Codonopsis

What Is Codonopsis?

Codonopsis is a common herb in traditional Chinese medicine — where it’s better known as Dang Shen. It’s used as a nourishing tonic for reinforcing qi.

It’s used for many of the same conditions as ginseng despite having a vastly different chemical makeup. Many refer to it as “poor man’s ginseng” due to the similarity in effects and much lower cost.

Codonopsis has a particularly impressive effect on the blood, which is likely the mechanism behind the traditional uses for poor “Qi”.

These conditions could be thought of in conventional terms as dysfunctional red and white blood cell production.

It’s been shown to increase lymphocytes (white blood cells), as well as both hemoglobin (concentration) and red blood cell count.

How Is Codonopsis Used?

Codonopsis can be used for many of the same conditions Panax ginseng is used for. It’s often used as an adaptogen during convalescence, especially when there is a need to stimulate blood cell production. This action is useful during chemotherapy or radiotherapy for cancer patients experiencing leukopenia.

Traditional Uses

Traditional Chinese Medicine

Codonopsis is considered “poor mans ginseng” in parts of Asia where it’s used as a substitute for ginseng. Although the actions are similar, Panax ginseng has differrent chemistry than codonopsis, and codonopsis does not contain triterpene saponins ^{22Reference 22Bone K · 2003A Clinical Guide to Blending Liquid Herbs: Herbal Formulations for the Individual Patient}.

Codonopsis was traditionally used for chronic coughs, fatigue, tired limbs, to reinforce qi, diarrhea, vomiting, lack of appetite, tuburculosis, psychoneurosis, dyspepsia, and prolaps of the uterus, stomach, or anus. ^{22,27,28,29Reference 22Bone K · 2003A Clinical Guide to Blending Liquid Herbs: Herbal Formulations for the Individual PatientReference 27Wang ZT et al. · 1995Chemotaxonomic study of Codonopsis (family Campanulaceae) and its related generaReference 28Lee KT et al. · 2002Structure of a new echinocystic acid bisdesmoside isolated from Codonopsis lanceolata rootsReference 29Ichikawa M et al. · 2009Simultaneous determination of seven saponins in the roots of Codonopsis lanceolata by LC-MS}.

Taste

Sweet ^{24Reference 24Hempen CH · 2009A Materia Medica for Chinese Medicine: Plants, Minerals, and Animal Products}

Energy

Neutral ^{24Reference 24Hempen CH · 2009A Materia Medica for Chinese Medicine: Plants, Minerals, and Animal Products}

Channels

Spleen, lung ^{24Reference 24Hempen CH · 2009A Materia Medica for Chinese Medicine: Plants, Minerals, and Animal Products}

Actions

Harmonizes and tonifies Qi, raises Qi, harmonizes and tonifies spleen and stomach, generates fluids ^{24Reference 24Hempen CH · 2009A Materia Medica for Chinese Medicine: Plants, Minerals, and Animal Products}.

Indications

Use with caution during pregnancy ^{24Reference 24Hempen CH · 2009A Materia Medica for Chinese Medicine: Plants, Minerals, and Animal Products}.

Dose

3-15g (Standard is 8g) decocted 20 min ^{24Reference 24Hempen CH · 2009A Materia Medica for Chinese Medicine: Plants, Minerals, and Animal Products}.

Contraindications

Damp heat, ascending liver-yang ^{24Reference 24Hempen CH · 2009A Materia Medica for Chinese Medicine: Plants, Minerals, and Animal Products}.

Description

Codonopsis is a popular qi tonic, used to invigorate spleen and lung infections by restoring qi. It promotes the production of body fluids, and is useful as a blood and immune system tonic. ^{25Reference 25Teeguarden R · 2000The Ancient Wisdom of the Chinese Tonic Herbs}.

Botanical Information

Codonopsis is a member of the Campanulaceae family of plants. This family contains roughly 2400 species, distributed into 84 different genera. South Africa is particularly rich in members from this family. Codonopsis, however, is native to Southeast Asia, and the Eastern edges of Russia.

Codonopsis can be found growing in grass, thickets, or the edges of woods.

Harvesting, Collection & Preparation

Codonopsis pilosa is the preferred species, however, Codonopsis tangshen is also common. The chemical marker that differentiates the two was shown to be the compound codonopyrrolidum A ^{23Reference 23Lin LC et al. · 2013Chemical constituents comparison of Codonopsis tangshen, Codonopsis pilosula varView study →}.

Phytochemistry

Despite sharing many of the uses of Panax ginseng, codonopsis has a completely different chemical profile and, importantly, does not contain the triterpenoid (ginsenoside-type) saponins that define ginseng ^{22,26Reference 22Bone K · 2003A Clinical Guide to Blending Liquid Herbs: Herbal Formulations for the Individual PatientReference 26He JY et al. · 2015ReviewThe genus Codonopsis (Campanulaceae): a review of phytochemistry, bioactivity and quality control}. Its activity is instead attributed to four groups: the inulin-type polysaccharides that make up the bulk of the root, the polyacetylene lobetyolin (its most-used quality marker), the phenylpropanoid glycoside tangshenoside I, and trace β-carboline alkaloids such as perlolyrin ^{26,30Reference 26He JY et al. · 2015ReviewThe genus Codonopsis (Campanulaceae): a review of phytochemistry, bioactivity and quality controlReference 30Hong DY · 2015ReviewA Monograph of Codonopsis and Allied Genera (Campanulaceae)}. The pyrrolidine alkaloid codonopyrrolidum A is used as a chemotaxonomic marker to tell C. tangshen apart from C. pilosula ^{23Reference 23Lin LC et al. · 2013Chemical constituents comparison of Codonopsis tangshen, Codonopsis pilosula varView study →}.

Storage carbohydrate dominates the root: inulin makes up roughly 62% (w/w) of the neutral polysaccharide fraction, and the crude polysaccharides themselves are typically extracted at low-double-digit yields from the dried root ^{31Reference 31Liang W et al. · 2024ReviewCodonopsis radix: a review of resource utilisation, postharvest processing, quality assessment, and its polysaccharide compositionView study →}. Lobetyolin, tangshenoside I and the alkaloids are present only at trace (sub-percent) levels and vary widely with species, growing site and processing, so they are reported as quality markers rather than fixed amounts.

Constituent Summary

Constituents of the dried root (Codonopsis pilosula). Polyacetylene and alkaloid figures vary widely with species and growing conditions and are used as quality markers rather than standardised contents; † marks the species-differentiating chemotaxonomic marker.

Pharmacology & Research

The modern literature on Codonopsis pilosula is moderate in size but sits almost entirely in the preclinical tier: several hundred indexed papers, dominated by cell-line and rodent studies of the root’s polysaccharides, with the polyacetylene marker lobetyolin a distant second. The most consistent and best-matched signals are immunomodulation and gastrointestinal protection — both studied with the water extracts and inulin-type fructans that reflect how the root is actually used ^{1,2,3,4,5,6,7,8Reference 1Bai J et al. · 2025ReviewCodonopsis Radix: a comprehensive review for its ethnopharmacology, phytochemistry, pharmacodynamics, pharmacokinetics, toxicity and potential clinical applicationsView study →Reference 2Xie X et al. · 2025AnimalAn inulin-type fructan from Codonopsis pilosula ameliorates cyclophosphamide-induced immunosuppression and intestinal barrier injury in miceView study →Reference 3Gao Z et al. · 2025Specific inulin in Codonopsis pilosula exerts immunological enhancement by promoting cellular uptake and regulating p65-dependent MAPK and NF-κB pathwaysView study →Reference 4Xia Z et al. · 2025AnimalImmunomodulatory effects and multi-omics analysis of Codonopsis pilosula extract in septic ratsView study →Reference 5Wang ZT et al. · 1997AnimalInvestigations on the protective action of Codonopsis pilosula (Dangshen) extract on experimentally-induced gastric ulcer in ratsView study →Reference 6Chen Q et al. · 2025The effect and mechanism of Codonopsis Radix and its active components tangshenoside I and lobetyolin on preventing gastric ulcer based on spectrum-effect relationshipView study →Reference 7Zhou J et al. · 2024An inulin-type fructan CP-A from Codonopsis pilosula alleviates TNBS-induced ulcerative colitis based on serum-untargeted metabolomicsView study →Reference 8Yang Q et al. · 2026Codonopsis pilosula (Dangshen) alleviates ulcerative colitis through activation of the aryl-hydrocarbon-receptor signaling pathway by the gut bacterium Alistipes onderdonkii and its metabolite 5-HIAAView study →}. Emerging work on anti-aging/antioxidant and neuroprotective activity is real but rests on D-galactose and Alzheimer’s-model rodents ^{11,12,13,14Reference 11Wang X et al. · 2024AnimalCodonopsis pilosula water extract delays D-galactose-induced aging of the brain in mice by activating autophagy and regulating metabolismView study →Reference 12Zhang B et al. · 2026Codonopsis pilosula polysaccharide (CPP) alleviates D-Gal-induced aging and gut microbiota dysbiosisView study →Reference 13Cai Y et al. · 2025AnimalCodonopsis pilosula polysaccharides alleviate neuronal apoptosis induced by endoplasmic-reticulum-stress-activated PERK-ATF4-CHOP signaling in APP/PS1 miceView study →Reference 14Yang L et al. · 2024Neuroprotective effect of Codonopsis pilosula polysaccharide on Aβ(25-35)-induced damage in PC12 cells via the p38 MAPK signaling pathwaysView study →}. No monotherapy human trial of C. pilosula exists; the single randomised controlled trial combined the herb’s total glycosides with Ginkgo biloba, so its cognitive result cannot be attributed to the root alone ^{20Reference 20Singh B et al. · 2004Dangshen (Codonopsis pilosula) and Bai guo (Ginkgo biloba) enhance learning and memoryView study →}. A recurring caveat runs through the whole literature: activity varies by preparation (whole-root decoction vs isolated polysaccharide vs trace-level lobetyolin) and by species — some effects attributed to “Codonopsis” were shown in the unrelated C. lanceolata, which, unlike C. pilosula, contains triterpenoid saponins ^{1,21Reference 1Bai J et al. · 2025ReviewCodonopsis Radix: a comprehensive review for its ethnopharmacology, phytochemistry, pharmacodynamics, pharmacokinetics, toxicity and potential clinical applicationsView study →Reference 21Cho K et al. · 2009AnimalProtective effect of Codonopsis lanceolata root extract against alcoholic fatty liver in the ratView study →}.

0. Evidence by indication

Support is an experimental score I’m building — a composite weighted by study type (human > animal > in vitro > review) and study volume. It’s a beta: a fast way to rank strength of evidence at a glance, not a validated metric, and I’ll keep honing the formula over time. Each indication name links down to its write-up.

Indication	Support	Rests on
Immunomodulation	███████░░░ 68%	Well-replicated animal + in-vitro: inulin-type fructans restore immunity in immunosuppressed/septic models and activate macrophages 1,2,3,4Reference 1Bai J et al. · 2025ReviewCodonopsis Radix: a comprehensive review for its ethnopharmacology, phytochemistry, pharmacodynamics, pharmacokinetics, toxicity and potential clinical applicationsView study →Reference 2Xie X et al. · 2025AnimalAn inulin-type fructan from Codonopsis pilosula ameliorates cyclophosphamide-induced immunosuppression and intestinal barrier injury in miceView study →Reference 3Gao Z et al. · 2025Specific inulin in Codonopsis pilosula exerts immunological enhancement by promoting cellular uptake and regulating p65-dependent MAPK and NF-κB pathwaysView study →Reference 4Xia Z et al. · 2025AnimalImmunomodulatory effects and multi-omics analysis of Codonopsis pilosula extract in septic ratsView study →. No human data on the herb alone; prep match is good (polysaccharides are the bulk of the root).
Gastroprotective	██████░░░░ 64%	Multiple rodent models — gastric ulcer, TNBS/DSS colitis, gut-barrier repair 5,6,7,8Reference 5Wang ZT et al. · 1997AnimalInvestigations on the protective action of Codonopsis pilosula (Dangshen) extract on experimentally-induced gastric ulcer in ratsView study →Reference 6Chen Q et al. · 2025The effect and mechanism of Codonopsis Radix and its active components tangshenoside I and lobetyolin on preventing gastric ulcer based on spectrum-effect relationshipView study →Reference 7Zhou J et al. · 2024An inulin-type fructan CP-A from Codonopsis pilosula alleviates TNBS-induced ulcerative colitis based on serum-untargeted metabolomicsView study →Reference 8Yang Q et al. · 2026Codonopsis pilosula (Dangshen) alleviates ulcerative colitis through activation of the aryl-hydrocarbon-receptor signaling pathway by the gut bacterium Alistipes onderdonkii and its metabolite 5-HIAAView study →. Water extract/decoction and polysaccharide, matching how the root is used. Human trials only as multi-herb formulas.
Anti-inflammatory	██████░░░░ 61%	Cytokine (TNF-α, IL-6, NF-κB) suppression across colitis, NAFLD and aging models with water extract/polysaccharide, plus isolated lobetyolin 7,8,9,17Reference 7Zhou J et al. · 2024An inulin-type fructan CP-A from Codonopsis pilosula alleviates TNBS-induced ulcerative colitis based on serum-untargeted metabolomicsView study →Reference 8Yang Q et al. · 2026Codonopsis pilosula (Dangshen) alleviates ulcerative colitis through activation of the aryl-hydrocarbon-receptor signaling pathway by the gut bacterium Alistipes onderdonkii and its metabolite 5-HIAAView study →Reference 9Chen Q et al. · 2025AnimalCodonopsis pilosula polysaccharides attenuate lipid accumulation and inflammatory response in the NAFLD mouse by regulating AMPK/ACC/SREBP1 signaling pathwayView study →Reference 17Chen Z et al. · 2024AnimalLobetyolin protects mice against LPS-induced sepsis by downregulating the production of inflammatory cytokines in macrophageView study →. Preclinical only.
Antioxidant	██████░░░░ 57%	D-galactose aging models show ↑SOD/GSH, ↓MDA with water extract/polysaccharide 11,12Reference 11Wang X et al. · 2024AnimalCodonopsis pilosula water extract delays D-galactose-induced aging of the brain in mice by activating autophagy and regulating metabolismView study →Reference 12Zhang B et al. · 2026Codonopsis pilosula polysaccharide (CPP) alleviates D-Gal-induced aging and gut microbiota dysbiosisView study →. Mostly secondary readouts within aging/metabolic studies; no human data.
Neuroprotective	██████░░░░ 55%	Animal AD/aging-brain and PC12-cell models 11,13,14Reference 11Wang X et al. · 2024AnimalCodonopsis pilosula water extract delays D-galactose-induced aging of the brain in mice by activating autophagy and regulating metabolismView study →Reference 13Cai Y et al. · 2025AnimalCodonopsis pilosula polysaccharides alleviate neuronal apoptosis induced by endoplasmic-reticulum-stress-activated PERK-ATF4-CHOP signaling in APP/PS1 miceView study →Reference 14Yang L et al. · 2024Neuroprotective effect of Codonopsis pilosula polysaccharide on Aβ(25-35)-induced damage in PC12 cells via the p38 MAPK signaling pathwaysView study →; one small human RCT 20Reference 20Singh B et al. · 2004Dangshen (Codonopsis pilosula) and Bai guo (Ginkgo biloba) enhance learning and memoryView study → combined the herb with Ginkgo, so not attributable to the root.
Hepatoprotective	█████░░░░░ 53%	One mouse NAFLD study (polysaccharide, AMPK/ACC/SREBP1) 9Reference 9Chen Q et al. · 2025AnimalCodonopsis pilosula polysaccharides attenuate lipid accumulation and inflammatory response in the NAFLD mouse by regulating AMPK/ACC/SREBP1 signaling pathwayView study →. The page’s existing fatty-liver claim rests on C. lanceolata — a different species 21Reference 21Cho K et al. · 2009AnimalProtective effect of Codonopsis lanceolata root extract against alcoholic fatty liver in the ratView study → — not C. pilosula.
Anti-fatigue	█████░░░░░ 47%	Single mouse swimming/hypoxia study; only the polysaccharide fraction extended endurance 18Reference 18Xie Q et al. · 2020AnimalAntifatigue and antihypoxia activities of oligosaccharides and polysaccharides from Codonopsis pilosula in miceView study →. Strong traditional (qi-tonic) correlate, thin experimental base.
Hematopoietic	████░░░░░░ 45%	One dedicated C. pilosula study (arabinogalactan) 19Reference 19Zhu Y et al. · 2025A highly branched arabinogalactan from Codonopsis pilosula: structural insights and hematopoietic-protective mechanismView study →; other “blood” data come from multi-herb formulas. Traditional use is strong here, the experimental data are not.
Anticancer	████░░░░░░ 43%	Cell-line + one in-vivo HCC study for whole extract 15Reference 15Li N et al. · 2024Molecular mechanisms of Codonopsis pilosula in inhibiting hepatocellular carcinoma growth and metastasisView study → and isolated lobetyolin 16Reference 16Hu J et al. · 2024Lobetyolin suppresses the proliferation of hepatocellular carcinoma through activating DUSP1-ERK1/2 signaling pathwayView study →. Lobetyolin is a trace marker, so isolated-compound effects don’t transfer to the whole root.

1. Immunomodulation

This is the strongest and best-matched body of evidence, and it centres on the root’s carbohydrates rather than any small molecule. In immunosuppressed mice (cyclophosphamide model), an inulin-type fructan restored immune-organ indices, raised serum immunoglobulins and cytokines (IgG, IL-2, IL-4, IL-6, TNF-α) and repaired intestinal-barrier damage ^{2Reference 2Xie X et al. · 2025AnimalAn inulin-type fructan from Codonopsis pilosula ameliorates cyclophosphamide-induced immunosuppression and intestinal barrier injury in miceView study →}. A purified inulin (lobetyolin is not the active here) activated THP-1 macrophages through p65-dependent MAPK and NF-κB signalling, and notably outperformed a chemically near-identical commercial inulin — the difference traced to smaller particle size and better cellular uptake ^{3Reference 3Gao Z et al. · 2025Specific inulin in Codonopsis pilosula exerts immunological enhancement by promoting cellular uptake and regulating p65-dependent MAPK and NF-κB pathwaysView study →}. In septic rats, a whole-root aqueous extract produced measurable immunomodulation on multi-omics readouts ^{4Reference 4Xia Z et al. · 2025AnimalImmunomodulatory effects and multi-omics analysis of Codonopsis pilosula extract in septic ratsView study →}. Because the polysaccharides make up the bulk of the dried root, these results align well with the traditional decoction.

Gap: every study is animal or in-vitro; there is no human trial of the isolated herb, and immune endpoints differ enough across models that no dose-response for a standardised human preparation can be drawn.

2. Gastroprotective

The oldest and one of the more consistent preclinical signals. A C. pilosula aqueous extract protected against gastric ulceration in several rat models (stress-, acetic-acid- and sodium-hydroxide-induced) and reduced gastric acid and pepsin secretion, though it did little against pyloric-ligation or indomethacin ulcers ^{5Reference 5Wang ZT et al. · 1997AnimalInvestigations on the protective action of Codonopsis pilosula (Dangshen) extract on experimentally-induced gastric ulcer in ratsView study →}. More recent spectrum–effect work links gastric-ulcer prevention to the decoction plus its markers tangshenoside I and lobetyolin ^{6Reference 6Chen Q et al. · 2025The effect and mechanism of Codonopsis Radix and its active components tangshenoside I and lobetyolin on preventing gastric ulcer based on spectrum-effect relationshipView study →}. In inflammatory-bowel models, an inulin-type fructan (CP-A) eased TNBS-induced ulcerative colitis via serum-metabolomic shifts ^{7Reference 7Zhou J et al. · 2024An inulin-type fructan CP-A from Codonopsis pilosula alleviates TNBS-induced ulcerative colitis based on serum-untargeted metabolomicsView study →}, and whole dangshen alleviated DSS colitis through a gut bacterium (Alistipes onderdonkii) and aryl-hydrocarbon-receptor signalling ^{8Reference 8Yang Q et al. · 2026Codonopsis pilosula (Dangshen) alleviates ulcerative colitis through activation of the aryl-hydrocarbon-receptor signaling pathway by the gut bacterium Alistipes onderdonkii and its metabolite 5-HIAAView study →}. Preparations used (water extract, decoction, isolated fructan) match traditional digestive use.

Gap: all rodent; the human evidence for GI benefit exists only inside multi-herb TCM formulas, where Codonopsis cannot be isolated as the active agent.

3. Anti-inflammatory

Anti-inflammatory activity is better read as a mechanism cutting across the other indications than as a standalone use. Across colitis, NAFLD and aging models, C. pilosula water extract and polysaccharides consistently lower TNF-α, IL-6 and NF-κB activity ^{7,8,9Reference 7Zhou J et al. · 2024An inulin-type fructan CP-A from Codonopsis pilosula alleviates TNBS-induced ulcerative colitis based on serum-untargeted metabolomicsView study →Reference 8Yang Q et al. · 2026Codonopsis pilosula (Dangshen) alleviates ulcerative colitis through activation of the aryl-hydrocarbon-receptor signaling pathway by the gut bacterium Alistipes onderdonkii and its metabolite 5-HIAAView study →Reference 9Chen Q et al. · 2025AnimalCodonopsis pilosula polysaccharides attenuate lipid accumulation and inflammatory response in the NAFLD mouse by regulating AMPK/ACC/SREBP1 signaling pathwayView study →}. The isolated polyacetylene lobetyolin reproduces this: it protected mice against LPS-induced sepsis by downregulating macrophage inflammatory cytokines ^{17Reference 17Chen Z et al. · 2024AnimalLobetyolin protects mice against LPS-induced sepsis by downregulating the production of inflammatory cytokines in macrophageView study →}. The signal is mechanistically coherent but is almost always a secondary readout rather than the primary endpoint.

Gap: no human anti-inflammatory data; and the cleanest effects come from isolated lobetyolin, which is present only at trace levels in the root, so whole-herb potency is uncertain.

4. Antioxidant

Antioxidant capacity shows up mostly as supporting biochemistry inside aging and metabolic studies rather than as a dedicated line of work. In D-galactose-induced aging mice, both the water extract and purified polysaccharides raised superoxide dismutase and glutathione and lowered malondialdehyde ^{11,12Reference 11Wang X et al. · 2024AnimalCodonopsis pilosula water extract delays D-galactose-induced aging of the brain in mice by activating autophagy and regulating metabolismView study →Reference 12Zhang B et al. · 2026Codonopsis pilosula polysaccharide (CPP) alleviates D-Gal-induced aging and gut microbiota dysbiosisView study →}. Similar redox improvements accompany the diabetic and hepatic models ^{10Reference 10Effects of Codonopsis pilosula crude pol et al. · 2023AnimalJournal of Functional FoodsView study →}. The whole-root preparations used here match traditional practice, and the direction of effect is consistent.

Gap: antioxidant endpoints are almost always secondary; there is no human data, and no study isolates antioxidant benefit from the broader anti-aging phenotype.

5. Neuroprotective

An emerging, still-preclinical area with one weak human data point. In aging and Alzheimer’s-model mice, C. pilosula polysaccharides reduced neuronal apoptosis through the PERK-ATF4-CHOP endoplasmic-reticulum-stress pathway and improved Morris-water-maze performance ^{13Reference 13Cai Y et al. · 2025AnimalCodonopsis pilosula polysaccharides alleviate neuronal apoptosis induced by endoplasmic-reticulum-stress-activated PERK-ATF4-CHOP signaling in APP/PS1 miceView study →}; the water extract delayed brain aging by activating autophagy ^{11Reference 11Wang X et al. · 2024AnimalCodonopsis pilosula water extract delays D-galactose-induced aging of the brain in mice by activating autophagy and regulating metabolismView study →}; and in cultured PC12 cells, the polysaccharide protected against amyloid-β(25-35) toxicity via p38 MAPK ^{14Reference 14Yang L et al. · 2024Neuroprotective effect of Codonopsis pilosula polysaccharide on Aβ(25-35)-induced damage in PC12 cells via the p38 MAPK signaling pathwaysView study →}. The only human study — a 60-participant double-blind RCT — found improved memory acquisition and retention, but tested C. pilosula total glycosides combined with Ginkgo biloba, so the effect cannot be assigned to Codonopsis ^{20Reference 20Singh B et al. · 2004Dangshen (Codonopsis pilosula) and Bai guo (Ginkgo biloba) enhance learning and memoryView study →}.

Gap: the human RCT is a combination product at a glycoside dose, not the whole root; all mechanistic work is animal or cell-line, so translational relevance is unestablished.

6. Hepatoprotective

The whole-herb liver evidence for C. pilosula is thin and needs to be separated from a species mix-up. One mouse study found that C. pilosula polysaccharides reduced hepatic lipid accumulation, serum ALT/AST and inflammatory markers in high-fat-diet NAFLD via AMPK/ACC/SREBP1 signalling ^{9Reference 9Chen Q et al. · 2025AnimalCodonopsis pilosula polysaccharides attenuate lipid accumulation and inflammatory response in the NAFLD mouse by regulating AMPK/ACC/SREBP1 signaling pathwayView study →}. Importantly, the fatty-liver claim carried on many Codonopsis pages traces to Cho et al. (2009), which studied Codonopsis lanceolata — a different species that (unlike C. pilosula) contains triterpenoid saponins — so it should not be read as evidence for this herb ^{21Reference 21Cho K et al. · 2009AnimalProtective effect of Codonopsis lanceolata root extract against alcoholic fatty liver in the ratView study →}.

Gap: only a single whole-herb NAFLD study in mice supports C. pilosula directly; the more frequently cited hepatoprotective data belong to another species and preparation.

7. Anti-fatigue

This is the experimental correlate of the traditional “qi tonic” reputation, but the data are slim. In a single mouse study, ethanol extract, water extract, polysaccharides, inulin and oligosaccharides were compared in weight-loaded swimming and hypoxia tests; only the polysaccharide fraction significantly prolonged swimming time and raised liver and muscle glycogen ^{18Reference 18Xie Q et al. · 2020AnimalAntifatigue and antihypoxia activities of oligosaccharides and polysaccharides from Codonopsis pilosula in miceView study →}. The fraction that worked is the one that dominates the root, which is reassuring, but the base is one study.

Gap: a single rodent study with no replication and no human anti-fatigue trial; the traditional claim outstrips the experimental evidence.

8. Hematopoietic

Traditional use frames Codonopsis as a blood tonic (raising red cells, haemoglobin and leukocytes), but dedicated experimental support for the isolated herb is limited. One study isolated a highly branched arabinogalactan (CP2A) from C. pilosula and demonstrated hematopoietic-protective effects ^{19Reference 19Zhu Y et al. · 2025A highly branched arabinogalactan from Codonopsis pilosula: structural insights and hematopoietic-protective mechanismView study →}. Most other “blood-building” data come from multi-herb formulas (e.g. Fufang E’jiao Jiang) in which Codonopsis is one of several ingredients and cannot be isolated.

Gap: essentially one whole-herb study; the widely repeated claim that Codonopsis raises blood counts “more effectively than ginseng” is not supported by any head-to-head human data.

9. Anticancer

Anticancer activity is entirely cell-line and early-animal, and largely attributable to the trace marker rather than the whole root. Whole C. pilosula extract inhibited hepatocellular-carcinoma growth and metastasis in vitro and in vivo by suppressing CDK1 ^{15Reference 15Li N et al. · 2024Molecular mechanisms of Codonopsis pilosula in inhibiting hepatocellular carcinoma growth and metastasisView study →}, and isolated lobetyolin suppressed HCC cell proliferation through DUSP1-ERK1/2 signalling ^{16Reference 16Hu J et al. · 2024Lobetyolin suppresses the proliferation of hepatocellular carcinoma through activating DUSP1-ERK1/2 signaling pathwayView study →}. Because lobetyolin is present only at sub-percent (trace-marker) levels in the root, isolated-compound potency does not carry over to a decoction.

Gap: no clinical evidence; the strongest effects are from an isolated compound at concentrations the whole herb cannot deliver, and human oncology use appears only within multi-herb supportive-care formulas.

Mechanisms

Mechanism	Drives	Key compounds
Inulin-type fructans → macrophage activation, ↑Ig/cytokines (MAPK, NF-κB)	immunomodulation, gastroprotection	inulin, polysaccharides
NF-κB ↓, TNF-α ↓, IL-6 ↓	anti-inflammatory, hepatoprotective, gastroprotective	lobetyolin
AMPK/ACC/SREBP1 modulation → ↓hepatic lipogenesis	hepatoprotective, metabolic	polysaccharides
↑SOD/GSH, ↓MDA; autophagy activation	antioxidant, neuroprotective	polysaccharides
PERK-ATF4-CHOP ER-stress ↓, p38 MAPK modulation → ↓neuronal apoptosis	neuroprotective	polysaccharides
DUSP1-ERK1/2 activation, CDK1 ↓ → tumour-cell growth inhibition	anticancer	lobetyolin
Gut-microbiota remodelling + AhR signalling	gastroprotection, immunomodulation	polysaccharides, tangshenoside

Clinical trials

No registered clinical trial of C. pilosula as a single herb was identified; the one published randomised controlled trial tested the herb’s total glycosides in combination with Ginkgo biloba ^{20Reference 20Singh B et al. · 2004Dangshen (Codonopsis pilosula) and Bai guo (Ginkgo biloba) enhance learning and memoryView study →}, and all other human data come from multi-herb TCM formulas where the herb cannot be isolated.

Completed	Planned	Terminated	Preclinical
1 (combination, not monotherapy)	0	0	~several hundred

Last checked: July 2026.

Dosage

No standalone human dose for the root is established — the only human trial combined the herb’s total glycosides with Ginkgo, and the modern efficacy work uses isolated polysaccharide fractions in animals. The doses below are what the studies used (research doses, not recommendations); the traditional decoction range is separate.

Indication	Preparation	Dose	Est. dried-herb equivalent	Source
Anti-fatigue	Polysaccharide fraction (oral, mice)	0.25–1.0 g/kg/day × 21 days	animal-only; not derivable from one mouse study	18Reference 18Xie Q et al. · 2020AnimalAntifatigue and antihypoxia activities of oligosaccharides and polysaccharides from Codonopsis pilosula in miceView study →
Neuroprotective / cognition (combination)	C. pilosula total glycosides + Ginkgo	75 mg total glycosides + 40 mg Ginkgo, twice daily	— (combination; marker-based back-conversion unreliable)	20Reference 20Singh B et al. · 2004Dangshen (Codonopsis pilosula) and Bai guo (Ginkgo biloba) enhance learning and memoryView study →
Immunomodulation / gastroprotection	Water extract / inulin-type fructan (oral, rodent)	model-specific mg/kg (not standardised)	— (polysaccharide-fraction doses don’t map to whole-root grams)	2,3,4,5,6,7,8Reference 2Xie X et al. · 2025AnimalAn inulin-type fructan from Codonopsis pilosula ameliorates cyclophosphamide-induced immunosuppression and intestinal barrier injury in miceView study →Reference 3Gao Z et al. · 2025Specific inulin in Codonopsis pilosula exerts immunological enhancement by promoting cellular uptake and regulating p65-dependent MAPK and NF-κB pathwaysView study →Reference 4Xia Z et al. · 2025AnimalImmunomodulatory effects and multi-omics analysis of Codonopsis pilosula extract in septic ratsView study →Reference 5Wang ZT et al. · 1997AnimalInvestigations on the protective action of Codonopsis pilosula (Dangshen) extract on experimentally-induced gastric ulcer in ratsView study →Reference 6Chen Q et al. · 2025The effect and mechanism of Codonopsis Radix and its active components tangshenoside I and lobetyolin on preventing gastric ulcer based on spectrum-effect relationshipView study →Reference 7Zhou J et al. · 2024An inulin-type fructan CP-A from Codonopsis pilosula alleviates TNBS-induced ulcerative colitis based on serum-untargeted metabolomicsView study →Reference 8Yang Q et al. · 2026Codonopsis pilosula (Dangshen) alleviates ulcerative colitis through activation of the aryl-hydrocarbon-receptor signaling pathway by the gut bacterium Alistipes onderdonkii and its metabolite 5-HIAAView study →

The human-relevant actives are polysaccharides (the bulk of the root), but the marker molecules (lobetyolin, tangshenoside I) sit at trace/sub-percent levels, so there is no reliable marker-to-whole-herb ratio — dried-herb equivalents are left blank rather than invented. These are a guide, not a recommendation.

Traditional Dosage

System	Preparation	Dose
Traditional Chinese Medicine	Dried root, decocted ~20 min	3–15 g/day (standard ~8–9 g)
Western herbal	Liquid extract 1:2	30–60 mL/week (≈4–8 mL/day)

Safety

Codonopsis pilosula has a reassuring traditional and food-use record — it is an officially recognised medicinal-and-edible herb in China — and the modern literature reports it as well tolerated with few adverse effects at customary doses ^{1Reference 1Bai J et al. · 2025ReviewCodonopsis Radix: a comprehensive review for its ethnopharmacology, phytochemistry, pharmacodynamics, pharmacokinetics, toxicity and potential clinical applicationsView study →}. That said, dedicated toxicology is limited: no human safety trial of the isolated root exists, and the available evidence is preclinical ^{1Reference 1Bai J et al. · 2025ReviewCodonopsis Radix: a comprehensive review for its ethnopharmacology, phytochemistry, pharmacodynamics, pharmacokinetics, toxicity and potential clinical applicationsView study →}. No specific cytochrome-P450 interaction has been demonstrated — a pharmacokinetic study characterised absorption of the root’s markers but did not establish enzyme inhibition or induction, so the page’s former “CYP3A4” flag has been removed as unsupported. People with known Campanulaceae-family sensitivities should exercise normal botanical caution.

Scope: no herb–drug interaction study of single-herb C. pilosula was identified, and nearly all human use is within multi-herb TCM formulas — so interaction potential is unassessed, not “safe.” Absence of adverse reports is not evidence of safety.

Pregnancy & lactation

Not established — not specifically researched for safety. Codonopsis pilosula has not been evaluated for reproductive or developmental toxicity; classical Chinese sources advise using it with caution in pregnancy. Absence of adverse reports is not evidence of safety — this corrects the former sidebar note (“adverse reactions not expected”), which overstated what is known.

References

1. Bai J, Xie N, Hou Y, et al. Codonopsis Radix: a comprehensive review for its ethnopharmacology, phytochemistry, pharmacodynamics, pharmacokinetics, toxicity and potential clinical applications. Phytomedicine. 2025. https://pubmed.ncbi.nlm.nih.gov/41275746/
2. Xie X, Gu Y, Liu Y, et al. An inulin-type fructan from Codonopsis pilosula ameliorates cyclophosphamide-induced immunosuppression and intestinal barrier injury in mice. International Journal of Biological Macromolecules. 2025. https://pubmed.ncbi.nlm.nih.gov/40250123/
3. Gao Z, Ren J, Ke C, et al. Specific inulin in Codonopsis pilosula exerts immunological enhancement by promoting cellular uptake and regulating p65-dependent MAPK and NF-κB pathways. Journal of Agricultural and Food Chemistry. 2025. https://pubmed.ncbi.nlm.nih.gov/40758307/
4. Xia Z, Li G, Zhai Y, et al. Immunomodulatory effects and multi-omics analysis of Codonopsis pilosula extract in septic rats. Journal of Ethnopharmacology. 2025. https://pubmed.ncbi.nlm.nih.gov/39368762/
5. Wang ZT, Du Q, Xu GJ, et al. Investigations on the protective action of Codonopsis pilosula (Dangshen) extract on experimentally-induced gastric ulcer in rats. General Pharmacology. 1997;28(3):469–473. https://pubmed.ncbi.nlm.nih.gov/9068993/
6. Chen Q, Sun Y, Hu X, et al. The effect and mechanism of Codonopsis Radix and its active components tangshenoside I and lobetyolin on preventing gastric ulcer based on spectrum-effect relationship. Journal of Ethnopharmacology. 2025. https://pubmed.ncbi.nlm.nih.gov/40653041/
7. Zhou J, Wang J, Li D, et al. An inulin-type fructan CP-A from Codonopsis pilosula alleviates TNBS-induced ulcerative colitis based on serum-untargeted metabolomics. American Journal of Physiology. Gastrointestinal and Liver Physiology. 2024. https://pubmed.ncbi.nlm.nih.gov/38193197/
8. Yang Q, Pang W, Ma L, et al. Codonopsis pilosula (Dangshen) alleviates ulcerative colitis through activation of the aryl-hydrocarbon-receptor signaling pathway by the gut bacterium Alistipes onderdonkii and its metabolite 5-HIAA. American Journal of Chinese Medicine. 2026. https://pubmed.ncbi.nlm.nih.gov/41692705/
9. Chen Q, Lin H, Huang X, et al. Codonopsis pilosula polysaccharides attenuate lipid accumulation and inflammatory response in the NAFLD mouse by regulating AMPK/ACC/SREBP1 signaling pathway. Tissue & Cell. 2025. https://pubmed.ncbi.nlm.nih.gov/40451044/
10. Effects of Codonopsis pilosula crude polysaccharides by hypoglycemic and modulating gut microbiome in a high-fat diet and streptozotocin-induced mouse model of T2DM. Journal of Functional Foods. 2023;111:105893. https://doi.org/10.1016/j.jff.2023.105893
11. Wang X, Kang J, Li X, et al. Codonopsis pilosula water extract delays D-galactose-induced aging of the brain in mice by activating autophagy and regulating metabolism. Journal of Ethnopharmacology. 2024. https://pubmed.ncbi.nlm.nih.gov/38462027/
12. Zhang B, Zhang C, Yu M, et al. Codonopsis pilosula polysaccharide (CPP) alleviates D-Gal-induced aging and gut microbiota dysbiosis. International Journal of Molecular Sciences. 2026. https://pubmed.ncbi.nlm.nih.gov/42123518/
13. Cai Y, Wang X, Xiang Y, et al. Codonopsis pilosula polysaccharides alleviate neuronal apoptosis induced by endoplasmic-reticulum-stress-activated PERK-ATF4-CHOP signaling in APP/PS1 mice. Journal of Alzheimer’s Disease. 2025. https://pubmed.ncbi.nlm.nih.gov/40325880/
14. Yang L, Song S, Li X, et al. Neuroprotective effect of Codonopsis pilosula polysaccharide on Aβ(25-35)-induced damage in PC12 cells via the p38 MAPK signaling pathways. Pharmaceuticals. 2024. https://pubmed.ncbi.nlm.nih.gov/39338393/
15. Li N, Yang C, Xia J, et al. Molecular mechanisms of Codonopsis pilosula in inhibiting hepatocellular carcinoma growth and metastasis. Phytomedicine. 2024. https://pubmed.ncbi.nlm.nih.gov/38520835/
16. Hu J, Wang D, Wang F, et al. Lobetyolin suppresses the proliferation of hepatocellular carcinoma through activating DUSP1-ERK1/2 signaling pathway. Biological & Pharmaceutical Bulletin. 2024. https://pubmed.ncbi.nlm.nih.gov/39477468/
17. Chen Z, Su Y, Ding J, et al. Lobetyolin protects mice against LPS-induced sepsis by downregulating the production of inflammatory cytokines in macrophage. Frontiers in Pharmacology. 2024. https://pubmed.ncbi.nlm.nih.gov/38799158/
18. Xie Q, Sun Y, Cao L, et al. Antifatigue and antihypoxia activities of oligosaccharides and polysaccharides from Codonopsis pilosula in mice. Food & Function. 2020. https://pubmed.ncbi.nlm.nih.gov/32608442/
19. Zhu Y, Li X, Wang S, et al. A highly branched arabinogalactan from Codonopsis pilosula: structural insights and hematopoietic-protective mechanism. International Journal of Biological Macromolecules. 2025. https://pubmed.ncbi.nlm.nih.gov/40997968/
20. Singh B, Song H, Liu XD, et al. Dangshen (Codonopsis pilosula) and Bai guo (Ginkgo biloba) enhance learning and memory. Alternative Therapies in Health and Medicine. 2004;10(4):52–56. https://pubmed.ncbi.nlm.nih.gov/15285274/
21. Cho K, Kim SJ, Park SH, et al. Protective effect of Codonopsis lanceolata root extract against alcoholic fatty liver in the rat. Journal of Medicinal Food. 2009;12(6):1293–1301. https://pubmed.ncbi.nlm.nih.gov/20041784/ (Note: C. lanceolata — a different species; cited only to flag the common cross-species misattribution.)
22. Bone K. A Clinical Guide to Blending Liquid Herbs: Herbal Formulations for the Individual Patient. Edinburgh: Churchill Livingstone; 2003. (Secondary source.)
23. Lin LC, Tsai TH, Kuo CL. Chemical constituents comparison of Codonopsis tangshen, Codonopsis pilosula var. modesta and Codonopsis pilosula. Natural Product Research. 2013;27(19):1812–1815. https://doi.org/10.1080/14786419.2013.778849
24. Hempen CH, Fischer T. A Materia Medica for Chinese Medicine: Plants, Minerals, and Animal Products. 2009:710–711. (Secondary source — TCM properties.)
25. Teeguarden R. The Ancient Wisdom of the Chinese Tonic Herbs. New York: Warner Books; 2000:157–158. (Secondary source.)
26. He JY, Ma N, Zhu S. The genus Codonopsis (Campanulaceae): a review of phytochemistry, bioactivity and quality control. Journal of Natural Medicines. 2015;69(1):1–21. (Review/secondary source.)
27. Wang ZT, Ma GY, Tu PF, Xu GJ, Ng TB. Chemotaxonomic study of Codonopsis (family Campanulaceae) and its related genera. Biochemical Systematics and Ecology. 1995;23:809–812.
28. Lee KT, Choi J, Jung WT, et al. Structure of a new echinocystic acid bisdesmoside isolated from Codonopsis lanceolata roots. Journal of Agricultural and Food Chemistry. 2002;50:4190–4193. (C. lanceolata.)
29. Ichikawa M, Ohta S, Komoto N, et al. Simultaneous determination of seven saponins in the roots of Codonopsis lanceolata by LC-MS. Journal of Natural Medicines. 2009;63:52–57. (C. lanceolata.)
30. Hong DY. A Monograph of Codonopsis and Allied Genera (Campanulaceae). Academic Press; 2015. (Secondary source.)
31. Liang W, Sun J, Bai G, et al. Codonopsis radix: a review of resource utilisation, postharvest processing, quality assessment, and its polysaccharide composition. Frontiers in Pharmacology. 2024;15:1366556. https://doi.org/10.3389/fphar.2024.1366556