Astragalus root (Astragalus membranaceus and Astragalus
mongholicus) (Figs. 1 and 2; flowers are shown in Fig.
2) is one of the most important plant products used
in traditional Chinese medicine (TCM) for supporting
immune resistance ( ; wei qi) and energy production
( ; bu qi). Astragalus is also one of the most popular
ingredients in botanical dietary supplements for its
putative effect of supporting healthy immune function.
Despite the widespread use of this botanical among
TCM practitioners and its extensive use in botanical
supplements, there are few clinical trials supporting
its use, though those that are available are positive.
Numerous preclinical studies provide evidence for a
number of pharmacological effects that are consistent
with the traditional and modern use of astragalus.
Traditional and Modern Uses
In Asia, astragalus is commonly used according to both
its traditional Chinese medical indications as a general
tonifier and specifically for immune enhancement and for
modern biomedical indications such as immune, liver, and
cardiovascular support. It has been used for the prevention
of the common cold and upper respiratory tract infections
and is widely prescribed to children for prevention
of infectious disease, though formal clinical English language
studies regarding this use are lacking. In the West,
astragalus is primarily used as an immune modulator.
Astragalus potentiates recombinant interleukin-2 (rIL-2)
and recombinant interferon-1 and -2 (rIFN-1 and -2) immunotherapy
and by lowering the therapeutic thresholds,
may reduce the side effects normally associated with these
therapies. The data and opinion of those expert with the
use of the botanical suggest that astragalus is useful as a
complementary treatment during chemotherapy and radiation
therapy and in immune deficiency syndromes. There
is some modern evidence for its use in hepatitis and the
treatment of cardiovascular disease.
In TCM and Western clinical herbal medicine, astragalus
is most commonly used in combination with other
botanicals and is very seldom used as a single agent. There
are numerous studies of some of the classic combinations
of astragalus (e.g., astragalus and Angelica sinensis). These
have not been reviewed, but use of formulas is more consistent
with the use of the astragalus than with the use of
the herb alone according to traditional Chinese medical
CHEMISTRY AND PREPARATION OF PRODUCTS
The primary compounds of interest in astragalus are triterpenes,
polysaccharides, and flavonoids. The triterpene astragaloside
IV is a relatively unique marker for astragalus
species used in Chinese medicine. A variety of preparations
are utilized in clinical practice and in herbal supplements.
A number of preparations, including crude extracts,
isolated polysaccharides, and triterpene saponins,
have been subject to study and correlated with activity.
Clinically, in China and among some practitioners in the
United States, decoctions are frequently given. However,
due to the time required for cooking and the subsequent
smell and taste of Chinese herb preparations in general
(though astragalus is very agreeable), many consumers
and practitioners prefer crude powder or extract preparations
(capsules, tablets), freeze-dried granules, or liquid
extracts. Astragalus is also used as a relatively common
ingredient in soups, especially during winter months.
Polysaccharides (12–36 kD) have been most often
correlated with immune activity, while triterpene
saponins have been predominantly associated with cardiovascular
and hepatoprotective effects. Astragalus
polysaccharides are generally composed of a mixture of
D-glucose, D-galactose, and L-arabinose or D-glucose
alone. The glucose units appear to be primarily -(1,4)-
linked with periodic -(1,6)-linked branches (1,2). The
triterpene glycosides vary by position, number, and type
of sugar residues at positions 3, 6, and 25. Several of
these “astragalosides” (e.g., astragaloside IV; Fig. 3) are
composed of a single xylopyranosyl substituent at the 3-
position, which may or may not be acetylated. Others possess
either disaccharide or trisaccharide substituents (3–
5). Primary flavonoids of astragalus for which activity has
been reported include calycosin, formononetin (Fig. 3),
and daidzein (Fig. 3) and additionally include isorhamnetin,
kaempferol, and quercetin, among others (6).
Pharmacokinetic data available in English language publications
on astragalus, its crude extracts, or its constituents
are very limited. In the most detailed study to
date, the pharmacokinetics of a decoction of astragalus,
the preparation most used traditionally were investigated
in four models: four complement in silico, a cacao-2 intestinal
cell model, an animal, and a human volunteer
(n = 1). Intestinal absorption was demonstrated for several
flavonoids including calycosin and formononetin,
along with their aglycone metabolites in all four
models. Triterpene saponins, used as chemical markers
of astragalus (e.g., astragaloside I and IV) in the Pharmacopoeia
of the People’s Republic of China and the American
Herbal Pharmacopoeia, were lacking, likely due to
their low concentrations in the preparation. In the human
volunteer, nine flavonoids, including calycosin, formononetin,
and the isoflavone daidzein, were detected
Figure 2 Astragalus flowers. Source: Photo courtesy of Bill Brevoort, American
in urine (7). In animal models (rats and dogs), astragaloside
IV, which has demonstrated cardioprotective activity,
showed moderate-to-fast elimination. The half-life in male
rats was from 67.2 to 98.1 minutes, in female rats 34.0 to
131.6 minutes, and was linear at the intravenous doses
given. The highest concentration of astragaloside IV was
found in the lungs and liver. Only 50% of the compound
was detected in urine and feces. Binding to plasma protein
was also linear at the concentration of 250–1000 ng/mL.
Slow systemic clearance of astragaloside IV occurred via
the liver at approximately 0.004 L/kg/min (8).
In another pharmacokinetic study, a two compartment,
first-order pharmacokinetic model was
used to describe the pharmacokinetics of intravenously administered
astragaloside IV. Systemic clearance of this
triterpene was reported as moderate and distribution into
peripheral tissues was limited (9).
A large percentage of research on astragalus has focused
on its immunostimulatory activity and its purported
ability to restore the activity of a suppressed immune
system. More recently, interest in its potential as a cardioprotective
agent has been shown. Reviews of a limited
number of clinical trials and preclinical data provide some
evidence for its usefulness in the prevention of the common
cold and as an adjunct to cancer therapies. There is
limited evidence to suggest a benefit to the cardiovascular
Figure 3 Some major constituents of Astragalus.
system, with improvement in clinical parameters associated
with angina, congestive heart failure, and acute myocardial
infarct. There is also some indication from animal
studies supporting its use in the treatment of hepatitis and
There are relatively strong preclinical data of pharmacological
mechanisms that provide support for the putative
immunomodulatory effects of astragalus.
In a rat study, animals were pretreated orally for 50 days
with a low or high dose of astragalus extract (3.3 or
10 g/kg/day) prior to IP injection of doxorubicin (cumulative
dose of 12 mg/kg over a 2-week period). After 5 weeks
of the final injection of doxorubicin, a significant inhibition
of cardiac diastolic function was observed. This was
accompanied by ascites, catexia, decreased heart weight,
and increased mortality. Treatment with astragalus at both
doses significantly attenuated the negative effects of doxorubicin
on cardiac functions and ascites, while the high
dose also improved survival. This protective effective
was at least partially associated with the ability of astragalus
to attenuate changes in cardiac SERCA2a mRNA
A broad array of immunomodulatory effects has
been demonstrated in numerous preclinical studies that
suggest a substantial value of astragalus in conjunction
with conventional cancer therapies. The most relevant
of these was a series of investigations conducted
by researchers at the MD Anderson Cancer Center
that found that astragalus extract restored to normal
the immune response of patients’ mononuclear cells
that were grafted into rats immunocompromised by cyclophosphamide.
These researchers concluded that astragalus
and its polysaccharide fraction reversed the immunosuppressive
effect of cyclophosphamide (11–15). In
other studies, astragalus and its various fractions were
shown to stimulate macrophage phagocytosis (16) and
One study reported on the gastroprotective effects
of astragalus extract (characterization not reported) in human
peritoneal mesothelial cells (HPMCs) subjected to
gastric cancer cell lines. Upon incubation with cancer cell
lines, apoptosis of the HPMC cells was observed. The astragalus
preparation, via regulation of Bcl-2 and Bax, partially
inhibited apoptosis. The authors interpreted these
findings as a potential that astragalus may slow down the
metastasis of the primary cancer and is therefore a potential
treatment for gastric cancer (18).
The ability of an astragalus fraction to potentiate the
effects of rIL-2 has been demonstrated in in vitro assays.
Lymphokine-activated killer (LAK) cells were treated with
a combination of the astragalus fraction and 100 units/mL
of IL-2. The combination therapy produced the same
amount of tumor-cell-killing activity as that generated
by 1000 units/mL of rIL-2 on its own, thus suggesting
that the astragalus fraction elicited a 10-fold potentiation
of rIL-2 in this in vitro model (19). These findings were
confirmed in a follow-up study by the MD Anderson researchers
using LAK cells from cancer and AIDS patients.
In this study, the cytotoxicity of a lower dose of 50 g/mL
of rIL-2 given with the astragalus fraction was comparable
to that of a higher dose of 500 g/mL of rIL-2 alone
against the Hs294t melanoma cell line of LAK cells. With
the combination, the effector-target cell ratio could be reduced
to one-half to obtain a level of cytotoxicity that was
equivalent to the use of rIL-2 alone. In addition, the astragalus
fraction was shown to increase the responsiveness
of peripheral blood lymphocytes that were not affected by
rIL-2. In this study, and in another by the same researchers,
it was concluded that the fraction potentiated the activity
of LAK cells and allowed for the reduction in rIL-2, thus
minimizing the toxicity of rIL-2 therapy (20). Other groups
of researchers reported almost identical findings (a 10-fold
potentiation) and concluded that astragalus is effective in
potentiating IL-2-generated LAK cell cytotoxicity in vitro
(21,22). Astragalus was also found to enhance the secretion
of tumor necrosis factor (TNF) from human peripheral
blood mononuclear cells (PBMCs). A polysaccharide
fraction (molecular weight 20,000–25,000) increased secretion
of TNF- and TNF- after isolation of adherent and
non adherent mononuclear cells from PBMCs (23).
Other investigations support the role of astragalus
polysaccharides as immunomodulating agents.
In an in vitro study, astragalus polysaccharides significantly
induced the proliferation of BALB/c mouse
splenocytes resulting in subsequent induction of interleukin
1 and tumor necrosis factor- and the activation
of murine macrophages. The researchers concluded
that astragalus had an intermediate-to-high affinity
for membrane immunoglobulin (Ig) of lymphocytes
In animal studies, astragalus or its compounds were reported
to elicit antioxidant (25), mild hypotensive (26),
and both positive (27) (50–200 g/mL) and negative
(30 g/mL) inotropic activity (28). The inotropic activity
was reported to be due to the modulation of Na+–K+
ATPase in a manner similar to strophanthin K. Antioxidant
(29), calcium channel blocking (30), and fibrinolytic
activity (31) have been reported in in vitro studies. Astragaloside
IV was studied for potential cardioactivity.
Various effects have been reported. Intravenous administration
of astragaloside IV reduced the area of myocardial
infarct and reduced plasma creatine phosphokinase
release in dogs subjected to 3-hour ligation and increased
coronary blood flow in anesthetized dogs. In isolated rat
heart perfusion investigations, astragaloside IV significantly
improved (P < 0.01) postischemic heart function
and reduced creatine phosphokinase release from the myocardium.
In addition, coronary blood flow during baseline
perfusion and reperfusion in ischemic rat hearts was
increased, while reperfusion damage was decreased. This
activity was shown to be at least partially attributable to
coronary dilation via an increase in endothelium-derived
nitric oxide. Antioxidant activity via an increase in superoxide
dismutase (SOD) activity has also been reported for
astragalus and is considered to contribute to its cardioprotective
effects (32). Astragaloside IV was also shown
to significantly attenuate blood–brain barrier permeability
in a rat ischemia/reperfusion model (33).
Hepatoprotective effects against numerous hepatotoxic
agents (e.g., acetaminophen, carbon tetrachloride, and Escherichia
coli endotoxin) have been reported in both animal
and in vitro studies. In these experiments, improvement
in histological changes in hepatic tissue, including
fatty infiltration, vacuolar degeneration, and hepatocellular
necrosis, was reported. These effects may be associated
with saponin fractions (34). In one clinical study of
hepatitis B patients, concomitant use of astragalus with
lamivudine and -2b interferon showed greater efficacy
than with lamivudine alone (35).
Systemic Lupus Erythematosus
Astragalus was also studied for its ability to affect natural
killer (NK) cell activity, using an enzyme-release assay.
The NK cell activity of PBMCs from 28 patients with systemic
lupus erythematosus (SLE) was increased after in
vitro incubation with an undefined astragalus preparation.
Low levels of NK cell activity were correlated with
disease activity. PBMCs from patients with SLE had significantly
decreased NK cell activity as compared with
those from healthy donors. The extent of stimulation by
the astragalus preparation was related to the dose and
length of the preincubation period (36). Despite its use as
an immune-enhancing agent, which would normally be
considered contraindicated in autoimmune disorders, investigation
of astragalus may be warranted as evidence
suggests that it elicits significant anti-inflammatory activity
and improves ratios and function of T lymphocytes in
Prophylaxis against flu and modulation of endogenously
produced interferon have been reported in several animal
studies utilizing astragalus alone (6).
In a new line of investigation for astragalus, two triterpenes
(astragaloside II and isoastragaloside I) were
shown to alleviate insulin resistance and glucose intolerance
in mice. The two compounds selectively increased
adiponectin secretion on primary adipocytes and potentiated
the effects of the insulin-sensitizer rosiglitazone.
Chronic administration of the compounds (specific details
lacking) to both dietary and genetically obese mice
resulted in a significant increase in serum adiponectin, resulting
in an alleviation of hyperglycemia, glucose intolerance,
and insulin resistance. These effects were diminished
in mice lacking adiponectin (38).
One study showed that a liquid extract of astragalus
(2 g/mL/intravenous) retarded the progression of renal
fibrosis in a manner similar to the angiotensin-II-receptor
antagonist losartan. The study reported that like losartan,
astragalus decreased deposition of fibronectin and
type-I collagen by significantly reducing the expression of
transforming growth factor-1 and -smooth muscle actin
(P < 0.05) (39).
Astragalus was investigated for its potential effect
of reducing atopic dermatitis in mice. Using prednisolone
(3 mg/kg/day) as a comparator, an astragalus water extract
was administered orally at 100 mg/kg. Astragalus
significantly reduced the severity of chemically induced
inflammation (2,4-dinitrofluorobenzene) to a degree similar
to the comparator but, unlike prednisolone, did not
inhibit interleukin-4 production (40).
There are both English and Chinese language studies on
astragalus. As with much of the literature regarding Chinese
herbs, there are few clinical data of high methodological
quality. In addition, a positive publication bias
regarding Chinese literature has been reported (41), while
in primary American medical literature, a negative publication
bias against dietary supplement studies has been
Among modern herbal practitioners, astragalus is recommended
as an immune supportive botanical in conjunction
with conventional chemo and radiation therapies for
cancer. There is a common belief and some clinical and
preclinical evidence that astragalus both reduces side effects
associated with conventional cancer therapies and
can potentiate the effects of certain therapies. The available
evidence is not strong enough to recommend astragalus
as a standard part of conventional cancer care. However,
its demonstrated safety, lack of negative interaction with
conventional therapies, and its putative benefit in building,
preserving, and restoring immunocompetency before
and after conventional therapies warrant specific study.
There is also potential for use of both oral and injectable
preparations, the latter of which are not approved in North
America but are widely used throughout Asia.
In one clinical study, an astragalus drip (20 mL in
250 mL saline solution daily for 84 days) was administered
to cancer patients (n = 60). Compared with the control
group (no astragalus), those in the astragalus group
showed a slower rate of tumor progression, a lower rate
of reduction in peripheral leukocytes and platelets, reduction
in suppressor CD8s, improved CD4/CD8 ratios,
increased IgG and IgM, and better Karnofsky scores (43).
In addition to its use alone, both as a primary treatment
and as an adjunct to conventional cancer therapies,
astragalus is most often combined with other similar acting
immune-enhancing plants. A number of randomized
prospective clinical studies of cancer patients were conducted
using a combination of astragalus and ligustrum
(Ligustrum lucidum) (undisclosed quantities) with positive
results, such as mortality reduction in breast and lung
cancer patients (44). These effects, of course, must be considered
to be due to the cumulative effects of the two
botanicals and cannot be presumed to occur with astragalus
alone but are more consistent with the manner in
which astragalus is used in TCM.
An early clinical trial reported that 53 cases of
chronic leukopenia responded favorably to an astragalus
extract (1:1; 2 mL daily intramuscularly for 1–2 weeks).
Improvements in symptoms and white blood cell counts
were observed, but specific data were lacking (34).
Various cardioactive properties have been reported for astragalus,
and astragalus is widely used in the treatment of
both chronic and acute cardiovascular disease in China.
In one study, 92 patients with ischemic heart disease were
given an unidentified preparation of astragalus. Marked
relief from angina pectoris and other improvements as
measured by electrocardiogram (ECG) and impedance
cardiogram were reported. Improvement in the ECG index
was reported as 82.6%. Overall improvement was significant
as compared with the control group (P<0.05) (45).
A similar result in cardiac performance was reported by
other groups of researchers. In one study, 43 patients were
hospitalized within 36 hours of acute myocardial infarct.
After administration of an astragalus preparation (undefined
profile), the ratio of pre ejection period/left ventricular
ejection time was decreased, the antioxidant activity of
SOD of red blood cells was increased, and the lipid peroxidation
content of plasma was reduced (46). In another experiment,
20 patients with angina pectoris were given an
undefined astragalus preparation. Cardiac output, as measured
by Doppler echocardiogram, increased from 5.09 °æ
0.21 to 5.95 °æ 0.18 L/min 2 weeks after administration
of astragalus (P < 0.01). In this study, neither improvement
in left ventricular diastolic function nor inhibition of
adenosine triphosphate was observed (47). Intravenous
administration of astragalus (undefined preparation) was
reported to significantly shorten the duration of ventricular
late potentials in cardiac patients (39.8 °æ 3.3 ms vs.
44.5 °æ 5.9 ms; P < 0.01) (48).
In another investigation, astragaloside IV (intravenous;
unspecified amount) was given to patients with
congestive heart failure for 2 weeks. Improvement in
symptoms such as tightness in the chest, difficult breathing,
and reduced exercise capacity were reported. Radionuclide
ventriculography showed that left ventricular
modeling improved and left ventricular end-diastolic and
left ventricular end-systolic volume diminished significantly.
The authors concluded that astragaloside IV is an
effective positive inotropic agent (49), an action supported
by others (27).
In China, astragalus is widely used in the treatment of
chronic hepatitis where reductions in elevated liver enzymes
and improvements in symptoms in humans have
been reported. This activity is stated to be associated with
polysaccharides that increase interferon production (35).
According to one English language review of the Chinese
literature, a prophylactic effect against the common cold
was reported in an epidemiological study in China involving
1000 subjects. Administration of astragalus, given either
orally or as a nasal spray, reportedly decreased the
incidence of disease and shortened cold duration. Studies
exploring this protective effect found that oral administration
of the preparation to subjects for 2 weeks enhanced
the induction of interferon by peripheral white blood cells.
Levels of IgA and IgG antibodies in nasal secretions were
reported to be increased following 2 months of treatment
(34). The effect of astragalus on the induction of interferon
was studied in a placebo-controlled study involving 28
people. Fourteen volunteers were given an extract equivalent
to 8 g of dried root per day and the rest were given
placebos. Blood samples were drawn before treatment,
then 2 weeks and 2 months after treatment. Interferon
production by leukocytes was statistically increased after
both time periods (P < 0.01) in the astragalus group but
not the control group (50). In another study, astragalus
was shown to potentiate the effects of interferon (rIFN-1)
in patients with chronic cervicitis (51).
Crude root: 9–30 g daily as a decoction (52).
Decoction: 0.5–1 L daily.
None cited in the literature.
None cited in the literature.
There is some evidence to suggest that astragalus and its
putative anti-inflammatory effects are beneficial in those
with autoimmune conditions such as lupus. However, astragalus
should be used cautiously for the treatment of
autoimmune diseases or in conjunction with immunosuppressive
therapies. Because immunostimulating polysaccharides
may stimulate histamine release, allergic symptoms
may be aggravated by the use of astragalus. This,
however, has not been reported in the literature or from
clinical use. According to the principles of TCM, astragalus
should not be used during acute infectious conditions
unless under the care of a qualified TCM practitioner.
Both positive and negative interactions may occur. Astragalus
potentiates the effects of acyclovir (53); IL-2, -20,
-21; and rIFN-1 and -2 therapies (50,51). Because of its immuno promoting
effects, astragalus may be incompatible
with immunosuppressive agents in general.
Pregnancy, Mutagenicity, and Reproductive Toxicity
According to one review, astragalus is reported to have no
mutagenic effects (54).
Based on an authoritative review of the available pharmacologic
and toxicologic literature, no limitation is to be
Studies suggest an anticarcinogenic activity.
Influence on Driving
Based on the available pharmacologic and toxicologic literature,
no limitation is to be expected (6,34,54).
Overdose and Treatment
Specific data are lacking.
Based on a review of the available data and the experience
of modern practitioners, astragalus can be considered
a very safe herb even when taken within its large
dosage range. Investigations of specific fractions including
flavonoids, polysaccharide, and triterpene similarly
show little toxicity (14,34,54).
In the United States, astragalus is regulated as a dietary
Astragalus is one of the most frequently used herbal
medicines throughout Asia and is a very popular botanical
used in western herbal supplements. In China, astragalus
is used for a myriad of purposes relating to its
high regard as a strengthening tonifier, immune modulator,
anti-inflammatory, and anti-hepatotoxic. In the West,
astragalus figures prominently in immune supportive formulas.
Despite its popularity, there are few clinical trials
regarding its use. There is some evidence to support
the oral administration of astragalus for the prevention of
colds and upper respiratory infections, and as an adjunct
to conventional cancer therapies. These are very common
indications for which astragalus is applied by herbal practitioners.
For its use in cancer therapies, there are no definitive
guidelines. The modern experience of practitioners
together with the limited clinical and preclinical data
pointing to an immunomodulatory effect suggests that
there may be some value for these indications, including
the concomitant use of astragalus to reduce doxorubicininduced
immune suppression. However, more specific investigation
in this area is needed.
Regarding its putative immunomodulating effects,
the following mechanisms of action have been proposed:
restoration of immune function, increased stem cell generation
of blood cells and platelets, lymphocyte proliferation,
rise in numbers of antibody-producing spleen cells,
potentiation of rIL-2 and rIFN-1 and -2 immunotherapy,
enhancement of phagocytic activity by macrophages and
leukocytes, and increased cytotoxicity by NK cells.
Potential benefits to cardiovascular health, including
relief from angina and congestive heart failure and
improvement in clinical parameters following acute myocardial
infarct, have been reported. Limited animal studies
suggest that astragalus enhances coronary blood flow,
may potentiate the release of nitric oxide, and potentiates
the effects of endogenous antioxidant systems (e.g., SOD).
In Asia, astragalus is also used in conjunction with
conventional medical treatments for hepatitis. Both animal
and in vitro studies offer support for such treatment.
As in the use of astragalus in cancer therapies, further
clinical trials are required.
Though methodologically sound clinical trials for
astragalus are generally lacking, natural health practitioners
have a generally high regard for its use as a prophylactic
against infectious disease and for its ability to build,
maintain, and restore immunocompetency when used as
a part of conventional cancer therapies. In addition to the
very limited number of formal clinical studies that are
available in English language sources, the published medical
literature on astragalus has to be considered cautiously,
as a number of the supporting studies utilize injectable
preparations of isolated fractions that are not consistent
with the oral use of astragalus supplements. Still, the existing
data do support many of the traditional uses for
which astragalus has been employed for centuries.
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