Eleven previously undescribed alkaloids, named sinometumines A-K, along with three known alkaloids, were isolated from the rhizomes of Sinomenium acutum. The chemical structures of these unreported compounds were established using extensive spectroscopic methods (IR, UV, HRESIMS, and NMR), and their absolute configurations were determined by single crystal X-ray diffraction analyses and calculated electronic circular dichroism spectroscopy (ECD). Sinometumine D was the first aporphine-type derived alkaloid inner salt with a rearranged dibenzofuran ring backbone. Sinometumine E was a rare protoberberine-type alkaloid with a complex 6/6/6/6/6/6 hexacyclic skeleton. This was the first report of alkaloids with these two skeletons isolated from S. acutum. All isolates were evaluated for their inhibitory activities against indoleamine 2,3-dioxygenase 1 (IDO1) and tryptophan 2,3-dioxygenase (TDO). Lysicamine possessed noteworthy inhibitory activities as an IDO1/TDO dual inhibitor with IC(50) values of 6.22 +/- 0.26 muM and 23.76 +/- 2.93 muM, respectively, and liriodenine revealed moderate dual inhibition with IC(50) values of 31.65 +/- 4.44 muM and 15.64 +/- 0.26 muM. The intermolecular interactions and binding modes between lysicamine and IDO1/TDO were elaborated by molecular docking studies. CI - Copyright (c) 2022 Elsevier Ltd. All rights reserved.