Herb Twig (枝 zhī)

Sang Zhi

Mulberry twig · 桑枝

Morus alba L. · Ramulus Mori

Sang Zhi (Mulberry twig) plant

Images shown are for educational purposes only

Mulberry twig is a gentle, commonly used herb that helps relieve joint pain, stiffness, and swelling caused by Wind and Dampness lodging in the body. It has a special affinity for the shoulders and upper limbs. It is also used to reduce water retention and support circulation to the extremities.

Category Wind-Damp dispelling herbs (祛风湿药)
Therapeutic focus Bone and Joint Health Arthritis Support Circulation Support Fluid Retention and Edema

TCM Properties

Temperature

Neutral

Taste

Bitter (苦 kǔ)

Channels entered

Liver

Parts used

Twig (枝 zhī)

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Educational content • Consult qualified TCM practitioners for diagnosis and treatment

What This Herb Does

Every herb has a specific set of actions — here's what Sang Zhi does in the body, explained in both everyday and TCM terms

Therapeutic focus

In practical terms, Sang Zhi is primarily used to support these areas of health:

Bone and Joint Health Arthritis Support Circulation Support Fluid Retention and Edema

TCM Actions

In TCM terminology, these are the specific therapeutic actions that Sang Zhi performs to restore balance in the body:

Dispels Wind-Dampness Benefits the joints Unblocks the Channels and Collaterals Promotes Urination and Reduces Edema

How these actions work

'Dispels Wind-Dampness' means Sang Zhi helps clear out the pathogenic Wind and Dampness that lodge in the muscles, joints, and channels, causing pain and stiffness. This is the herb's primary action and applies to the various forms of painful obstruction syndrome (bi zheng) where joints ache, swell, or feel heavy. Because twigs are shaped like limbs and extend outward, classical theory holds that Sang Zhi has a natural affinity for the extremities, especially the upper limbs and shoulders.

'Benefits the joints' means Sang Zhi specifically eases joint stiffness, soreness, and restricted movement. It is particularly valued for shoulder and arm pain, where it is considered one of the most effective guiding herbs, directing the formula's effects to the upper body.

'Unblocks the channels and collaterals' means Sang Zhi opens the network of channels through which Qi and Blood flow. When Wind-Dampness obstructs these pathways, numbness, tingling, spasm, and even paralysis can result. Sang Zhi's ability to open these channels makes it useful not only for rheumatic conditions but also for post-stroke limb dysfunction (hemiplegia).

'Promotes urination and reduces edema' refers to Sang Zhi's ability to regulate water metabolism and help the body drain excess fluid. This is why classical texts mention it for conditions like swollen legs (leg Qi or 'jiao qi') and generalized edema.

Patterns Addressed

In TCM, symptoms cluster into recognizable patterns of disharmony. Sang Zhi is used to help correct these specific patterns.

Why Sang Zhi addresses this pattern

Wind-Damp Painful Obstruction (Wind-Damp Bi) arises when Wind and Dampness invade the channels and joints, obstructing the flow of Qi and Blood. Sang Zhi is bitter and neutral, entering the Liver channel which governs the sinews. Its core actions of dispelling Wind-Dampness and unblocking the channels directly address the pathomechanism of this pattern. Its twig form gives it a natural tendency to reach the extremities and joints. It is particularly effective when the obstruction manifests in the upper limbs and shoulders, making it a first-choice herb for upper-body bi pain.

A practitioner would look for one or more of these signs

Moving Pain

Especially in the shoulders and arms

Skin Numbness

Numbness and tingling in the limbs

Joint Stiffness

Difficulty moving the joints freely

Muscle Spasm

Cramping and spasm of the limbs

Commonly Used For

These are conditions where Sang Zhi is frequently used — but only when they arise from the specific patterns it addresses, not in all cases

Arises from: Wind-Damp Wind-Damp

TCM Interpretation

TCM understands rheumatoid arthritis as a form of bi zheng (painful obstruction syndrome) where pathogenic Wind, Dampness, and often Heat lodge in the joints and channels. During acute flares with red, hot, swollen joints, this is typically seen as Wind-Damp-Heat bi. In chronic stages, Dampness and Blood stasis may predominate, leading to joint deformity and fixed pain. The Liver governs the sinews and the Spleen manages Dampness, so both organ systems are usually involved in the underlying pathomechanism.

Why Sang Zhi Helps

Sang Zhi enters the Liver channel and specifically dispels Wind-Dampness from the joints and channels. Its neutral temperature makes it suitable for both Heat-type and Cold-type presentations, unlike many Wind-Dampness herbs that are strongly warming. Modern pharmacological studies have shown anti-inflammatory activity. Its special affinity for the upper extremities makes it particularly valuable when RA affects the shoulders, elbows, wrists, and finger joints.

Also commonly used for

Moving Pain

Especially shoulder and upper limb pain

Osteoarthritis
Skin Numbness

In the extremities

Muscle Spasm

Limb cramping and spasms

Hypertension

Traditionally used as a foot soak

Hemiplegia

Post-stroke limb paralysis

Twitching

Generalized skin itching from Wind

Herb Properties

Every herb has an inherent temperature, taste, and affinity for specific channels — these properties determine how it interacts with the body

Temperature

Neutral

Taste

Bitter (苦 kǔ)

Channels Entered

Liver

Parts Used

Twig (枝 zhī)

Dosage & Preparation

These are general dosage guidelines for Sang Zhi — always follow your practitioner's recommendation, as dosages vary based on the formula and your individual condition

Standard dosage

9-15g

Maximum dosage

Up to 30g in decoction for pronounced joint pain, or larger amounts when used as an external wash. Some classical sources use up to 60g externally.

Dosage notes

The standard decoction dose is 9 to 15g. For more severe joint pain, swelling, or numbness, the dose can be increased to 15 to 30g. When used externally as a wash for skin itching, larger quantities can be decocted and applied topically. The wine-processed form (酒桑枝) is preferred when stronger channel-opening and pain-relieving action is desired, as the wine enhances its ability to reach the upper body and limbs. Dry-fried Sang Zhi (炒桑枝) is the standard form for general use. Fresh Sang Zhi can also be sliced and decocted when available, and some classical sources consider the fresh form more effective.

Preparation

No special decoction handling required. Sang Zhi is decocted normally with other herbs. Sliced pieces are preferred over whole segments to improve extraction.

Processing Methods

In TCM, the same herb can be prepared in different ways to change its effects — here's how processing alters what Sang Zhi does

Processing method

Sang Zhi slices are dry stir-fried over low heat until they turn slightly yellow and release a fragrant aroma.

How it changes properties

Stir-frying enhances Sang Zhi's ability to dispel Wind-Dampness and open the channels by making the herb slightly warmer and more aromatic. The mild warming from the dry-frying process improves its dispersing action and helps it penetrate the channels more effectively.

When to use this form

Preferred for Wind-Cold-Damp bi and when a slightly stronger channel-opening effect is desired. This is the most commonly used processed form in clinical practice.

Common Herb Pairs

These ingredients are traditionally combined with Sang Zhi for enhanced therapeutic effect

Gui Zhi
Gui Zhi Sang Zhi 15g : Gui Zhi 9g

Sang Zhi dispels Wind-Dampness and opens the channels while Gui Zhi warms the channels, disperses Cold, and promotes the flow of Qi and Blood. Together they provide a powerful combination for unblocking painful, stiff joints, especially in the shoulders and arms. The classical text Ben Cao Cuo Yao specifically records this pairing for shoulder and arm bi pain.

When to use: Wind-Cold-Damp bi affecting the shoulders and upper limbs, with cold, stiff, aching joints that worsen in cold weather.

Ji Xue Teng
Ji Xue Teng 1:1 (both at 15-30g)

Sang Zhi excels at dispelling Wind and unblocking the channels, while Ji Xue Teng (spatholobus stem) nourishes Blood and invigorates Blood circulation. Together they address both the pathogenic obstruction and the underlying Blood insufficiency or stasis that often accompanies chronic joint pain, providing channel-opening and Blood-moving effects simultaneously.

When to use: Chronic bi syndrome with both Wind-Dampness and Blood stasis, presenting as joint pain with numbness, tingling, or purplish discoloration of the affected area.

Sang Ji Sheng
Sang Ji Sheng 1:1 (both at 9-15g)

Sang Zhi focuses on opening the channels and dispelling Wind-Dampness (a 'clearing through' approach), while Sang Ji Sheng (mulberry mistletoe) tonifies the Liver and Kidneys, strengthens the sinews and bones, and also dispels Wind-Dampness (a 'supplementing' approach). One clears obstruction while the other nourishes the foundation, working as a complementary pair.

When to use: Bi syndrome in patients with underlying Liver-Kidney deficiency, presenting as joint pain with weak knees and lower back soreness, or hypertension with dizziness.

Sang Ye
Sang Ye 1:1 (both at 9-15g)

Sang Ye (mulberry leaf) disperses external Wind-Heat and clears Liver Heat, while Sang Zhi unblocks the channels and dispels Wind-Dampness. Together they combine surface-dispersing with channel-opening actions, amplifying the ability to clear Wind and Heat from the joints.

When to use: Wind-Damp-Heat bi with red, swollen, hot joints, or joint pain in the context of an external Wind-Heat invasion.

Comparable Ingredients

These ingredients have overlapping uses — here's how to tell them apart

Gui Zhi
Sang Zhi vs Gui Zhi

Both Sang Zhi and Gui Zhi unblock the channels and are used for bi syndrome of the upper limbs. However, Gui Zhi is warm and acrid, making it specifically suited for Cold-type bi where warming the channels is essential. Sang Zhi is neutral and slightly bitter, making it more versatile and better suited for Heat-type or mixed bi presentations. When Cold predominates, choose Gui Zhi; when Heat signs are present or the patient runs warm, Sang Zhi is preferred. The two are often used together for Cold-type bi.

Luo Shi Teng
Sang Zhi vs Luo Shi Teng

Both herbs dispel Wind-Dampness and unblock the channels to treat bi syndrome. Luo Shi Teng (star jasmine vine) is bitter and slightly cold, with a stronger cooling action, making it especially suited for Heat bi with inflamed joints. Sang Zhi is neutral and has a particular affinity for the shoulders and upper limbs, whereas Luo Shi Teng acts more broadly on both upper and lower limbs and also cools the Blood.

Ha
Sang Zhi vs Hai Feng Teng

Both dispel Wind-Dampness and unblock the channels for bi syndrome. Hai Feng Teng (kadsura vine) is acrid, bitter, and slightly warm, with a stronger ability to dispel Cold and Wind from the channels and is used more for Cold-Damp bi. Sang Zhi is neutral and better tolerated when Heat signs are present. Both are frequently combined in the same formula (as in Juan Bi Tang from Yi Xue Xin Wu).

Identity & Adulterants

Related species and common adulterations to be aware of when sourcing Sang Zhi

Sang Zhi is occasionally confused with or substituted by the twigs of other Morus species such as Morus australis (Ji Sang, chicken mulberry) or Morus mongolica, which were historically used as related varieties but may differ in potency and chemical composition. The 2020 Chinese Pharmacopoeia recognises only Morus alba L. as the official source. Because mulberry trees are extremely common and widely cultivated, outright adulteration is relatively rare compared to more expensive herbs. However, older, thicker woody branches may be sold in place of the preferred young tender twigs, resulting in reduced efficacy. Buyers should look for slender pieces with a yellowish-white cross-section to ensure the correct young material is being used.

Educational content — always consult a qualified healthcare provider or TCM practitioner before using any herb.

Toxicity Classification

Classical Chinese pharmacopoeia toxicity rating for Sang Zhi

Non-toxic

Sang Zhi is classified as non-toxic in classical literature and modern pharmacopoeias. The Ben Cao Zai Xin explicitly states it is 'wu du' (without toxicity). No toxic components have been identified in the twig at standard medicinal dosages. It is considered one of the mildest and safest herbs in the materia medica, suitable even for prolonged use according to classical sources.

Contraindications

Situations where Sang Zhi should not be used or requires extra caution

Caution

Spleen and Stomach deficiency cold with loose stools (脾胃虚寒作泄). The Ben Cao Jing Shu explicitly warns against use in this condition, as Sang Zhi's bitter taste and wind-dampness dispelling nature can further impair weakened digestive function.

Caution

Pregnancy. The Ben Cao Sheng Chang states that excessive consumption may cause nosebleeds and that pregnant women should avoid it. Its ability to move through the channels and mobilize Qi and Blood is the likely concern.

Caution

Joint pain or body aches caused by Yin deficiency or Blood deficiency rather than actual Wind-Dampness. Sang Zhi dispels Wind-Dampness from the channels but does not nourish Yin or Blood, so using it when deficiency is the root cause may be ineffective or aggravating.

Caution

Cough due to cold fluids constricting the Lungs (寒饮束肺). Sang Zhi is not warming enough to address this pattern and is not indicated for it.

Caution

Heavy menstrual bleeding. Its channel-moving properties may theoretically increase blood flow. Use with caution in women with excessive menstruation.

Special Populations

Important considerations for pregnancy, breastfeeding, and pediatric use

Pregnancy

Classical sources advise against use during pregnancy. The Ben Cao Sheng Chang states that excessive consumption may cause nosebleeds and that pregnant women should avoid it (孕妇忌之). The concern relates to Sang Zhi's ability to move through the channels and mobilise Qi and Blood, which could theoretically disturb the fetus. While no specific teratogenic mechanism has been identified and the herb is relatively mild, it is best avoided during pregnancy as a precaution, or used only under close practitioner supervision when clearly indicated.

Breastfeeding

No specific classical or modern warnings exist regarding Sang Zhi use during breastfeeding. There are no documented concerns about transfer of harmful constituents through breast milk, and the herb is classified as non-toxic. However, formal safety studies in lactating women have not been conducted. At standard dosages and short-term use, it is generally considered acceptable, but as with most herbs, consultation with a qualified practitioner is advisable.

Children

Sang Zhi is a mild, non-toxic herb that is generally considered safe for children when indicated, particularly for Wind-Dampness conditions affecting the limbs. Dosage should be reduced proportionally based on age and body weight. A common guideline is approximately one-third to one-half of the adult dose for children aged 6 to 12. It is not commonly prescribed for very young children under age 3 unless specifically indicated by a practitioner.

Drug Interactions

If you are taking pharmaceutical medications, be aware of these potential interactions with Sang Zhi

No well-documented drug interactions have been established in peer-reviewed literature for Sang Zhi (mulberry twig) at standard decoction doses.

However, given that mulberry twig alkaloids have demonstrated alpha-glucosidase inhibitory activity (the same mechanism as acarbose), there is a theoretical potential for additive hypoglycemic effects when combined with oral diabetes medications, particularly alpha-glucosidase inhibitors or insulin. Patients on blood sugar-lowering medications should inform their healthcare provider before using Sang Zhi, and blood glucose levels may need closer monitoring.

Similarly, given classical and modern reports of blood pressure-lowering effects, patients taking antihypertensive medications should exercise caution and monitor blood pressure when using Sang Zhi.

Dietary Advice

Foods and dietary considerations when taking Sang Zhi

When using Sang Zhi to treat Wind-Dampness joint pain, it is helpful to avoid cold, raw, and greasy foods that can generate Dampness and impair Spleen function. Limit dairy, iced drinks, excessively sweet or fatty foods, and raw salads. Moderate consumption of warming, circulation-promoting foods such as ginger and green onion can complement its therapeutic action.

Botanical Description

Physical characteristics and morphology of the Sang Zhi source plant

Morus alba L. (white mulberry) is a fast-growing deciduous tree or sometimes a large shrub in the family Moraceae, native to central and northern China. It typically grows 3 to 15 metres tall, though specimens can reach 20 metres or more, with a trunk up to 50 cm in diameter. The bark is thick and grey with shallow vertical fissures. Young twigs are slender and slightly zigzag, grey-brown to orange-brown in colour, with reddish-brown winter buds and small pale lenticels.

The leaves are highly variable, ovate or broadly ovate, 5 to 15 cm long and 5 to 12 cm wide, with coarsely serrated margins. On vigorous young shoots the leaves may be deeply and intricately lobed. The upper leaf surface is bright green and smooth, while the underside has sparse hairs along the veins. Small yellowish-green flowers appear in drooping catkins in spring. The fruit is a composite multiple fruit (syncarp), 1 to 5 cm long, ripening from white through pink to purple or black.

The medicinal twigs (Sang Zhi) are harvested from young branches of the current or previous year's growth. After removing the leaves, these are sun-dried whole or sliced fresh and then dried. The mulberry tree has been cultivated in China for over 4,000 years, primarily for silkworm rearing, and is now widely grown and naturalised across temperate and subtropical regions worldwide.

Sourcing & Harvesting

Where Sang Zhi is sourced, when it's harvested or collected, and how to assess quality

Harvesting season

Late spring to early summer (typically May to June), when the young branches are still tender

Primary growing regions

Sang Zhi is produced throughout most of China, as the mulberry tree has been widely cultivated across the country for millennia in connection with the silk industry. The principal producing regions include Jiangsu, Zhejiang, Anhui, Hunan, Hubei, Sichuan, and Hebei provinces. Historically, the Jiangsu and Zhejiang region (江浙) became the centre of production from the Ming-Qing period onward due to the flourishing silk trade. The tree grows readily on hillsides, along roadsides, in fields, and near villages, and is extensively cultivated rather than wild-harvested. There is no single narrow dao di (terroir) region for Sang Zhi, as the tree adapts to a wide range of soils and climates from northeast to southwest China.

Quality indicators

Good quality Sang Zhi consists of young, slender twig segments (0.5 to 1.5 cm diameter) that are cut into even slices or short lengths. The outer surface should be greyish-yellow to yellowish-brown with numerous visible small yellowish-brown lenticels and fine vertical striations. Semi-circular leaf scars and yellowish-brown axillary buds should be visible. The texture should be tough and resilient, not easily snapped. The cross-section should show a thin bark layer, with the wood section being distinctly yellowish-white with visible radiating lines, and a white to yellowish-white pith at the centre. The best quality pieces are from tender young branches with a yellowish-white cross-section. The odour should be faint and the taste bland. Avoid old, thick, woody branches that are dark or hollow inside.

Classical Texts

Key passages from the classical Chinese medical texts that describe Sang Zhi and its therapeutic uses

《本草图经》(Tu Jing Ben Cao, Song Dynasty)

Original: 桑枝，平，不冷不热，可以常服。疗遍体风痒干燥，脚气风气，四肢拘挛，上气，眩晕，肺气嗽，消食；利小便，久服轻身，聪明耳目，令人光泽，兼疗口干。

Translation: Sang Zhi is neutral in nature, neither cold nor hot, and can be taken regularly over long periods. It treats generalised itching and dryness of the body, leg Qi wind conditions, spasm and contracture of the four limbs, counterflow Qi, dizziness, Lung Qi cough, and aids digestion. It promotes urination. Long-term use lightens the body, sharpens the mind and senses, and gives the skin a healthy lustre. It also treats dry mouth.

《本草纲目》(Ben Cao Gang Mu, Li Shizhen, Ming Dynasty)

Original: 痈疽后渴，用嫩条细切一升，熬香煎饮，亦无禁忌。久服，终身不患偏风。

Translation: For thirst after carbuncles and sores, finely slice one sheng of tender twigs, toast until fragrant, and decoct as a drink. There are no contraindications for this use. Long-term consumption will prevent one from ever suffering hemiplegia (Wind-stroke).

《本草备要》(Ben Cao Bei Yao, Qing Dynasty)

Original: 利关节，养津液，行水祛风。

Translation: Benefits the joints, nourishes the body's fluids, promotes water movement, and dispels Wind.

《本草撮要》(Ben Cao Cuo Yao)

Original: 桑枝，功专去风湿拘挛，得桂枝治肩臂痹痛；得槐枝、柳枝、桃枝洗遍身痒。

Translation: Sang Zhi specialises in removing Wind-Dampness and relieving spasm and contracture. Combined with Gui Zhi (cinnamon twig), it treats painful obstruction of the shoulders and arms. Combined with Huai Zhi (Sophora twig), Liu Zhi (willow twig), and Tao Zhi (peach twig) as a wash, it treats generalised itching.

Historical Context

The history and evolution of Sang Zhi's use in Chinese medicine over the centuries

The mulberry tree (桑, sang) is one of the most culturally significant plants in Chinese civilisation, inseparable from the history of silk production dating back over 4,000 years. Among the various medicinal parts of the mulberry tree, the root bark (Sang Bai Pi) was the first to be recorded as a medicine, appearing in the Shen Nong Ben Cao Jing. Sang Zhi (the twig) entered the medical literature later, first appearing in the Tang Dynasty text Ben Cao Shi Yi by Chen Cangqi, where it was noted under the Sang Ye (mulberry leaf) entry for its ability to "remove old Wind and stagnant Blood."

During the Song Dynasty, the Tu Jing Ben Cao formally recorded Sang Zhi's properties and clinical uses in detail, describing it as mild and safe for long-term consumption. By the Ming Dynasty, Li Shizhen gave Sang Zhi its own dedicated subsection in the Ben Cao Gang Mu, expanding its indications and adding the notable claim that lifelong use could prevent Wind-stroke (hemiplegia). Classical physicians particularly valued Sang Zhi for pain and stiffness in the upper limbs and shoulders, drawing on the principle of using branch-form medicines to treat the limbs (a form of "like treats like" reasoning in TCM). In modern times, Sang Zhi has gained renewed attention as the source material for Sangzhi Total Alkaloids Tablet, China's first approved natural-product drug for type 2 diabetes, developed by the Chinese Academy of Medical Sciences and approved in 2020.

Modern Research

3 published studies investigating the pharmacological effects or clinical outcomes of Sang Zhi

1

Efficacy and Safety of Mulberry Twig Alkaloids Tablet for Treatment of Type 2 Diabetes: A Phase IIIa Multicenter RCT (2021)

Liang X, Tian G, et al. Diabetes Care, 2021, 44(6), e95-e97.

This large-scale Phase IIIa trial enrolled 600 patients with type 2 diabetes across 23 clinical centres in China. Total alkaloids extracted from Sang Zhi were compared head-to-head with acarbose in a randomised, double-blind design. The Sang Zhi alkaloid group showed a 0.93% reduction in HbA1c with a 47.7% target achievement rate, comparable to acarbose, but with nearly half the gastrointestinal side effects. The alkaloids work by selectively inhibiting intestinal alpha-glucosidase while also promoting GLP-1 secretion and protecting pancreatic beta-cells.

PubMed
2

Phytochemistry, Pharmacology, and Clinical Trials of Morus alba: A Comprehensive Review (2016)

Chan EW, Lye PY, Wong SK. Chinese Journal of Natural Medicines, 2016, 14(1), 17-30.

This review comprehensively summarised the botany, phytochemistry, pharmacology, and clinical evidence for all parts of Morus alba. It documented that mulberry tissues contain flavonoids, alkaloids, stilbenes and other bioactive compounds with demonstrated anti-diabetic, anti-inflammatory, antioxidant, antimicrobial, anti-hyperlipidemic, and cardioprotective activities across preclinical and clinical studies.

PubMed
3

Morus alba: A Comprehensive Phytochemical and Pharmacological Review (2023)

Batiha GE, Al-Snafi AE, Thuwaini MM, et al. Naunyn-Schmiedeberg's Archives of Pharmacology, 2023, 396(7), 1399-1413.

A systematic review cataloguing the phytochemical constituents and pharmacological effects of all Morus alba parts. It confirmed a diverse chemical profile including tannins, steroids, alkaloids, flavonoids, anthocyanins, and stilbenoids. Documented pharmacological activities spanning antimicrobial, anti-inflammatory, analgesic, antioxidant, anti-cancer, antidiabetic, cardiovascular, hypolipidemic, anti-obesity, and neuroprotective effects across multiple studies.

PubMed

Research on individual TCM herbs is growing but still limited by Western clinical trial standards. These studies provide emerging evidence and should be considered alongside practitioner expertise.