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Thunder god vine

CautionNot approved by the FDA for any use. Across 594 studies, 26.7% of users had side effects, most often stomach and gut symptoms, irregular periods, skin reactions and blood count changes. It is offered here as cautiously helpful.

Meta-analyses of mostly Chinese trials report fewer swollen and tender joints in rheumatoid arthritis, and a 207-patient trial found ACR50 response at least as high as methotrexate. Pooled trials report less urine protein in IgA nephropathy, lupus nephritis and diabetic kidney disease. In a 594-study review, 26.7% of users had side effects, including irregular periods, liver and blood count changes.

Add to Bio HackChecked 2026-11-09
Status
Not approved by the FDA for any use. Tripterygium glycoside tablets are a Chinese patent medicine.
Also called
Tripterygium wilfordii, Tripterygium wilfordii Hook F, TwHF, lei gong teng, triptolide, celastrol, tripterygium glycosides, Tripterygium wilfordii polyglycoside, TWP, tripterygium glycoside tablets
Taken for
rheumatoid arthritis, lupus, lupus nephritis, kidney disease, IgA nephropathy, diabetic kidney disease, autoimmune disease, inflammation, joint pain

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help4

Reported risks4

What people take it for, and what was found

Shown to help4

Strong

Rheumatoid arthritis

Shown to improve joint swelling, stiffness and grip in adults with rheumatoid arthritis, matching or beating standard drugs, in trials mostly from China.

The numbers and sources
Effect
Across 14 RCTs, TwHF extracts improved grip strength, swollen joint count and morning stiffness against placebo (P < 0.001). Against DMARDs, grip strength, morning stiffness, CRP and tender joint count differed (P < 0.05), and ESR and swollen joint count did not [1]. Across 40 RCTs (3,092 patients), tripterygium glycosides added to DMARDs lowered morning stiffness, tender and swollen joint counts, pain scores, CRP, ESR and rheumatoid factor against DMARDs alone (all p < .001) [2]. A network meta-analysis of 21 trials (5,039 participants) ranked TwHF with methotrexate first and TwHF alone second for ACR20 response among the conventional DMARDs compared [3]. In 207 patients, ACR50 response at 24 weeks was 46.4% on methotrexate, 55.1% on TwHF (p 0.014) and 76.8% on both (p < 0.001) [4]. In 121 US patients, 65.0% on TwHF extract and 32.8% on sulfasalazine met ACR20 at 24 weeks (P 0.001) [5].
Population
Adults with active rheumatoid arthritis, mostly in China [1][2][3][4]. 121 patients at US centers [5].
Sources
[1], [2], [3], [4], [5]
Caveats
The methotrexate trial was open label, with blinded assessors [4]. In the sulfasalazine trial only 62 patients had outcome data at 24 weeks, and 62% and 41% stayed on treatment [5]. Most pooled trials were small and Chinese.
Moderate

IgA nephropathy

Shown to raise remission rates in IgA nephropathy over blood pressure drugs, in trials of limited quality. Creatinine did not differ.

The numbers and sources
Effect
Across 30 RCTs, Tripterygium wilfordii polyglycoside alone gave higher complete remission (OR 4.74) and total remission (OR 3.90) than ACE inhibitors or angiotensin receptor blockers, with lower 24-hour urine protein and higher serum albumin. Serum creatinine did not differ (p 0.08). Added to those drugs, it raised complete remission (OR 2.57). It also gave higher remission than glucocorticoids (OR 1.93) and mycophenolate mofetil (OR 2.05) [6].
Population
Patients with IgA nephropathy in 30 RCTs, searched to December 2019 [6].
Sources
[6]
Caveats
The authors note the included studies were of limited quality [6]. The abstract does not give confidence intervals or the total number of patients.
Strong

Diabetic kidney disease and membranous nephropathy

Shown to lower urine protein and raise albumin in diabetic kidney disease, added to blood pressure drugs. Kidney failure and dialysis were not reported.

The numbers and sources
Effect
Across 44 RCTs (3,537 patients), tripterygium glycosides added to ACE inhibitors or angiotensin receptor blockers lowered 24-hour urine protein (SMD -1.46, 95% CI -1.70 to -1.23) and serum creatinine (SMD -0.35, 95% CI -0.59 to -0.11) and raised serum albumin (SMD 0.85). Blood urea nitrogen did not differ [7]. A meta-analysis of 16 studies found added TWP lowered 24-hour urine protein in diabetic kidney disease without a significant change in eGFR. In primary membranous nephropathy it was non-inferior to glucocorticoids for total remission [8].
Population
Patients with diabetic nephropathy [7]. Patients with primary membranous nephropathy, diabetic kidney disease and Henoch-Schönlein purpura nephritis [8].
Sources
[7], [8]
Caveats
Urine protein is a lab measure. Neither abstract reports kidney failure or dialysis outcomes [7][8].
Moderate

Lupus nephritis

Shown to raise remission in lupus nephritis when added to steroids. It did not differ from azathioprine or leflunomide.

The numbers and sources
Effect
Across 8 RCTs (583 participants), adding tripterygium glycoside tablets to glucocorticoids raised total remission (ratio 1.27, 95% CI 1.08 to 1.50) and complete remission (ratio 1.61, 95% CI 1.05 to 2.47) against glucocorticoids alone. Against azathioprine or leflunomide with glucocorticoids, remission, urine protein and serum creatinine did not differ [9].
Population
Patients with lupus nephritis in 8 RCTs, searched to June 2020 [9].
Sources
[9]
Caveats
The abstract does not name the ratio type. The authors call for larger, higher-quality trials [9].

Doses studied

The methotrexate comparison trial gave TwHF 20 mg three times a day for 24 weeks, then followed patients for 2 years [4][10]. The sulfasalazine comparison trial gave TwHF extract 60 mg three times a day for 24 weeks [5].

Risks

Reported risks4

Strong

Side effects across studies

Adverse events occurred in about 27% to 31% of users across hundreds of studies, most often digestive, reproductive and skin effects, with 4.7% severe.

The numbers and sources
Effect
Across 594 studies of 23,256 TwHF users, 26.7% had adverse events (95% CI 24.8% to 28.8%). Digestive symptoms occurred in 13.3%, reproductive adverse outcomes in 11.7%, skin reactions in 7.8%, blood count events in 6.5% and cardiovascular events in 4.9% [11]. Across 46 studies (2,437 people on Tripterygium wilfordii polyglycoside), 30.75% had adverse events and 4.68% had severe events. The authors list intestinal, reproductive, liver, kidney, blood and skin toxicity, related to dose, course and combined drugs [12].
Population
Users in trials and observational studies [11]. Users in RCTs, controlled trials and single-arm trials [12].
Sources
[11], [12]
Caveats
Rates varied widely by study type [11]. Heterogeneity was high (I² 97%) [12].
Strong

Irregular periods and reproductive effects

Shown to raise irregular periods about fourfold over control. In lupus nephritis trials, they were more common than on azathioprine or leflunomide.

The numbers and sources
Effect
Irregular menstruation was more common on TwHF than on control (OR 4.65, 95% CI 3.08 to 7.03) [11]. In lupus nephritis trials, new irregular menstruation was more common on tripterygium glycosides with glucocorticoids than on azathioprine (ratio 3.57, 95% CI 1.40 to 9.11) or leflunomide (ratio 6.69, 95% CI 2.42 to 18.46) with glucocorticoids [9]. In the 207-patient rheumatoid arthritis trial, 7 women on TwHF, 3 on methotrexate and 5 on both developed irregular menstruation (p 0.216 for TwHF against methotrexate) [4].
Population
Users across pooled studies [11]. Lupus nephritis trial patients [9]. 207 rheumatoid arthritis patients [4].
Sources
[11], [9], [4]
Caveats
The abstracts do not report sperm counts or fertility outcomes in men.
Moderate

Liver injury

Shown to raise adverse reactions, mainly liver damage, added to blood pressure drugs in diabetic kidney disease. In lupus nephritis, liver problems matched steroids alone.

The numbers and sources
Effect
In diabetic nephropathy trials, adverse reactions were more common with tripterygium glycosides added to ACE inhibitors or angiotensin receptor blockers (RR 1.96, 95% CI 1.43 to 2.68), and the authors name liver function damage as the main one [7]. A synthesis of 46 studies lists hepatotoxicity among the organ toxicities [12]. In lupus nephritis trials, liver dysfunction did not differ from glucocorticoids alone [9].
Population
3,537 diabetic nephropathy patients [7]. 2,437 TWP users [12]. Lupus nephritis trial patients [9].
Sources
[7], [12], [9]
Caveats
The abstracts do not give a separate liver injury rate.
Moderate

Blood count changes

Blood count changes occurred in about 6.5% of users. In lupus nephritis trials, low white cell counts were less common than on azathioprine.

The numbers and sources
Effect
Blood count events occurred in 6.5% of TwHF users (95% CI 5.7% to 7.4%) [11]. Hematotoxicity is one of the organ toxicities in a second synthesis [12]. In lupus nephritis trials, low white cell counts were less common than on azathioprine (ratio 0.38, 95% CI 0.17 to 0.85) [9].
Population
Users across pooled studies [11][12]. Lupus nephritis trial patients [9].
Sources
[11], [12], [9]
Caveats
The abstracts do not split blood count events by type.

Claims tested and not found

  1. That TwHF slows joint damage more than methotrexate. Over 2 years, changes in total Sharp score, erosion and joint space narrowing were comparable across TwHF, methotrexate and the combination [10].
  2. That tripterygium glycosides improve kidney filtration in diabetic kidney disease. eGFR did not change significantly in a meta-analysis of 16 studies [8].

Sources

  1. Zhou YY, Xia X, Peng WK, et al. The Effectiveness and Safety of Tripterygium wilfordii Hook. F Extracts in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Frontiers in Pharmacology. 2018. https://doi.org/10.3389/fphar.2018.00356
  2. Zheng W, Mei Y, Chen C, et al. The effectiveness and safety of Tripterygium wilfordii glycosides combined with disease-modifying anti-rheumatic drugs in the treatment of rheumatoid arthritis: A systematic review and meta-analysis of 40 randomized controlled trials. Phytotherapy Research. 2021. https://doi.org/10.1002/ptr.6996
  3. Wang HL, Zhao Q, Li W, et al. A Systematic Review and Network Meta-Analysis about the Efficacy and Safety of Tripterygium wilfordii Hook F in Rheumatoid Arthritis. Evidence-Based Complementary and Alternative Medicine. 2022. https://doi.org/10.1155/2022/3181427
  4. Lv QW, Zhang W, Shi Q, et al. Comparison of Tripterygium wilfordii Hook F with methotrexate in the treatment of active rheumatoid arthritis (TRIFRA): a randomised, controlled clinical trial. Annals of the Rheumatic Diseases. 2015. https://doi.org/10.1136/annrheumdis-2013-204807
  5. Goldbach-Mansky R, Wilson M, Fleischmann R, et al. Comparison of Tripterygium wilfordii Hook F versus sulfasalazine in the treatment of rheumatoid arthritis: a randomized trial. Annals of Internal Medicine. 2009. https://doi.org/10.7326/0003-4819-151-4-200908180-00005
  6. Wang RX, Liao BQ, Chen W, et al. A meta-analysis of effects and safety of Tripterygium wilfordii polyglycoside in the treatment of IgA nephropathy. European Review for Medical and Pharmacological Sciences. 2022. https://pubmed.ncbi.nlm.nih.gov/36524494/
  7. Yao Z, Wang P, Fu Q, et al. Efficacy and safety of tripterygium glycosides combined with ACEI/ARB on diabetic nephropathy: a meta-analysis. Frontiers in Pharmacology. 2025. https://doi.org/10.3389/fphar.2024.1493590
  8. Yan X, Shi J, Zhang Y, et al. Effectiveness and safety of tripterygium wilfordii poly-glycosides on glomerulonephritis: a systematic review and meta-analysis. Frontiers in Pharmacology. 2024. https://doi.org/10.3389/fphar.2024.1339153
  9. Yingyan Z, Huasheng L, Jingyao Y, et al. Effectiveness and safety of tripterygium glycosides tablet for lupus nephritis: a systematic review and Meta-analysis. Journal of Traditional Chinese Medicine. 2022. https://pubmed.ncbi.nlm.nih.gov/36083472/
  10. Zhou YZ, Zhao LD, Chen H, et al. Comparison of the impact of Tripterygium wilfordii Hook F and Methotrexate treatment on radiological progression in active rheumatoid arthritis: 2-year follow up of a randomized, non-blinded, controlled study. Arthritis Research & Therapy. 2018. https://doi.org/10.1186/s13075-018-1563-6
  11. Zhang C, Sun PP, Guo HT, et al. Safety Profiles of Tripterygium wilfordii Hook F: A Systematic Review and Meta-Analysis. Frontiers in Pharmacology. 2016. https://doi.org/10.3389/fphar.2016.00402
  12. Ru Y, Luo Y, Zhou Y, et al. Adverse Events Associated With Treatment of Tripterygium wilfordii Hook F: A Quantitative Evidence Synthesis. Frontiers in Pharmacology. 2019. https://doi.org/10.3389/fphar.2019.01250

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