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Poria

Scientific Name(s): Poria cocos (Schw.) Wolf.
Common Name(s): Fu-ling, Hoelen, Indian bread, Poria, Tuckahoe

Clinical Overview

Use

Poria is widely used in Asia, and approximately 10% of medicinal preparations in the 2000 Pharmacopoeia of the People's Republic of China contain poria (fu-ling). Animal studies suggest potential uses as an immunomodulator and anti-inflammatory agent, and in the management of cancer and diabetes; however, clinical studies are lacking.

Dosing

There is no clinical evidence to support a specific dosage of poria. Doses ranging from 3 to 45 g daily have been used.

Contraindications

Contraindications have not been clinically validated. The Chinese pharmacopoeia lists poria as contraindicated in polyuria, spermatorrhoea, and urogenital prolapse.

Pregnancy/Lactation

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

Interactions

None well documented.

Adverse Reactions

Reports of adverse events are lacking.

Toxicology

Information is lacking.

Botany

Poria, a saprophytic fungus that grows on pine tree roots, has a large potato-shaped formation known as a sclerotium that can be as large as 30 cm long and 1 kg in mass. The texture is soft and elastic, and the flavor is sweet and bland. The fungus is harvested and then dried in the shade. Different parts of fu-ling are used in Chinese medicine including the bark (fu-ling-pi), outermost reddish layer (chih-fu-ling), middle white layer (bai-fu-ling), and the core (fu-shen). P. cocos synonyms include Sclerotium cocos, Wolfiporia extensa, Wolfiporia cocos, Daedalea extensa, Macrohyporia extensa, Macrohyporia cocos, and Pachyma cocos.1, 2

History

Poria has been used in Chinese and Japanese medicine for "draining dampness," and to treat insomnia, balance electrolytes, and invigorate the spleen. Poria has been known as "the medicine of immortality" and is widely used in Asia, with approximately 10% of medicinal preparations in the 2000 Pharmacopoeia of the People's Republic of China containing fu-ling.1, 2, 3

Chemistry

Poria contains 2 main chemical groups, polysaccharides and triterpenes. Several reports have identified lanostane triterpene derivatives, polyporenic acid C, pachymaic acid, pachymic acid, tumulosic acid, a carboxylic acid, and dehydropachymic acid. Several monosaccharides, including the D- forms of glucose, xylose, mannose, galactose, fucose, and rhamnose, have been identified. The glucan pachyman has specifically been evaluated. Naming contradictions for the various monosaccharides exist in the literature. Poria also contains amino acids, enzymes, steroids and choline, as well as histidine and potassium salts.2, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18

Uses and Pharmacology

Clinical studies in which P. cocos is only one of several chemical or plant derivatives included in preparations as is common in traditional Chinese medicine, cannot be evaluated for efficacy of poria alone.

Anti-inflammatory effects

Animal data

Triterpene carboxylic acids and derivatives in poria extract inhibited induced mouse ear edema, paw edema, and other edemas, as well as long-term inflammation and dermatitis in mice.19, 20, 21, 22 Pachymic and dehydrotumulosic acids inhibited phospholipase A2 in snake venom, showing potential as anti-inflammatory agents.23

Clinical data

In human volunteers with induced contact dermatitis, poria emollient cream was effective in the induction phase of inflammation, but not in well-established inflammation.24 Inhibition of key pro-inflammatory enzymes was demonstrated in this study, comparable with that of indomethacin. The cream was not irritating to healthy skin.

Cancer

Both triterpene and polysaccharide fractions of poria demonstrated anticancer actions in laboratory experiments. Proposed mechanisms include down regulation of nuclear factor-kappa B activity and its signaling pathway, antiangiogenesis, and induced apoptosis. Cytotoxicity has been demonstrated against many human cancer cell lines, including leukemia and melanoma, as well as lung, prostate, ovarian, stomach, pancreatic, breast, and skin cancers.2, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35

Animal data

Limited animal studies exist.2 In mice, extracts of poria delayed the formation of chemically induced papillomas36 while in induced sarcomas in mice, poria reduced the weight of tumors.34

Clinical data

A systematic review of herbal medicines as adjuvants to the FOLFOX4 regimen used for treating colorectal cancer was conducted to identify evidence of safety and efficacy as well as management of chemotherapy side effects. A total of 13 Chinese randomized clinical trials involving 940 patients were included, which compared herbal medicines plus FOLFOX4 combination to the FOLFOX4 regimen alone in patients with advanced (stage IV) colorectal cancer. Although 58 different herbs and/or extracts were used, Poria cocos was the 6th most common herb found in treatment preparations (n = 4 in studies). Tumor response rate, overall survival at 1 year, time to progression, quality of life, body weight, nausea/vomiting, and neutropenia improved significantly (P values ranged from P < 0.00001 to P = 0.01) with herbal adjuvants. Poria was in each of the studies contributing to these results, except for overall survival and body weight.52

Diabetes

Animal data

Animal studies are limited. In mice with induced diabetes, the methanol extract of poria improved insulin sensitivity, with a resultant decrease in blood glucose that has been attributed to some triterpenoids. Other effects include induction of adipose conversion, increased glucose uptake, and activation of the peroxisome proliferator-activated receptor.2, 37, 38

Clinical data

Research reveals no clinical data regarding the use of P. cocos in treating diabetes.

Immunomodulation

Enhanced immune activity of mice spleen and thymus has been reported with administration of poria extracts. An increase in the immune response measured in macrophages is attributed to effect on cytokines, including tumor necrosis factor and interleukins, as well as on nuclear factor kappa B. A suppressant effect has been noted on transforming growth factor (an immune suppressor).2, 39, 40, 41

Animal data

In rats with implanted cardiac allografts, poria induced immune tolerance and increased the survival time of the graft. Increased CD-3,-4, and -8 counts were also observed.42

Clinical data

Research reveals no clinical data regarding the use of P. cocos as an immunomodulator. A study conducted in male wrestlers found a diminished immune response to P. cocos among dehydrated subjects.43

Other effects

Other effects reported for poria include nematocidal, antibacterial, and antiviral activity2, 17, 18; antioxidant action2, 44, 45; antiemetic effects2, 46, 47; and improved cerebral blood flow.48, 49

Dosing

There is no clinical evidence to support a specific dosage of poria. The Chinese Compendium of Materia Medica recommends daily dosages for reinforcing the spleen and stomach of 9 to 18 g, 30 to 45 g daily for edema, and 3 to 9 g daily for sedation or treatment of palpitations.2

Pregnancy / Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking. Poria is the main component of a traditional Chinese medicine used to prevent spontaneous abortion.42 Until safety in pregnancy has been established, the use of poria cannot be recommended.

Interactions

None well documented. P. cocos glucan has been suggested to inhibit platelet aggregation; however, the clinical importance of this effect is unknown.25

Adverse Reactions

Research reveals little or no information regarding adverse reactions with the use of this product. The Chinese pharmacopoeia lists poria as contraindicated in polyuria, spermatorrhoea, and urogenital prolapse.2

Toxicology

Specific studies are lacking; however, no reports of cytotoxicity exist in the literature. The Chinese Compendium of Materia Medica recommends daily dosages of up to 45 g daily.2 Toxicity of poria polysaccharides has been reported to be low during intraperitoneal administration of 100 mg/kg, killing none of the mice in 1 report.50 Glucans and modified derivatives from poria were suggested to be less toxic than 5-fluorouracil in cancer studies.51

References

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2. Ríos JL. Chemical constituents and pharmacological properties of Poria cocos. Planta Med. 2011;77(7):681-691.21347995
3. Song Z, Bi K, Luo X, Chan K. The isolation, identification and determination of dehydrotumulosic acid in Poria cocos. Anal Sci. 2002;18(5):529-531.12036119
4. Zhang L, Ding Q, Zhang P, Feng H. Isolation and structural analysis of polysaccharides from the sclerotium of Poria cocos Wolf [in Chinese]. Gaodeng Xuexiao Huaxue Xuebao. 1997;18(6):990-993.
5. Ding Q, Zhang L, Cheung P. Isolation and structural analysis of polysaccharides from Poria cocos mycelia [in Chinese]. Gaofenzi Xuebao. 2000;2:224-227.
6. Zhang L, Ding Q, Zhang P, Zhu R, Zhou Y. Molecular weight and aggregation behavior in solution of β-D-glucan from Poria cocos sclerotium [in Chinese]. Carbohydr Res. 1997;303(2):193-197.
7. Zhang L, Ding Q, Meng D, Ren L, Yang G, Liu Y. Investigation of molecular masses and aggregation of β-D-glucan from Poria cocos sclerotium by size-exclusion chromatography. J Chromatogr. 1999;839(1-2):49-55.
8. Zhao J, Yao Y, Chen Y, Xu S, Yao X, Liu Y. Preparation of antitumor sulfated pachymaran from Poria cocos (Schw.) Wolf [in Chinese]. Shenyang Yaoke Daxue Xuebao. 1996;13(2):125-128,138.
9. Wang LY, Wan HJ, Chen LX, Zhang HM, Yu ZY. Studies on chemical constituents from solvent extracts of Poria cocos (Schw.) Wolf [in Chinese]. Zhongguo Zhong Yao Za Zhi. 1993;18(10):613-614, 639.8003216
10. Zhong Z, Xu X. The recent studies of triterpenes from the Poria cocos [in Chinese]. Zhongguo Yaowu Huaxue Zazhi. 1997;7(1):71-78.
11. Yasukawa K, Kaminaga T, Kitanaka S, et al. 3 beta-p-hydroxybenzoyldehydrotumulosic acid from Poria cocos, and its anti-inflammatory effect. Phytochemistry. 1998;48(8):1357-1360.9720314
12. Kwon M, Chung S, Choi J, Song K, Lee I. Antimicrobial and antitumor activity of triterpenoids fraction from Poria cocos Wolf [in Korean]. Han'guk Sikp'um Yongyang Kwahak Hoechi. 1999;28(5):1029-1033.
13. Zhong Z, Xu X, Zhou J, Li D. Study on chemical structures and bioactivities of triterpenes and their derivatives of Chinese Poria cocos [in Chinese]. Zhongguo Yaowu Huaxue Zazhi. 1998;8(4):239-244.
14. Li J, Li H, Xu J. Chemical constituents of CSFs inducer from Poria cocos [in Chinese]. Zhongguo Yaoxue Zazhi (Beijing). 1997;32(7):401-404.
15. Rhee S, Cho S, Park J, et al. Chemical composition and biological activities of immunostimulants purified from alkali extract of Poria cocos sclerotium [in Korean]. Han'guk Kyunhakhoechi. 1999;27(4):293-298.
16. Zheng Y, Yang XW. Absorption and transport of pachymic acid in the human intestinal cell line Caco-2 monolayers. Zhong Xi Yi Jie He Xue Bao. 2008;6(7):704-710.18601852
17. Li GH, Shen YM, Zhang KQ. Nematicidal activity and chemical component of Poria cocos. J Microbiol. 2005;43(1):17-20.15765052
18. Wang Y, Xu W, Chen Y. Surface modification on polyurethanes by using bioactive carboxymethylated fungal glucan from Poria cocos. Colloids Surf B Biointerfaces. 2010;81(2):629-633.20817490
19. Kaminaga T, Yasukawa K, Kanno H, Tai T, Nunoura Y, Takido M. Inhibitory effect of Poria cocos on 12-O-tetradecanoylphorbol-13-acetate-induced ear edema and tumor promotion in mouse skin. Phytother Res. 1996;10:581-584.
20. Nukaya H, Yamashiro H, Fukazawa H, Ishida H, Tsuji K. Isolation of inhibitors of TPA-induced mouse ear edema from Hoelen, Poria cocos. Chem Pharm Bull (Tokyo). 1996;44(4):847-849.8681415
21. Cuellar MJ, Giner RM, Recio MC, Just MJ, Mañez S, Rios JL. Effect of the basidiomycete Poria cocos on experimental dermatitis and other inflammatory conditions. Chem Pharm Bull (Tokyo). 1997;45(3):492-494.9085556
22. Giner-Larza EM, Máñez S, Giner-Pons RM, Carmen Recio M, Ríos JL. On the anti-inflammatory and anti-phospholipase A(2) activity of extracts from lanostane-rich species. J Ethnopharmacol. 2000;73(1–2)61-69.11025140
23. Cuélla MJ, Giner RM, Recio MC, Just MJ, Máñez S, Ríos JL. Two fungal lanostane derivatives as phospholipase A2 inhibitors. J Nat Prod. 1996;59(10):977-979.
24. Fuchs SM, Heinemann C, Schliemann-Willers S, Härtl H, Fluhr JW, Elsner P. Assessment of anti-inflammatory activity of Poria cocos in sodium lauryl sulphate-induced irritant contact dermatitis. Skin Res Technol. 2006;12(4):223-227.
25. Sagar SM, Yance D, Wong RK. Natural health products that inhibit angiogenesis: a potential source for investigational new agents to treat cancer-Part 1. Curr Oncol. 2006;13(1):14-26.17576437
26. Zhou L, Zhang Y, Gapter LA, Ling H, Agarwal R, Ng KY. Cytotoxic and anti-oxidant activities of lanostane-type triterpenes isolated from Poria cocos. Chem Pharm Bull (Tokyo). 2008;56(10):1459-1462.18827390
27. Kikuchi T, Uchiyama E, Ukiya M, et al. Cytotoxic and apoptosis-inducing activities of triterpene acids from Poria cocos. J Nat Prod. 2011;74(2):137-144. 21250700
28. Ling H, Zhang Y, Ng KY, Chew EH. Pachymic acid impairs breast cancer cell invasion by suppressing nuclear factor-ΚB-dependent matrix metalloproteinase-9 expression. Breast Cancer Res Treat. 2011;126(3):609-620.20521099
29. Ling H, Zhou L, Jia X, Gapter LA, Agarwal R, Ng KY. Polyporenic acid C induces caspase-8-mediated apoptosis in human lung cancer A549 cells. Mol Carcinog. 2009;48(6):498-507.
30. Akihisa T, Uchiyama E, Kikuchi T, Tokuda H, Suzuki T, Kimura Y. Anti-tumor-promoting effects of 25-methoxyporicoic acid A and other triterpene acids from Poria cocos. J Nat Prod. 2009;72(10):1786-1792.
31. Zhang M, Chiu LC, Cheung PC, Ooi VE. Growth-inhibitory effects of a beta-glucan from the mycelium of Poria cocos on human breast carcinoma MCF-7 cells: cell-cycle arrest and apoptosis induction. Oncol Rep. 2006;15(3):637-643. 16465424
32. Kang HM, Lee SK, Shin DS, et al. Dehydrotrametenolic acid selectively inhibits the growth of H-ras transformed rat2 cells and induces apoptosis through caspase-3 pathway. Life Sci. 2006;78(6):607-613.16112686
33. Gapter L, Wang Z, Glinski J, Ng KY. Induction of apoptosis in prostate cancer cells by pachymic acid from Poria cocos [published correction appears in Biochem Biophys Res Commun. 2006;339(1):457]. Biochem Biophys Res Commun. 2005;332(4):1153-1161.15913545
34. Wang Y, Zhang L, Li Y, Hou X, Zeng F. Correlation of structure to antitumor activities of five derivatives of a beta-glucan from Poria cocos sclerotium. Carbohydr Res. 2004;339(15):2567-2574.15476718
35. Chen YY, Chang HM. Antiproliferative and differentiating effects of polysaccharide fraction from fu-ling (Poria cocos) on human leukemic U937 and HL-60 cells. Food Chem Toxicol. 2004;42(5):759-769. 15046822
36. Akihisa T, Nakamura Y, Tokuda H, et al. Triterpene acids from Poria cocos and their anti-tumor-promoting effects. J Nat Prod. 2007;70(6):948-953.17488130
37. Li TH, Hou CC, Chang CL, Yang WC. Anti-Hyperglycemic Properties of Crude Extract and Triterpenes from Poria cocos. Evid Based Complement Alternat Med. 2011;2011. pii: 128402. Epub 2010 Sep 16.20924500
38. Huang YC, Chang WL, Huang SF, Lin CY, Lin HC, Chang TC. Pachymic acid stimulates glucose uptake through enhanced GLUT4 expression and translocation. Eur J Pharmacol. 2010;648(1-3):39-49.20816811
39. Chen X, Zhang L, Cheung PC. Immunopotentiation and anti-tumor activity of carboxymethylated-sulfated beta-(1→3)-d-glucan from Poria cocos. Int Immunopharmacol. 2010;10(4):398-405. 20093198
40. Chang HH, Yeh CH, Sheu F. A novel immunomodulatory protein from Poria cocos induces Toll-like receptor 4-dependent activation within mouse peritoneal macrophages. J Agric Food Chem. 2009;57(14):6129-6139.19548679
41. Spelman K, Burns J, Nichols D, Winters N, Ottersberg S, Tenborg M. Modulation of cytokine expression by traditional medicines: a review of herbal immunomodulators. Altern Med Rev. 2006;11(2):128-150. 16813462
42. Zhang GW, Liu HY, Xia QM, et al. Anti-rejection effect of ethanol extract of Poria cocos wolf in rats after cardiac allograft implantation. Chin Med J (Engl). 2004;117(6):932-935.15198902
43. Jang TR, Kao MF, Chen CH, Hsieh KC, Lai WY, Chen YY. Alleviating effects of dehydration under no hyperthermia on the immunomodulatory response to the polysaccharide fraction from fu-ling (Poria cocos) in male collegiate wrestlers. Chin Med J (Engl). 2011;124(4):530-536. 21362276
44. Wu SJ, Ng LT, Lin CC. Antioxidant activities of some common ingredients of traditional chinese medicine, Angelica sinensis, Lycium barbarum and Poria cocos. Phytother Res. 2004;18(12):1008-1012.15742346
45. Park YH, Son IH, Kim B, Lyu YS, Moon HI, Kang HW. Poria cocos water extract (PCW) protects PC12 neuronal cells from beta-amyloid-induced cell death through antioxidant and antiapoptotic functions. Pharmazie. 2009;64(11):760-764.20099523
46. Tai T, Akita Y, Kinoshita K, Koyama K, Takahashi K, Watanabe K. Anti-emetic principles of Poria cocos. Planta Med. 1995;61(6):527-530.8824947
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50. Komatsu N, et al. Polysaccharides with antitumor activity [in German]. Offen. 1969;Patent number 19691016.
51. Ding Q, Zhang L, Zeng F. Influence of molecular weight and periodate modification of β-D-glucans from Poria cocos. sclerotium on antitumor activities. Chin J Polym Sci. 1998;16(1):62-66.
52. Chen M, May BH, Zhou IW, Xue CC, Zhang AL. FOLFOX 4 combined with herbal medicine for advanced colorectal cancer: a systematic review. Phytother Res. 2014;28(7):976-991.24343974

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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.

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