effects provide pharmacological support for the TCM indication of kidney-yang deficiency manifesting as poor memory and mental dullness.

[4]
Immunomodulating (mild)

Modulates and balances immune function

Epimedium polysaccharides and flavonoids show immunomodulating activity in preclinical studies — enhancing macrophage function, modulating T-cell responses, and increasing natural killer cell activity. The immunomodulating effect supports the TCM classification as a tonic that 'strengthens the Wei Qi' (defensive energy).

[1]

Therapeutic Indications

Reproductive System

supported

Erectile dysfunction and male sexual debility

The most well-known indication, supported by the PDE5 inhibitory mechanism of icariin and its metabolites. In TCM, impotence (Yang Wei) is a cardinal sign of Kidney Yang Deficiency for which Yin Yang Huo is a primary herb. Preclinical studies demonstrate that icariin improves erectile function in cavernous nerve-injured rats and in aged rats through cGMP/PDE5 pathways and nitric oxide synthesis. In vitro, icaritin inhibits PDE5 with an IC50 approaching that of sildenafil. Human clinical evidence is limited to small, uncontrolled studies showing subjective improvement in erectile function scores, but no large RCTs against placebo or active comparator.

[1, 2]
traditional

Female sexual dysfunction and low libido

In TCM, Yin Yang Huo is used for both male and female Kidney Yang Deficiency manifesting as low libido, infertility, and reproductive weakness. The phytoestrogenic effects of icaritin (weak estrogen receptor agonist activity) and the PDE5-mediated vasodilation provide pharmacological rationale for effects on female sexual arousal. Clinical evidence in women is extremely limited.

[1]
traditional

Male infertility (oligospermia, asthenospermia)

TCM indication for Kidney Yang Deficiency with reproductive failure. Limited animal studies suggest icariin may improve sperm quality parameters. Not supported by human clinical trials.

[1]

Musculoskeletal System

supported

Osteoporosis and bone loss

Strong preclinical evidence for osteogenic effects. Icariin promotes osteoblast differentiation through BMP-2/Smad signaling and Wnt/beta-catenin pathways, inhibits osteoclastogenesis through RANKL/OPG modulation, and increases bone mineral density in ovariectomized rat models (a standard model for postmenopausal osteoporosis). The TCM indication of 'strengthening sinews and bones' in Kidney Yang Deficiency aligns with this pharmacological evidence. Clinical trials are small but suggestive of benefit.

[3, 4]
supported

Osteoarthritis and rheumatic joint pain

In TCM, Yin Yang Huo 'expels Wind-Dampness' — the traditional explanation for its use in bi syndrome (rheumatic joint pain). The anti-inflammatory mechanisms (NF-kB inhibition, COX-2 suppression, cytokine modulation) provide pharmacological support. Icariin shows chondroprotective activity in vitro, protecting cartilage from IL-1beta-induced degradation.

[1, 4]
traditional

Weakness of low back and knees (Kidney Yang Deficiency pattern)

A classic TCM indication: weak, aching lumbar region and knees associated with Kidney Yang Deficiency and aging. The bone-strengthening and anti-inflammatory effects provide relevant mechanisms. Often combined with Du Zhong (Eucommia bark), Xu Duan (Dipsacus root), and Gu Sui Bu (Drynaria rhizome).

[1]

Nervous System

preliminary

Cognitive decline and memory impairment

Preclinical evidence supports neuroprotective and cognitive-enhancing effects of icariin: improved spatial learning in Morris water maze tests, increased hippocampal BDNF and nerve growth factor, protection against beta-amyloid-induced neurotoxicity, and acetylcholinesterase inhibition. Being investigated as a potential therapeutic agent for Alzheimer's disease and age-related cognitive decline. Human clinical evidence is very limited.

[4]

Cardiovascular System

preliminary

Endothelial dysfunction and cardiovascular risk

Icariin improves endothelial function through increased NO production and PDE5 inhibition. Cardioprotective effects demonstrated in animal models of ischemia-reperfusion injury. May have relevance for cardiovascular risk reduction, particularly in metabolic syndrome. Not a primary cardiovascular herb but the vascular effects are clinically relevant.

[4]

Endocrine System

preliminary

Menopausal symptoms (hot flashes, bone loss, mood changes)

The weak phytoestrogenic activity of icaritin, combined with the osteogenic effects of icariin, provides a rationale for use in menopausal women. Limited clinical studies in China suggest benefit for menopausal symptoms and bone density preservation. The TCM use for Kidney Yang Deficiency overlaps significantly with menopausal presentations.

[4]

Energetics

Temperature

warm

Moisture

dry

Taste

bittersweet

Tissue States

cold/depression, atrophy/deficiency

In TCM energetics: Taste (Wei) is pungent (xin) and sweet (gan). Nature (Xing) is warm (wen). Channel entry: Kidney and Liver. Actions: tonifies Kidney Yang, strengthens sinews and bones, expels Wind-Dampness. Yin Yang Huo is specifically indicated for Kidney Yang Deficiency patterns manifesting as impotence, infertility, cold limbs, weak low back and knees, fatigue, and frequent urination. The warming quality reflects its role in 'stoking the Ministerial Fire' (Ming Men Huo). In Western energetic terms, Epimedium is warming and mildly drying, indicated for cold, deficient, depleted constitutions with poor vitality, weak libido, and musculoskeletal weakness. Contraindicated in Yin Deficiency with Heat signs (night sweats, five-palm heat, dry mouth) — the warming quality can further damage Yin.

Traditional Uses

Traditional Chinese Medicine (TCM)

  • Tonifies Kidney Yang: primary use for Kidney Yang Deficiency manifesting as impotence, premature ejaculation, infertility, cold extremities, frequent urination, and fatigue
  • Strengthens sinews and bones: for weakness of low back and knees, osteoporosis, and delayed bone healing
  • Expels Wind-Dampness: for bi syndrome (rheumatic joint pain, stiffness, and numbness) — used when Wind-Dampness lodges in sinews and bones
  • Classically combined with other Kidney Yang tonics: Rou Gui (cinnamon bark), Du Zhong (Eucommia bark), Ba Ji Tian (Morinda root), Tu Si Zi (Cuscuta seed)
  • In formula Er Xian Tang (Two Immortals Decoction) for menopausal symptoms with both Yin and Yang Deficiency
  • In formula You Gui Wan (Restore the Right Kidney Pill) for Kidney Yang Deficiency
  • Traditional processing (pao zhi): stir-fried with sheep fat to enhance warming, Yang-tonifying quality

"Yin Yang Huo first appears in the Shen Nong Ben Cao Jing (Divine Farmer's Classic of Materia Medica, c. 200 CE), where it is classified as a middle-grade herb. The name 'Yin Yang Huo' (淫羊藿) literally translates to 'licentious goat plant' — legend holds that a goat herder noticed his flock becoming sexually vigorous after eating the plant. The Ben Cao Gang Mu (Compendium of Materia Medica, Li Shizhen, 1578) provides extensive discussion of its kidney-yang-tonifying properties and specifies sheep-fat processing."

[1]

Korean traditional medicine (Hanyak)

  • Known as Eumyanggwak (음양곽)
  • Used for similar indications as TCM: kidney-yang tonification, sexual debility, joint pain
  • Incorporated into traditional tonic formulas for aging and vitality
  • E. koreanum is the preferred species in Korean practice

"Korean traditional medicine (Hanyak) shares the TCM theoretical framework and utilizes Epimedium for kidney-yang deficiency patterns. The Korean species E. koreanum Nakai is indigenous and preferred in Korean practice, generally considered to have high icariin content."

[1]

Japanese Kampo medicine

  • Known as Inyokaku (淫羊藿)
  • Used in traditional Kampo formulations for sexual debility, lumbago, and rheumatic conditions
  • Less prominently featured than in Chinese or Korean traditions

"In Japanese Kampo medicine, Epimedium (Inyokaku) is used in certain formulations but is less central to the materia medica compared to Chinese or Korean practice. Japanese ornamental species (E. grandiflorum) are not typically used medicinally."

[1]

Modern Research

in vitro

PDE5 inhibition — mechanism of erectile function effects

In vitro studies characterizing the PDE5 inhibitory activity of icariin and its metabolites.

Findings: Dell'Agli et al. (2008) demonstrated that icariin and its metabolites inhibit PDE5 in a concentration-dependent manner. Icaritin (the fully deglycosylated aglycone) was the most potent inhibitor with an IC50 of approximately 1 μM — comparable to sildenafil's binding affinity but with lower selectivity. Icariside II was intermediate in potency. Icariin itself was the least potent of the three, suggesting that gut metabolism (deglycosylation) is necessary for full activity. The inhibition was competitive with cGMP binding site.

Limitations: In vitro PDE5 inhibition does not directly translate to clinical efficacy for erectile dysfunction. Bioavailability of icariin and its metabolites after oral administration is low (estimated oral bioavailability of icariin is <12%). The clinical dose of Epimedium extract needed to achieve PDE5-relevant tissue concentrations is uncertain.

[2]

in vitro

Osteogenic effects — bone formation and osteoporosis prevention

Preclinical studies on the bone-protective effects of icariin in ovariectomized rat models.

Findings: Multiple studies demonstrate that icariin promotes osteoblast differentiation through BMP-2/Smad4 signaling pathway activation and Wnt/beta-catenin pathway stimulation. Icariin also inhibits osteoclast formation by modulating the RANKL/OPG ratio. In ovariectomized rats (postmenopausal osteoporosis model), icariin supplementation significantly increased bone mineral density, improved trabecular microarchitecture, and increased biomechanical strength compared to control. Zhang et al. (2007) found that icariin-containing Epimedium extract prevented bone loss comparable to estrogen replacement in ovariectomized rats.

Limitations: Almost exclusively preclinical data. Ovariectomized rat models are a standard but imperfect model for human postmenopausal osteoporosis. Human clinical trials are few, small, and mostly from Chinese institutions with limited methodological quality reporting. Optimal clinical dose for bone effects in humans is not established.

[3, 4]

in vitro

Neuroprotective effects — Alzheimer's disease models

Animal and cell-culture studies on the neuroprotective mechanisms of icariin.

Findings: Icariin demonstrates neuroprotective activity through multiple mechanisms: (1) reduced beta-amyloid (Aβ) production and aggregation; (2) increased BDNF and nerve growth factor expression in hippocampal tissue; (3) inhibition of neuronal apoptosis via Bcl-2/Bax modulation; (4) anti-inflammatory effects in microglia (reduced TNF-alpha, IL-1beta); (5) acetylcholinesterase inhibition. In APP/PS1 transgenic mouse models (Alzheimer's disease), icariin improved spatial learning and memory in Morris water maze tests.

Limitations: Entirely preclinical. Transgenic mouse models of Alzheimer's disease have limited translational value. No human clinical trials for cognitive indications have been published in indexed peer-reviewed journals.

[4]

cohort

Erectile function in animal models

In vivo studies evaluating the effects of icariin on erectile function in animal models.

Findings: Icariin improved erectile function in cavernous nerve-injured rats (a model for post-prostatectomy erectile dysfunction) and in aged rats with naturally declining erectile function. Mechanisms included increased intracavernous pressure, enhanced NO synthase (eNOS) expression, and increased cGMP levels in cavernous tissue. Some studies also showed increased testosterone levels and improved testicular function.

Limitations: Animal models only. Rat erectile physiology differs from human. Doses used in animal studies are often higher (on a mg/kg basis) than typical human doses. No large human RCTs.

[4]

in vitro

Anti-inflammatory and immunomodulating activity

Studies on the anti-inflammatory mechanisms of icariin in various disease models.

Findings: Icariin inhibits NF-kB activation, reduces pro-inflammatory cytokines (TNF-alpha, IL-1beta, IL-6), suppresses COX-2 and iNOS expression, and modulates MAPK signaling pathways. In arthritis models, icariin reduced joint inflammation and cartilage degradation. Immunomodulating effects include enhancement of macrophage phagocytosis and modulation of T-cell responses.

Limitations: Predominantly in vitro and animal data. Anti-inflammatory doses in human clinical use not established.

[4]

Preparations & Dosage

Decoction

Strength: 6-15 g dried herb per daily decoction

Add 6-15 g of dried Epimedium leaf (Yin Yang Huo) to 500 mL of water. Bring to a boil, then simmer for 20-30 minutes. Strain. Typically used as part of a multi-herb TCM formula rather than as a single-herb decoction.

Adult:

6-15 g of dried herb daily in decoction (traditional TCM dose range). Start at 6 g and increase based on response. In formula, typically 9-12 g.

Frequency:

Divide daily dose into 2 portions, taken morning and afternoon.

Duration:

In TCM practice, used for 2-4 weeks as part of a formula, then reassessed. May be used long-term as a tonic in appropriate cases.

Pediatric:

Not typically used in children. Not recommended.

Decoction is the traditional TCM preparation method. The fat-processed form (Zhi Yin Yang Huo — stir-fried with sheep fat) is considered more therapeutically potent for kidney-yang tonification than the raw herb. If using the processed form, dose may be reduced slightly. In TCM formulation, Yin Yang Huo is typically combined with other herbs to create a balanced formula addressing the patient's complete pattern.

[1]

Standardized Extract

Strength: Standardized to 10-20% icariin (varies by manufacturer)

Commercially prepared extract standardized to icariin content. Available as capsules, tablets, or liquid extracts. Look for products specifying E. brevicornu, E. sagittatum, E. pubescens, or E. koreanum — NOT E. grandiflorum.

Adult:

250-1000 mg of standardized extract (10-20% icariin) daily, providing approximately 25-200 mg of icariin per day. For erectile function: typically 500-1000 mg daily. For bone health: 300-600 mg daily.

Frequency:

1-2 times daily with meals.

Duration:

Clinical trials typically 3-6 months. Long-term safety data is limited but traditional use supports extended use.

Pediatric:

Not recommended.

Standardized extracts provide more consistent dosing than crude herb preparations and are the basis of most modern research. The standardization to icariin content is important because icariin concentration varies widely between species and growing conditions. Verify that the extract uses one of the four Chinese Pharmacopoeia-recognized species. Products using E. grandiflorum (a Japanese ornamental) may have significantly lower icariin content.

[4]

Tincture

Strength: 1:5, 45-55% ethanol

Macerate dried Epimedium leaf in 45-55% ethanol menstruum. Ratio 1:5 for dried herb.

Adult:

3-5 mL, 2-3 times daily.

Frequency:

2-3 times daily.

Duration:

Ongoing for chronic conditions.

Pediatric:

Not recommended.

Tincture is a Western herbal preparation form, not traditional in TCM. The ethanol extracts the prenylated flavonoids effectively. Less commonly used than decoction (in TCM) or standardized extract (in modern practice).

[4]

Capsule / Powder

Strength: Crude dried leaf powder

Dried, powdered Epimedium leaf in capsule form. Ensure species identification and icariin content verification.

Adult:

500-1000 mg of dried herb powder per capsule; 2-4 capsules daily (1-4 g total).

Frequency:

1-2 times daily with meals.

Duration:

Long-term use as a tonic.

Pediatric:

Not recommended.

Capsules of crude herb powder provide a less precise dose of icariin than standardized extracts, as icariin content varies significantly by species, harvest, and processing. Adequate for general tonic use but standardized extracts are preferred when targeting specific icariin doses for researched indications.

[1]

Safety & Interactions

Class 2c

Not to be used with specific medications (AHPA Botanical Safety Handbook)

Contraindications

relative Yin Deficiency with Heat signs (TCM pattern)

In TCM, Yin Yang Huo is contraindicated in patterns of Yin Deficiency with Empty Heat — characterized by night sweats, hot flashes (not due to Yang Deficiency), five-palm heat, dry mouth, red tongue with scanty coating. The warming, Yang-tonifying quality can exacerbate these symptoms. This is a pattern-based rather than biomedical contraindication.

relative Hormone-sensitive cancers (breast, prostate, ovarian, endometrial)

Icaritin has weak estrogenic activity (estrogen receptor binding). Although the estrogenic potency is low, caution is warranted in patients with hormone-sensitive cancers. Some preliminary research suggests icaritin may have antiproliferative effects in certain cancer cell lines, but the clinical significance is unclear. Avoid until more safety data is available.

Drug Interactions

Drug / Class Severity Mechanism
PDE5 inhibitors (sildenafil/Viagra, tadalafil/Cialis, vardenafil/Levitra) (PDE5 inhibitors) major Additive PDE5 inhibition. Both icariin metabolites and pharmaceutical PDE5 inhibitors increase cGMP levels in smooth muscle, causing vasodilation. Combined use could cause excessive hypotension, priapism, headache, flushing, and visual disturbances.
Nitrates (nitroglycerin, isosorbide mononitrate/dinitrate) (Nitrate vasodilators) major Nitrates increase NO/cGMP; icariin inhibits PDE5 (which degrades cGMP). Combined effect: excessive cGMP accumulation → severe vasodilation → dangerous hypotension. Same mechanism as the sildenafil-nitrate interaction.
Anticoagulants (warfarin) and antiplatelet agents (aspirin, clopidogrel) (Anticoagulants / Antiplatelets) moderate Some animal studies suggest icariin may have mild antiplatelet activity. Combined with anticoagulants, there is a theoretical increased risk of bleeding.
Antihypertensive medications (all classes) (Antihypertensives) moderate Additive blood pressure-lowering effect. Icariin causes vasodilation through PDE5/NO pathways. Combined with antihypertensive drugs, may cause excessive hypotension.
Hormone replacement therapy (estrogen, testosterone) and oral contraceptives (Hormonal agents) minor Icaritin has weak estrogenic activity. Theoretical additive estrogenic effects when combined with exogenous estrogen. May also affect testosterone metabolism.
CYP3A4 substrates (numerous medications) (CYP3A4 substrates) minor In vitro studies suggest icariin may inhibit CYP3A4 at high concentrations. This could theoretically increase plasma levels of CYP3A4-metabolized drugs.

Pregnancy & Lactation

Pregnancy

possibly unsafe

Lactation

insufficient data

PREGNANCY: Epimedium is not traditionally used during pregnancy in TCM. The warming, Yang-tonifying quality and the weak estrogenic/hormonal activity of icaritin make it inappropriate during pregnancy. No safety data for pregnancy exists. Avoid. LACTATION: No data on excretion of icariin or metabolites into breast milk. The phytoestrogenic activity warrants caution. Avoid during lactation.

Adverse Effects

uncommon Dizziness, headache, and nosebleed — Associated with the warming and vasodilatory effects at higher doses. More common in patients with underlying Yin Deficiency or excess Heat patterns.
uncommon Dry mouth and thirst — Reflects the warming, drying energetic quality. May indicate the dose is too high or the herb is inappropriate for the patient's constitution.
uncommon Tachycardia and palpitations — Reported at higher doses. The cardiovascular stimulatory effect is dose-dependent.
uncommon Gastrointestinal discomfort (nausea, abdominal pain) — Mild GI effects may occur, particularly when taken on an empty stomach.

References

Monograph Sources

  1. [1] Bensky D, Clavey S, Stöger E. Chinese Herbal Medicine: Materia Medica, Third Edition — Yin Yang Huo (Herba Epimedii). Eastland Press, Seattle (2004)

Clinical Studies

  1. [2] Dell'Agli M, Galli GV, Dal Cero E, Belluti F, Matera R, Zironi E, Pagliuca G, Bosisio E. Potent inhibition of human phosphodiesterase-5 by icariin derivatives. J Nat Prod (2008) ; 71 : 1513-1517 . PMID: 18778098
  2. [3] Zhang G, Qin L, Shi Y. Epimedium-derived phytoestrogen flavonoids exert beneficial effect on preventing bone loss in late postmenopausal women: a 24-month randomized, double-blind and placebo-controlled trial. J Bone Miner Res (2007) ; 22 : 1072-1079 . PMID: 17419681

Traditional Texts

  1. [4] Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine, Second Edition — Epimedium. Churchill Livingstone/Elsevier, Edinburgh (2013)

Pharmacopeias & Reviews

  1. [5] Chinese Pharmacopoeia Commission. Pharmacopoeia of the People's Republic of China, 2020 Edition — Epimedii Folium (Yin Yang Huo). China Medical Science Press, Beijing (2020)

Last updated: 2026-03-23 | Status: published

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Full botanical illustration of Epimedium brevicornu Maxim.

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