Cao Guo (草果) — Tsaoko Cardamom | TCM Herb Guide

At a Glance

• Herb: Cao Guo
• Chinese name: 草果 (Cǎo Guǒ)
• Latin name: Amomum tsaoko fruit
• Nature: Warm
• Taste: Acrid
• Meridian: Spleen / Stomach
• Category: Herbs that Transform Dampness
• Introduction: Cao Guo (草果), Fructus Tsaoko, is the dried ripe fruit of Amomum tsaoko, a large ginger-family herb native to Yunnan province. The strongest of the dampness-drying aromatic herbs, it powerfully dispels cold-dampness from the spleen and stomach, and has a classical reputation for treating malaria. Its intense volatile oils, primarily geraniol and 1,8-cineole, produce a pungent warming action that cuts through cold-phlegm accumulations in the middle jiao.

Action

• Strongly dries dampness and warms the middle jiao
• Disperses cold accumulation and relieves distension
• Destroys malaria and cuts malarial episodes
• Dissolves phlegm and food stagnation

Clinical Application

• Cold-damp obstruction of spleen and stomach: severe epigastric fullness, vomiting, greasy tongue coat — combines with Cang Zhu, Hou Po, Gan Jiang
• Phlegm-damp malarial disease (疟疾): alternating chills and fever with prominent cold phase — combines with Chang Shan, Bing Lang
• Cold accumulation with food stagnation: abdominal pain, undigested food in stools — combines with Shan Zha, Shen Qu, Bing Lang
• Damp-turbid headache from cold-phlegm — combines with Ban Xia, Tian Ma

Precautions

• Dosage: 3–6 g in decoction; remove seeds before use (seeds are intensely hot)
• The strongest dampness-drying herb — use sparingly; prolonged use damages yin
• Contraindicated in yin deficiency, blood deficiency, or patterns without cold-dampness
• Avoid in febrile illness without cold-damp component
• Avoid in pregnancy

Formula

• Da Yuan Yin (达原饮): Cao Guo, Bing Lang, Hou Po, Zhi Mu, Huang Qin, Bai Shao, Gan Cao — opens membrane source, dispels filthy dampness in epidemic diseases (Wen Yi)
• Cao Guo Yin (草果饮): Cao Guo, Chang Shan, Bing Lang, Chen Pi — classic anti-malarial formula
• Hou Po Wen Zhong Tang (厚朴温中汤): includes Cao Guo to warm middle and dry dampness in cold-damp spleen patterns

Combinations

• 常山 (Cháng Shān) + 槟榔 (Bīng Láng) — phlegm-damp malaria with chills, fever, and nausea (达原饮 component). 2. 厚朴 (Hòu Pò) + 苍术 (Cāng Zhú) — severe cold-damp spleen with bloating and thick greasy tongue coat. 3. 知母 (Zhī Mǔ) + 黄芩 (Huáng Qín) — damp-warm disease with cold-heat complex pattern (达原饮 from 温疫论). 4. 干姜 (Gān Jiāng) + 附子 (Fù Zǐ) — cold-damp penetrating deeply into the membranes. 5. 半夏 (Bàn Xià) + 陈皮 (Chén Pí) — phlegm-damp nausea with thick white tongue coat. Source: 温疫论 (达原饮), 本草纲目.

Pharmacological Effects

• tsaokoarylone and diarylheptanoids
  • Antimalarial: inhibit Plasmodium falciparum heme polymerization
  • Antimalarial: synergistic with artemisinin
• kaempferol and calyxin
  • Anti-inflammatory: suppress NF-κB and NLRP3 inflammasome
• volatile oils
  • Digestive: stimulate gastric secretion, bile flow, and intestinal peristalsis
  • Digestive: reduce food stagnation and bloating
• trans-2-decenal
  • Antiemetic: reduces nausea via 5-HT₃ antagonism
• Antifungal
  • inhibits Aspergillus flavus aflatoxin production
• Antioxidant
  • diarylheptanoids scavenge hydroxyl and DPPH radicals

Classic Description

• Yin Shan Zheng Yao (《饮膳正要》): ‘Treats Heart and abdominal pain, stops vomiting, supplements the Stomach, and descends qi.’
• Ben Cao Gang Mu (《本草纲目》): ‘Tsaoko Fruit is acrid, warm, drying, and intense; excels at eliminating cold-damp and warming and drying the middle jiao, intercepting malaria and eliminating phlegm, digesting food and dispersing distension.’
• Ben Cao Bei Yao (《本草备要》): ‘Acrid and hot; dries dampness and eliminates cold, breaks qi and opens depression, digests food and calms the Stomach, intercepts malaria; treats miasma qi and cold-damp accumulation.’