Astragalus

Scientific Name(s): Astragalus membranaceus (Moench), Astragalus mongholicus Bunge
Common Name(s): Astragalus, Huáng chí, Huáng qí, Hwanggi, Jin Fu Kang, Membranous milk-vetch, Meng gu huang qi, Ogi, Ougi, Radix Astragali

Medically reviewed by Drugs.com. Last updated on Oct 24, 2022.

Clinical Overview

Use

Evidence from older studies of limited quality suggests that astragalus root may be beneficial in modulating immune function. Evidence in the literature for other purported therapeutic uses of astragalus is not robust. Clinical trial data are lacking to recommend use for any indication.

Dosing

Clinical trial data are lacking to guide dosing recommendations for A. membranaceus products.

Contraindications

Contraindications have not yet been identified.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Allergy has been reported. A case report exists of increased carbohydrate antigen 19-9 and induction of reversible liver and kidney cysts in a woman consuming A. membranaceus daily for 1 month.

Toxicology

Data are equivocal.

Scientific Family

Fabaceae (pea)
Leguminosae (bean)

Botany

The genus Astragalus, commonly known as milk vetches, comprises more than 2,000 species distributed worldwide. The perennial herbs grow to approximately 1 m in height, are native to the northern provinces of China, and are cultivated in China, Korea, and Japan. The plants bear tubular yellowish flowers and small (3 to 6 cm) leaves. The dried root harvested from mature plants (4 to 7 years old) is used medicinally and sold as 15 to 20 cm pieces with a tough, fibrous skin and a light interior.Fu 2014, Khan 2009, Tang 1992, WHO 1999

History

Astragalus root is well known in traditional Chinese medicine and is listed in the Pharmacopoeia of the People's Republic of China. It is an important component of Chinese Fu Zheng herbal therapy, in which the goal is to restore immune system function by reinforcing the body's Qi. It is principally used as a tonic and for treatment of diabetes and nephritis. There is extensive literature on the herb/plant published in Chinese. Astragalus is sold as shredded roots in powder, tincture, and encapsulated forms. Some products are produced by frying the roots with honey, and the untreated root has a sweet, licorice-like taste of its own. Astragalus root is used in the United States as an immunostimulant to counteract the immune suppression associated with cancer chemotherapy.Fu 2014, Khan 2009, Tang 1992, WHO 1999

Chemistry

The main active substance of A. membranaceus is astragaloside IV (AS-IV).Li 2017 Other compounds identified in A. membranaceus include polysaccharides, saponins, flavonoids, isoflavonoids, sterols, amino acids (including gamma-aminobutyric acid), volatile oils, and trace elements such as zinc, iron, copper, manganese, vanadium, and tin. Polysaccharides include astragalans I, II, and III, and astraglucans, which are of primary interest along with saponins (astragalosides I-VIII and isoastragalosides I and II).Behl 2017

The flavones kaempferol and quercetin, as well as the isoflavonoids (including isoflavones, isoflavans, and pterocarpans) are present.Bratkov 2016, Tang 2018 Formononetin is a bioactive isoflavone isolated from a number of different plants, including A. membranaceus.Jiang 2019

The saponin AS-IV has also been used as a marker for quality assurance of astragalus products.Agyemang 2013, Duke 2003, WHO 1999, Zhang 2014

Uses and Pharmacology

AS-IV has multiple pharmacologic effects, including anti-inflammatory, antifibrotic, antioxidant (oxidative stress), anti-asthmatic, antidiabetic, immunoregulatory, and cardioprotective effects via numerous signaling pathways.(Li 2017) Pharmacological research indicates that the extract component of A. membranaceus can increase telomerase activity and has antioxidant, anti-inflammatory, immunoregulatory, anticancer, hypolipidemic, antihyperglycemic, hepatoprotective, expectorant, and diuretic effects.(Liu 2017)

Anti-aging effects

Animal and in vitro data

A proprietary extract of the dried root of A. membranaceus, TA-65, was associated with an age-reversal effect on the immune system.(Liu 2017) In rats, age-related hepatic changes were significantly decreased by an A. membranaceus extract.(Selim 2020)

Cancer

Formononetin is a bioactive isoflavone of A. membranaceus with well-documented anti-inflammatory, anticancer, and antioxidant properties. Formononetin fights progression of cancer by inducing apoptosis, arresting cell cycle, and halting metastasis via targeting various pathways that are generally modulated in several cancers. Further experimentation is needed to ascertain the full array of pharmacological and biological potential.(Jiang 2019)

Clinical data

Astragalus root has been studied in limited trials for use as adjunctive therapy in cancer; a combination preparation developed in China (Jin Fu Kang) was used for the treatment of non–small cell lung cancer, and astragalus injection was used for malignant tumors.(Cassileth 2009, Duan 2002, Zou 2003)

A systematic review of herbal medicines as adjuvants to the leucovorin calcium (folinic acid)-fluorouracil-oxaliplatin (FOLFOX-4) regimen used for treating colorectal cancer was conducted to identify evidence of safety and efficacy of treatment, as well as the management of chemotherapy adverse reactions. A total of 13 randomized clinical trials involving 940 Chinese patients with advanced (stage IV) colorectal cancer compared herbal medicines plus the FOLFOX-4 regimen with the FOLFOX-4 regimen alone. Although 58 different herbs and/or extracts were used in 7 studies, A. membranaceus was the most common herb found in treatment preparations. Tumor response rate, overall survival at 1 year, time to progression, quality of life, body weight, nausea/vomiting symptoms, and neutropenia improved significantly (P values from P<0.00001 to P=0.01) with herbal adjuvants. Astragalus was included in each of the studies contributing to these results.(Chen 2014) A meta-analysis of randomized 34 trials found that the addition of astragalus to chemotherapy was associated with a reduced risk of death, an improved response rate, and a better performance status. However, significant methodologic limitations in these trials prevented definitive conclusions about the efficacy of this herb.(McCulloch 2006) A. membranaceus is currently among the top 3 most commonly prescribed single herbs for cancer patients in Taiwan.(Cheng 2018)

Cardiovascular effects

Animal and in vitro data

Alcohol extracts of Radix Astragali improved contractility and contraction amplitude of isolated frog and toad hearts. Intravenous administration of Radix Astragali produced hypotension in cats, dogs, and rabbits. Saponins from astragalus exerted positive inotropic activity in isolated rat heart tissue.(WHO 1999) Astragalosides also increased fibrinolytic potential in human umbilical vein tissue, with effects on plasminogen expression.(Stargrove 2008)

Clinical data

Astragalus has been studied in clinical trials of patients with cardiopulmonary bypass, ischemic heart disease, angina pectoris, and chronic heart failure, with positive results.(Dai 2014, Qu 2009, Yang 2010, Zhang 2005) Astragalus was not found to improve clinical outcomes in viral myocarditis, and the quality of studies included in a Cochrane review was reported to be poor.(Liu 2013) A systematic review has shown that adjuvant therapy with a Chinese herbal medicine named Huangqi from A. membranaceus may be of benefit in managing fatigue and quality of life in stroke patients. However, stronger evidence and more rigorous randomized controlled trials are needed.(Liu 2016, Xu 2020)

Diabetes

Animal data

Studies in rodents suggest potential applications of A. membranaceus in diabetes.(Wu 2005, Zou 2009)

Clinical data

A small clinical study in patients with type 2 diabetes showed improvements in glucose metabolism but not other glycemic indices.(Agyemang 2013, Chao 2009) The anti-inflammatory, antiangiogenic, and antiapoptotic properties of A. membranaceus suggest that it potentially reduces the extent of retinal damage during hyperglycemia and hence prevents the progression of diabetic retinopathy.(Behl 2017)

Immune effects

Animal and in vitro data

Several studies on immune function have been conducted in rodents and in vitro using human cells.(Calis 1997, Chen 2014, Lau 1989, Liu 1994, Shimizu 1991, Sun 1983, Sun 1983, Tomoda 1991) In vitro and in vivo, astragalus and its active components have beneficial effects on immune responses that facilitate liver fibrosis, resulting in the inhibition of occurrence and development of liver fibrosis.(Liu 2019)

Clinical data

A number of clinical trials have been conducted in Chinese populations with immune-related conditions, including systemic lupus erythematosus, myasthenia gravis, and herpes simplex keratitis. The studies were small and published in Chinese, with findings generally supportive of enhanced immune function, as demonstrated by indices of cytokines or other relevant measures.(Cai 2006, Mao 2004, Niu 2009, Su 2007, Yang 2006) Other published clinical studies report improvements in subjective outcomes in patients with chronic fatigue or cancer-related fatigue, but not cytokine expression.(Cho 2009) T-cell activation by an oral extract of A. membranaceus has been reported in healthy volunteers.(Brush 2006)

Astragalus use as adjunctive therapy has been studied in viral diseases, including HIV, herpes simplex, and coxsackie-B infections, with reported benefits most likely due to immune effects rather than direct action on a virus itself. T-cell responses to A. membranaceus in patients with viral myocarditis reflected an enhanced immune response; however, no reduction in deaths due to cardiac failure was shown.(Liu 2013) Initial interest in the extract for a therapeutic role in HIV treatment has not persisted.(Burack 1996, Ono 1989, Yao 1992)

Nerve injury

Animal data

AS-IV has been shown to promote the repair of sciatic nerve injury in a rodent study.(Zhang 2013)

Renal effects

Clinical data

In a double-blind, randomized, crossover study in 12 healthy men, Astragali Radix aqueous extract induced marked natriuresis, which was attributed to enhanced renal responses to endogenous atrial natriuretic peptide.(Ai 2008) Studies have demonstrated effects on kidney function, including reducing proteinuria in chronic kidney disease; however, methodologies have varied. An updated systematic review and meta-analysis suggested that adjunctive use of A. membranaceus preparations in addition to conventional therapies may be effective and tolerated for short-term reduction of albuminuria, proteinuria, and serum creatinine in patients with diabetic kidney disease. However, these findings should be considered with caution due to the lack of high-quality randomized controlled trials and presence of heterogeneity and publication bias. Further randomized controlled trials are needed to confirm the long-term efficacy and safety of A. membranaceus preparations.(Zhang 2019, Zhang 2014, Zhang 2009)

Respiratory tract infections

Although astragalus is often recommended for prevention of the common cold, clinical trials supporting this use are lacking.(Su 2016)

Dosing

Clinical trial data are lacking to guide dosing recommendations for A. membranaceus products.

Pregnancy / Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Allergy has been reported.Zhang 2014 A case report exists of increased carbohydrate antigen 19-9 and induction of reversible liver and kidney cysts in a woman consuming A. membranaceus daily for 1 month.Tong 2014

Toxicology

An astragalus hot water extract was mutagenic in the Ames test in Salmonella typhimurium TA98 when activated by S9 rat liver fractions. The same preparations given by intraperitoneal injection at 1 to 10 g/kg produced chromosomal aberrations in the bone marrow of mice and increased the incidence of micronucleated cells in bone marrow. No attempt was made to isolate the mutagenic compounds responsible for these effects.Yin 1991 Other tests suggest astragalus is antimutagenic.WHO 1999 At doses 100 times higher than the effective oral doses in humans, no adverse effects were observed in mice; it should be noted that a median lethal intraperitoneal dose of 40 g/kg in mice has been reported.WHO 1999

References

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

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