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Poria

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

Medically reviewed by Drugs.com. Last updated on Sep 21, 2023.

Clinical Overview

Use

Poria is widely used in Asia, with approximately 10% of medicinal preparations included in the Pharmacopoeia of the People's Republic of China containing poria (fu-ling). Animal studies suggest immunomodulatory, anti-inflammatory, and diuretic effects, and potential benefit in the treatment of dysmenorrhea, cancer, and diabetes. However, clinical studies are lacking to recommend use of poria for any indication.

Dosing

There is no clinical evidence to support dosing recommendations for poria. Doses ranging from 3 to 45 g daily have been used for various indications.

Contraindications

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

Pregnancy/Lactation

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

Interactions

None well documented.

Adverse Reactions

Reports of adverse events are lacking.

Toxicology

No data.

Scientific Family

Botany

Poria is a saprophytic fungus that grows on pine tree roots; its large, potato-shaped formation known as a sclerotium can grow up to 30 cm in length 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.Leung 1996, Ríos 2011

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 Pharmacopoeia of the People's Republic of China containing fu-ling.Leung 1996, Ríos 2011, Song 2002

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, 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.Ding 2000, Kwon 1999, Li 1997, Li 2005, Rhee 1999, Ríos 2011, Wang 1993, Wang 2010, Yasukawa 1998, Zhang 1997, Zhang 1997, Zhang 1999, Zhao 1996, Zheng 2008, Zhong 1997, Zhong 1998

Uses and Pharmacology

Most clinical evidence is based on combination preparations containing poria. Clinical studies in which P. cocos is only one of several chemical or plant derivatives included in preparations, which 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 ear edema, paw edema, and other edemas, as well as long-term inflammation and dermatitis in mice.Cuellar 1997, Giner-Larza 2000, Kaminaga 1996, Nukaya 1996 Pachymic and dehydrotumulosic acids inhibited phospholipase A2 in snake venom, suggesting potential as anti-inflammatory agents.Cuélla 1996

Clinical data

In human volunteers with induced contact dermatitis, poria incorporated into an amphiphilic emollient cream was effective in the induction phase of inflammation, but not in well-established inflammation. Inhibition of key proinflammatory enzymes comparable with that of indomethacin was demonstrated. The cream was not irritating to healthy skin.Fuchs 2006

Cancer

Both triterpene and polysaccharide fractions of poria have demonstrated anticancer actions in laboratory experiments. Proposed mechanisms include downregulation 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.Akihisa 2009, Chen 2004, Gapter 2005, Kang 2006, Kikuchi 2011, Ling 2009, Ling 2011, Ríos 2011, Sagar 2006, Wang 2004, Zhang 2006, Zhou 2008

Animal data

Limited animal studies exist.Ríos 2011 In mice, extracts of poria delayed the formation of chemically induced papillomasAkihisa 2007 and reduced the weight of tumors in mice with induced sarcomas.Wang 2004 In mice injected with breast cancer cells, an ethanol extract of poria demonstrated inhibition of tumor development and final tumor weight, and was associated with fewer organ and muscle adverse effects than the comparator, cisplatin.Jiang 2020

Clinical data

A systematic review of herbal medicines used as adjuvants to the 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) regimen for treatment of colorectal cancer was conducted to identify evidence of safety and efficacy as well as management of chemotherapy adverse effects. A total of 13 Chinese randomized clinical trials (N=940) comparing herbal medicines plus FOLFOX4 with the FOLFOX4 regimen alone in patients with advanced (stage IV) colorectal cancer were included. Although 58 different herbs and/or extracts were used, P. cocos was the sixth most common herb found in treatment preparations (4 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 present in the preparations used in each of the studies contributing to these results, except for overall survival and body weight.Chen 2014

Depression

Animal data

A study in mice demonstrated promising results for oral treatment with polysaccharides purified from P. cocos; antidepressant effects were shown through inflammatory mechanisms.Zhang 2018 In rats, a P. cocos water extract reduced depressive behavioral issues associated with chronic stress via anti-inflammatory effects.Huang 2020 Similar results were noted with a triterpenoid extract of poria, with potential mediation by gut flora metabolism.Gao 2020

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.Huang 2010, Li 2011, Ríos 2011 At least one poria component seemed to reduce hyperglycemia via effects on the gut biome.Sun 2019

Diuresis

Animal data

In one study in rats, increased urine output and sodium and chloride excretion were observed after oral administration of ethanol extracts of P. cocos.Hu 2017

Dysmenorrhea

Animal data

In a study in which female mice with oxytocin-induced uterine contractions were administered oral extracts from Guizhi Fuling (a Chinese herbal capsule formulation containing P. cocos and 4 other herbal ingredients) for 5 days, treatment resulted in reduced writhing response and inhibition of spontaneous uterine contractions; further studies are needed to determine a role in dysmenorrhea.Sun 2016

Immunomodulatory effects

Enhanced immune activity of mice spleen and thymus has been reported with administration of poria extracts. An increase in the immune response by activated macrophages has been attributed to effects 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).Chang 2009, Chen 2010, Ríos 2011, Spelman 2006

Animal data

In rats with implanted cardiac allografts, poria induced immune tolerance and increased survival time of the graft. Increased CD3, CD4, and CD8 counts were also observed.Zhang 2004

Clinical data

While there are no clinical data regarding use of P. cocos as an immunomodulator, a study conducted in male wrestlers showed a diminished immune response to a polysaccharide fraction from P. cocos among dehydrated subjects.Jang 2011

Osteoporosis

Animal data

A hydroethanolic P. cocos extract inhibited osteoclast functioning and reduced bone loss in ovariectomized mice.Hwang 2020

Other uses

Other effects reported for poria include nematocidal, antibacterial, and antiviral activitiesLi 2005, Ríos 2011, Wang 2010; antioxidant activityPark 2009, Ríos 2011, Wu 2004; antiemetic effectsRíos 2011, Tai 1995; and improved cerebral blood flow.Jingyi 1997, Wang 1998

Dosing

There is no clinical evidence to support dosing recommendations for poria. The Chinese Compendium of Materia Medica states that dry powder of P. cocos sclerotium is used in infusions at daily doses of 6 to 18 g. For reinforcing the spleen and stomach, the recommended dose is 9 to 18 g daily; for edema, the recommended dose is 30 to 45 g daily; and for sedative purposes or for treatment of palpitations and insomnia, the recommended dose is 3 to 9 g daily.Ríos 2011

Pregnancy / Lactation

Avoid use. 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.Zhang 2004 However, until safety in pregnancy has been established, 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.Sagar 2006

Adverse Reactions

Research reveals little or no information regarding adverse reactions with the use of poria. The Chinese Pharmacopoeia lists poria as contraindicated in polyuria, spermatorrhea, and urogenital prolapse.Ríos 2011

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.Ríos 2011 Glucans and modified derivatives from poria were suggested to be less toxic than 5-fluorouracil in cancer studies.Ding 1998

Index Terms

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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