Scientific Name(s): Poria cocos (Schw.) Wolf.
Common Name(s): Fu-ling, Hoelen, Indian bread, Poria, Tuckahoe
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.
There is no clinical evidence to support a specific dosage of poria. Doses ranging from 3 to 45 g daily have been used.
Contraindications have not been clinically validated. The Chinese pharmacopoeia lists poria as contraindicated in polyuria, spermatorrhoea, and urogenital prolapse.
Information regarding safety and efficacy in pregnancy and lactation is lacking.
None well documented.
Reports of adverse events are lacking.
Information is lacking.
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
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
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.
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
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.
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
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
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
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
Research reveals no clinical data regarding the use of P. cocos in treating diabetes.
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
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
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 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
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.
None well documented. P. cocos glucan has been suggested to inhibit platelet aggregation; however, the clinical importance of this effect is unknown.25
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
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
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