Astragalus

Astragalus is huang qi (黄芪), a name taken from the root’s yellow colour and its strength as a tonic ^{33Reference 33Wang et al. · 2023ReviewA review of the botany, phytochemistry, traditional uses, pharmacology, toxicology, and quality control of the Astragalus memeranaceus — reviewView study →}. It was first recorded in the Shennong Ben Cao Jing as a high-grade herb, and Li Shizhen’s Compendium of Materia Medica (16th century) lists it as the leading tonic ^{33Reference 33Wang et al. · 2023ReviewA review of the botany, phytochemistry, traditional uses, pharmacology, toxicology, and quality control of the Astragalus memeranaceus — reviewView study →}.

Its classical functions are to supplement qi, secure the exterior, promote urination, draw out toxins and generate flesh ^{33Reference 33Wang et al. · 2023ReviewA review of the botany, phytochemistry, traditional uses, pharmacology, toxicology, and quality control of the Astragalus memeranaceus — reviewView study →}. It is used for weakness of the spleen and stomach, qi deficiency with bleeding, oedema, chronic nephritis and sores or ulcers that will not heal ^{33Reference 33Wang et al. · 2023ReviewA review of the botany, phytochemistry, traditional uses, pharmacology, toxicology, and quality control of the Astragalus memeranaceus — reviewView study →}.

The raw root is used to secure the exterior, promote urination and expel toxins. Stir-baked with an adjuvant, it is used to tonify and replenish the middle qi ^{33Reference 33Wang et al. · 2023ReviewA review of the botany, phytochemistry, traditional uses, pharmacology, toxicology, and quality control of the Astragalus memeranaceus — reviewView study →}.

It is mainly a formula herb. Dang Gui Buxue Tang combines it with dong quai in a 5:1 ratio by weight, a proportion stipulated in 1247 CE ^{34Reference 34Lin et al. · 2017ReviewDanggui Buxue Tang (Astragali Radix and Angelicae Sinensis Radix) for menopausal symptoms — reviewView study →}. It also leads Bu Zhong Yi Qi Tang, used for chronic gastritis, a dropped stomach and uterine prolapse, and Yu Ping Feng San (“Jade Windscreen Powder”), given for colds, night sweats and allergic rhinitis ^{33Reference 33Wang et al. · 2023ReviewA review of the botany, phytochemistry, traditional uses, pharmacology, toxicology, and quality control of the Astragalus memeranaceus — reviewView study →}.

Astragalus has been tested as an add-on to chemotherapy, not as a cancer treatment on its own.

A 2006 meta-analysis in the Journal of Clinical Oncology included 34 randomised trials (2,815 patients) of astragalus-based Chinese herbal medicine added to platinum chemotherapy for advanced non-small-cell lung cancer. In the 12 trials (940 patients) that reported it, the risk of death at 12 months was lower (RR 0.67, 95% CI 0.52–0.87), and in 30 trials (2,472 patients) tumour response improved (RR 1.34, 95% CI 1.24–1.46) ^{1Reference 1McCulloch et al. · 2006Meta-analysisAstragalus-based Chinese herbs and platinum-based chemotherapy for advanced non-small-cell lung cancer — meta-analysis of randomized trialsView study →}.

A 2019 meta-analysis of astragalus injection with platinum chemotherapy (19 trials, 1,635 patients) found higher response rates, better performance status and 1-year survival, and less leukopenia and vomiting, but rated the evidence as low quality ^{2Reference 2Cao et al. · 2019Meta-analysisEvidence of Astragalus injection combined with platinum-based chemotherapy in advanced non-small cell lung cancer — a systematic review and meta-analysisView study →}. A meta-analysis of Kangai injection, a patent medicine made from astragalus, ginseng and matrine, found similar results in 19 trials (1,389 patients) ^{3Reference 3Zhu et al. · 2022Meta-analysisEffect of Kangai injection combined with platinum-based chemotherapy on immune function in advanced NSCLC — a meta-analysisView study →}.

Astragalus is reported to stimulate macrophage and natural killer cell activity and to inhibit T-helper type 2 cytokines ^{1,12Reference 1McCulloch et al. · 2006Meta-analysisAstragalus-based Chinese herbs and platinum-based chemotherapy for advanced non-small-cell lung cancer — meta-analysis of randomized trialsView study →Reference 12Li et al. · 2022ReviewAstragalus polysaccharide: a review of its immunomodulatory effectView study →}.

Gap: the pooled trials are of low quality, use injectable or multi-herb products, and were conducted in China; the 2006 authors stated that their results require confirmation in rigorously controlled trials ^{1Reference 1McCulloch et al. · 2006Meta-analysisAstragalus-based Chinese herbs and platinum-based chemotherapy for advanced non-small-cell lung cancer — meta-analysis of randomized trialsView study →}.

Diabetic kidney disease is the best-replicated use outside cancer. A 2011 meta-analysis of 25 trials (1,804 patients) found astragalus injection improved kidney-function markers (BUN, serum creatinine, creatinine clearance and urine protein) and serum albumin compared with controls ^{4Reference 4Li et al. · 2011Meta-analysisMeta-analysis of the clinical value of Astragalus membranaceus in diabetic nephropathy — randomized/controlled trialsView study →}.

A 2024 meta-analysis of 32 randomised trials (2,462 patients) found astragalus added to renin–angiotensin–aldosterone-system (RAAS) blockers in stage III diabetic nephropathy improved the total effective rate and lowered urinary protein, creatinine, BUN and HbA1c. Possible publication bias was found for some outcomes ^{5Reference 5Lin et al. · 2024Meta-analysisEfficacy of astragalus combined with RAAS blockers in stage III diabetic nephropathy — a systematic review and meta-analysis of randomized controlled trialsView study →}.

A 2014 Cochrane review of astragalus for chronic kidney disease (22 studies, 1,323 participants) found that, as an add-on to conventional treatment, it reduced 24-hour proteinuria and raised haemoglobin and serum albumin. Neither time to dialysis nor death was reported in any study, and study quality was low overall ^{6Reference 6Zhang et al. · 2014Systematic reviewAstragalus (a traditional Chinese medicine) for treating chronic kidney disease — Cochrane systematic review of randomised controlled trialsView study →}.

In rat models of diabetic kidney disease, astragalus root lowered fasting blood glucose and albuminuria ^{7Reference 7Zhang et al. · 2009Systematic reviewSystematic review of the renal protective effect of Astragalus membranaceus on diabetic nephropathy in animal modelsView study →}.

Gap: the benefits are on surrogate markers only; no trial reported progression to dialysis or death, heterogeneity is high, and most protocols pair astragalus with standard drugs rather than testing the root alone ^{6Reference 6Zhang et al. · 2014Systematic reviewAstragalus (a traditional Chinese medicine) for treating chronic kidney disease — Cochrane systematic review of randomised controlled trialsView study →}.

Astragalus injection added to conventional care for viral myocarditis has been reviewed several times. A 2014 systematic review of six trials (639 patients) reported a higher overall effective rate and better recovery of heart-enzyme and ECG measures. Two trials reported no adverse effects, and the reviewers judged its safety uncertain ^{8Reference 8Piao et al. · 2014Systematic reviewAstragalus membranaceus injection combined with conventional treatment for viral myocarditis — a systematic review of randomized controlled trialsView study →}.

A 2022 meta-analysis of 19 studies, all conducted in China, found astragalus injection lowered TNF-α (SMD −2.27) and other inflammatory markers ^{9Reference 9Guo et al. · 2022Meta-analysisEffect of Astragalus injection on inflammatory mediators in patients with viral myocarditis — a systematic review and meta-analysisView study →}.

A 2020 clinical and preclinical review (28 clinical studies with 2,522 participants; 16 animal studies) found reduced cardiac troponin I and heart enzymes, with no difference in adverse reactions, but scored trial quality low (average 3.32 out of 7) ^{10Reference 10Zheng et al. · 2020Systematic reviewClinical and preclinical systematic review of Astragalus membranaceus for viral myocarditisView study →}.

Gap: the trials are of low quality, small and use the injectable form, with a high risk of publication bias ^{8,10Reference 8Piao et al. · 2014Systematic reviewAstragalus membranaceus injection combined with conventional treatment for viral myocarditis — a systematic review of randomized controlled trialsView study →Reference 10Zheng et al. · 2020Systematic reviewClinical and preclinical systematic review of Astragalus membranaceus for viral myocarditisView study →}.

Astragalus polysaccharide activates macrophages, natural killer cells, dendritic cells and T and B lymphocytes, and induces a broad range of cytokines in cell and animal studies ^{12Reference 12Li et al. · 2022ReviewAstragalus polysaccharide: a review of its immunomodulatory effectView study →}.

A 2016 Cochrane review searched 6,080 records for placebo-controlled trials of oral astragalus alone to prevent frequent respiratory infections in children. No trial met the inclusion criteria; 44 studies were excluded only because they had no placebo control ^{11Reference 11Su et al. · 2016Systematic reviewOral Astragalus (Huang qi) for preventing frequent episodes of acute respiratory tract infection in children — Cochrane systematic reviewView study →}.

In a six-week placebo-controlled trial in 48 adults with seasonal allergic rhinitis, a herbal-mineral food supplement with astragalus as an active component significantly reduced runny nose, but not the other main measures. Investigators and patients rated it more effective than placebo, and in people allergic to weed pollen the main measures improved ^{13Reference 13Matkovic et al. · 2010RCTEfficacy and safety of Astragalus membranaceus in the treatment of patients with seasonal allergic rhinitis — a double-blind, placebo-controlled randomized trialView study →}.

Gap: there is no placebo-controlled trial of the whole root for preventing infection or modulating immunity; the human immune data come from combination products or from cancer add-on trials ^{11,13Reference 11Su et al. · 2016Systematic reviewOral Astragalus (Huang qi) for preventing frequent episodes of acute respiratory tract infection in children — Cochrane systematic reviewView study →Reference 13Matkovic et al. · 2010RCTEfficacy and safety of Astragalus membranaceus in the treatment of patients with seasonal allergic rhinitis — a double-blind, placebo-controlled randomized trialView study →}.

A 2011 trial randomised 90 patients with chronic heart failure to astragalus granules at 7.5 g, 4.5 g or 2.25 g twice daily, alongside perindopril, for 30 days. All three groups improved; heart-function grade and left-ventricular ejection fraction improved more on the high and moderate doses than on the low dose, and walking distance and quality of life improved in step with dose. There was no placebo arm ^{14Reference 14Yang et al. · 2011RCTClinical effect of Astragalus granule of different dosages on quality of life in patients with chronic heart failure — a randomized controlled trialView study →}.

In animals, astragaloside IV reduced infarct size in dogs and improved post-ischaemic function in isolated rat hearts, with increased coronary flow ^{16Reference 16Zhang et al. · 2006In vitroAstragaloside IV from Astragalus membranaceus shows cardioprotection during myocardial ischemia in vivo and in vitroView study →}. In rats it reduced ischaemia/reperfusion injury through calcium-sensing-receptor and ERK1/2 signalling ^{17Reference 17Yin et al. · 2019AnimalAstragaloside IV attenuates myocardial ischemia/reperfusion injury in rats via inhibition of calcium-sensing-receptor-mediated apoptotic signalingView study →}. A meta-analysis of 22 animal studies (484 animals) found it consistently reduced infarct size ^{15Reference 15Zheng et al. · 2018Meta-analysisA preclinical systematic review and meta-analysis of astragaloside IV for myocardial ischemia/reperfusion injury (animal models)View study →}.

Gap: the human trial is small and short, compares doses rather than placebo, and adds astragalus to an ACE inhibitor; the strong cardioprotective data are almost entirely animal or isolated-constituent ^{14,15Reference 14Yang et al. · 2011RCTClinical effect of Astragalus granule of different dosages on quality of life in patients with chronic heart failure — a randomized controlled trialView study →Reference 15Zheng et al. · 2018Meta-analysisA preclinical systematic review and meta-analysis of astragaloside IV for myocardial ischemia/reperfusion injury (animal models)View study →}.

Antioxidant activity underpins several of the other indications and is well replicated preclinically. Astragaloside IV and astragalus polysaccharide reduce reactive oxygen species and lipid peroxidation and activate the Nrf2/HO-1 pathway in endothelial and other cell models ^{18,28Reference 18Zhang et al. · 2020ReviewAstragaloside IV derived from Astragalus membranaceus — a research review on the pharmacological effectsView study →Reference 28Zhang et al. · 2021ReviewActivation of Nrf2/HO-1 signaling — an important molecular mechanism of herbal medicine in the treatment of atherosclerosis (review, includes astragalus constituents)View study →}.

A 2022 meta-analysis of 20 animal studies of ulcerative colitis (591 animals) found astragalus polysaccharide lowered oxidative-stress and inflammatory markers and restored superoxide dismutase activity, with evidence of publication bias ^{19Reference 19Hu et al. · 2022Meta-analysisAnti-inflammatory and antioxidant activity of astragalus polysaccharide in ulcerative colitis — a systematic review and meta-analysis of animal studiesView study →}.

Astragaloside IV suppresses NF-κB signalling across many cell and animal models ^{18Reference 18Zhang et al. · 2020ReviewAstragaloside IV derived from Astragalus membranaceus — a research review on the pharmacological effectsView study →}.

In the meta-analysis of animal colitis studies, astragalus polysaccharide lowered TNF-α, IL-6 and IL-1β in the colon ^{19Reference 19Hu et al. · 2022Meta-analysisAnti-inflammatory and antioxidant activity of astragalus polysaccharide in ulcerative colitis — a systematic review and meta-analysis of animal studiesView study →}.

Gap: there is no human trial with an anti-inflammatory endpoint.

Preclinical liver-protection data are consistent. Astragaloside IV reduced liver damage, fat accumulation, inflammation and oxidative stress in rats with alcoholic liver disease ^{20Reference 20Hao et al. · 2024AnimalMetabolomics combined with network pharmacology reveals the protective effect of astragaloside IV on alcoholic liver disease (rat model)View study →}.

Cycloastragenol at 200 mg/kg reduced liver fibrosis caused by carbon tetrachloride in mice ^{21Reference 21Luangmonkong et al. · 2023AnimalHepatoprotective efficacy of cycloastragenol alleviated the progression of liver fibrosis in carbon-tetrachloride-treated miceView study →}.

Astragalus polysaccharide combined with Schisandra lignans protected rats from chronic chemical liver injury better than either alone ^{22Reference 22Yan et al. · 2009AnimalSynergistic hepatoprotective effect of Schisandra lignans with Astragalus polysaccharides on chronic liver injury in ratsView study →}.

The one human study is a 48-week randomised trial in 92 people with liver fibrosis from chronic hepatitis B. An astragalus–polygonum decoction lowered serum fibrosis markers (HA, LN, PCIII, CIV) and improved liver function more than the comparator, Jinshuibao capsules ^{29Reference 29Chen et al. · 2000RCTComparison of efficacy in treating liver fibrosis of chronic hepatitis B between Astragalus-Polygonum anti-fibrosis decoction and Jinshuibao capsule — a randomized controlled trialView study →}.

Gap: the human trial tested a multi-herb decoction against an active comparator, not placebo; the root alone has not been tested in liver disease, and the strong data are animal or constituent-level ^{20,21Reference 20Hao et al. · 2024AnimalMetabolomics combined with network pharmacology reveals the protective effect of astragaloside IV on alcoholic liver disease (rat model)View study →Reference 21Luangmonkong et al. · 2023AnimalHepatoprotective efficacy of cycloastragenol alleviated the progression of liver fibrosis in carbon-tetrachloride-treated miceView study →}.

Astragalus is a key component of many Chinese anti-diabetic formulas, and its polysaccharides, saponins and flavonoids have been studied for their effects in diabetes and its complications ^{23Reference 23Zhang et al. · 2015Systematic reviewBiological active ingredients of traditional Chinese herb Astragalus membranaceus on treatment of diabetes — a systematic reviewView study →}.

In rat models of diabetic kidney disease, astragalus root lowered fasting blood glucose ^{7Reference 7Zhang et al. · 2009Systematic reviewSystematic review of the renal protective effect of Astragalus membranaceus on diabetic nephropathy in animal modelsView study →}. In the 2024 meta-analysis of astragalus added to RAAS blockers in diabetic nephropathy, HbA1c also fell ^{5Reference 5Lin et al. · 2024Meta-analysisEfficacy of astragalus combined with RAAS blockers in stage III diabetic nephropathy — a systematic review and meta-analysis of randomized controlled trialsView study →}.

Gap: the human trials were designed around kidney disease; none made blood sugar control its primary outcome.

In a small placebo-controlled trial, 12 athletes took Huangqi Jianzhong Tang, a formula led by astragalus, or placebo for eight weeks. The formula group showed longer time to exhaustion, a better anaerobic threshold and faster recovery from fatigue ^{24Reference 24Chen et al. · 2002RCTReducing fatigue of athletes following oral administration of Huangqi Jianzhong Tang — a randomized placebo-controlled trialView study →}.

Gap: the only published trial is tiny and tests a multi-herb decoction, not astragalus root; there is no adequately powered trial of the herb for fatigue or exercise performance ^{24Reference 24Chen et al. · 2002RCTReducing fatigue of athletes following oral administration of Huangqi Jianzhong Tang — a randomized placebo-controlled trialView study →}.

A 2026 systematic review of astragalus as a skincare ingredient found that its active compounds, including astragaloside IV, cycloastragenol, flavonoids and polysaccharides, reduced reactive oxygen species and inflammatory signalling and promoted collagen synthesis. Clinical trials in the review reported improvements in skin hydration, tone and wrinkles ^{25Reference 25Jackson et al. · 2026Systematic reviewAstragalus membranaceus extract as a botanical ingredient for pigmentary and anti-aging skincare — a systematic reviewView study →}.

In human dermal fibroblasts and keratinocytes, cycloastragenol reduced UVB-induced matrix metalloproteinases and reactive oxygen species, increased collagen I and raised skin hydration factors ^{26Reference 26Yang et al. · 2023In vitroCycloastragenol exerts protective effects against UVB irradiation in human dermal fibroblasts and HaCaT keratinocytes (in vitro)View study →}.

Gap: this is a topical, cosmetic use of isolated constituents; it does not transfer to the oral dried root, and the review called for further randomised trials ^{25,26Reference 25Jackson et al. · 2026Systematic reviewAstragalus membranaceus extract as a botanical ingredient for pigmentary and anti-aging skincare — a systematic reviewView study →Reference 26Yang et al. · 2023In vitroCycloastragenol exerts protective effects against UVB irradiation in human dermal fibroblasts and HaCaT keratinocytes (in vitro)View study →}.

Cycloastragenol and astragaloside IV modulate telomerase activity and support telomere maintenance, and TA-65, a commercial telomerase activator, is among the astragalus-derived compounds reviewed for vascular ageing ^{27Reference 27Canale et al. · 2025ReviewTargeting telomere shortening in vascular aging and atherosclerosis — therapeutic promise of cycloastragenol/astragaloside IV (review)View study →}.

Interest centres on vascular ageing, where telomere dysfunction contributes to the ageing of blood-vessel cells ^{27Reference 27Canale et al. · 2025ReviewTargeting telomere shortening in vascular aging and atherosclerosis — therapeutic promise of cycloastragenol/astragaloside IV (review)View study →}.

Gap: telomerase activation is a cell-level finding; no trial shows oral astragalus extends healthspan or lifespan.

Tolerability. In the Cochrane review of chronic kidney disease, six of 22 studies reported no adverse effects and the other 16 did not report them ^{6Reference 6Zhang et al. · 2014Systematic reviewAstragalus (a traditional Chinese medicine) for treating chronic kidney disease — Cochrane systematic review of randomised controlled trialsView study →}. In the viral myocarditis trials, adverse reactions did not differ from control ^{10Reference 10Zheng et al. · 2020Systematic reviewClinical and preclinical systematic review of Astragalus membranaceus for viral myocarditisView study →}.

Toxicity. In rats, a single oral dose of astragalus extract up to 5,000 mg/kg and a 13-week study of daily dosing caused no deaths or toxic reactions. Astragaloside showed no acute, subchronic, genetic or immune toxicity in animal studies, although it was toxic to embryos and mothers at higher doses ^{33Reference 33Wang et al. · 2023ReviewA review of the botany, phytochemistry, traditional uses, pharmacology, toxicology, and quality control of the Astragalus memeranaceus — reviewView study →}.

Immunosuppressant drugs. Astragalus polysaccharide activates macrophages, NK cells and T cells ^{12Reference 12Li et al. · 2022ReviewAstragalus polysaccharide: a review of its immunomodulatory effectView study →}. It should be avoided alongside immunosuppressant drugs and after organ transplantation, where stronger immune activity could work against treatment.

Allergy. As a legume, astragalus may cross-react in people allergic to other members of the pea family.

Traditional cautions. Chinese medicine avoids astragalus during the acute feverish stage of an infection and in heat or yin-deficiency patterns. Some herbal sources also advise against it in late-stage Lyme disease.

Quality. The root can carry pesticide or heavy-metal residues from cultivation ^{33Reference 33Wang et al. · 2023ReviewA review of the botany, phytochemistry, traditional uses, pharmacology, toxicology, and quality control of the Astragalus memeranaceus — reviewView study →}.

Drug metabolism. No human herb–drug interaction study has been published. In rats, astragalus granules roughly doubled the activity of the liver enzyme CYP3A, which clears many prescription drugs; this has not been tested in people ^{35Reference 35Zhang et al. · 2013In vitroStudy of the upregulation of the activity of cytochrome P450 3A isoforms by Astragalus injection and Astragalus granules in rats and in cells — rat in vivo / in vitroView study →}.

In laboratory tests on human liver enzymes, an astragalus extract inhibited CYP1A2 and CYP2C9 ^{36Reference 36Wang et al. · 2025In vitroHerb-drug interaction of Astragali Radix based on in vitro incubation and pharmacokinetic assessment — in vitro (human liver microsomes) / rat pharmacokineticsView study →}. In mice, the root and its main compounds raised levels of the drug transporter P-glycoprotein in the liver ^{37Reference 37Lou et al. · 2019In vitroAstragali radix and its main bioactive compounds activate the Nrf2-mediated signaling pathway to induce P-glycoprotein and breast cancer resistance protein — mouse in vivo / in vitroView study →}.