Cordyceps

In Traditional Chinese Medicine, cordyceps (dong chong xia cao) is considered sweet and warm, and deeply tonic.

It is used to tonify the Kidney and Lung, and to replenish exhaustion. Classical indications include fatigue, chronic cough, weakness after illness, low libido and age-related decline.

Modern Western herbalism classes cordyceps as an adaptogen and restorative tonic.

It is used for fatigue, athletic endurance, stress, immune support, respiratory weakness and recovery from burnout or chronic illness. It is often combined with other adaptogens such as reishi, rhodiola, eleuthero and ashwagandha.

Two Cochrane reviews and several meta-analyses pool Chinese RCTs of fermented Cordyceps sinensis preparations (Bailing, Jinshuibao) added to standard care, including ACE-inhibitor or ARB therapy ^{3,6,8Reference 3Zhang HW et al. · 2014Systematic reviewCordyceps sinensis (a traditional Chinese medicine) for treating chronic kidney disease — systematic reviewView study →Reference 6Yan G et al. · 2023Meta-analysisThe effects of Ophiocordyceps sinensis combined with ACEI/ARB on diabetic kidney disease: A systematic review and meta-analysis — systematic review and meta-analysisView study →Reference 8Tao Y et al. · 2024Meta-analysisUse of bailing capsules (cordyceps sinensis) in the treatment of chronic kidney disease: a meta-analysis and network pharmacology — meta-analysisView study →}.

The 2014 Cochrane review included 22 studies with 1,746 participants. In people not on dialysis, cordyceps preparations lowered serum creatinine, raised creatinine clearance and reduced proteinuria ^{3Reference 3Zhang HW et al. · 2014Systematic reviewCordyceps sinensis (a traditional Chinese medicine) for treating chronic kidney disease — systematic reviewView study →}.

A 2023 GRADE-rated meta-analysis in diabetic kidney disease found consistent benefit as an add-on ^{6Reference 6Yan G et al. · 2023Meta-analysisThe effects of Ophiocordyceps sinensis combined with ACEI/ARB on diabetic kidney disease: A systematic review and meta-analysis — systematic review and meta-analysisView study →}. A separate one found lower C-reactive protein and better nutritional markers in haemodialysis patients ^{7Reference 7Bee Yean O · 2019Meta-analysisEfficacy of Cordyceps sinensis as an adjunctive treatment in hemodialysis patients: a systematic review and Meta-analysis — systematic review and meta-analysisView study →}.

⚠ The Cochrane authors rated the risk of bias as high or unclear in every included study, and could not reach a definitive conclusion ^{3Reference 3Zhang HW et al. · 2014Systematic reviewCordyceps sinensis (a traditional Chinese medicine) for treating chronic kidney disease — systematic reviewView study →}.

Gap: the evidence rests on fermented-mycelium pharmaceutical preparations, not the dried fruiting body or powder sold as a supplement, and no rigorous trial outside China has replicated it.

A 1995 trial first reported that C. sinensis reduced ciclosporin-associated kidney toxicity in kidney-transplant recipients ^{9Reference 9Xu F et al. · 1995RCTAmelioration of cyclosporin nephrotoxicity by Cordyceps sinensis in kidney-transplanted recipients — randomised controlled trialView study →}.

A Cochrane review and a 2017 systematic review and meta-analysis of RCTs found that cordyceps added to calcineurin-inhibitor immunosuppression was associated with fewer acute rejection episodes, less kidney toxicity, fewer infections and better graft function ^{4,5Reference 4Hong T et al. · 2015Systematic reviewCordyceps sinensis (a traditional Chinese medicine) for kidney transplant recipients — systematic reviewView study →Reference 5Ong BY · 2017Meta-analysisEfficacy of Cordyceps sinensis as an adjunctive treatment in kidney transplant patients: A systematic-review and meta-analysis — systematic review and meta-analysisView study →}.

The evidence is graded low to moderate quality and rests on fermented preparations in Chinese transplant centres.

Gap: every trial studied cordyceps as an add-on to standard immunosuppression, never in place of it.

A 2015 randomised placebo-controlled trial in 79 healthy Korean men gave ethanol-treated C. militaris (1.5 g/day for 4 weeks). It increased natural-killer-cell activity, lymphocyte proliferation, IL-2 and interferon-γ compared with placebo ^{10Reference 10Kang HJ et al. · 2015RCTCordyceps militaris Enhances Cell-Mediated Immunity in Healthy Korean Men — randomised, placebo-controlled trialView study →}.

Cordyceps β-glucans activate macrophages, NK cells and cytokine signalling through pattern-recognition receptors ^{11Reference 11Bi S et al. · 2018In vitroStructural elucidation and immunostimulatory activity of a new polysaccharide from Cordyceps militaris — in vitroView study →}.

Gap: the trial measured natural-killer-cell activity in a laboratory assay. No trial has measured the number or length of infections.

Cordycepin (3’-deoxyadenosine) suppresses NF-κB signalling through Akt and p38 inhibition in LPS-stimulated macrophages, lowering TNF-α, iNOS and COX-2 ^{12Reference 12Kim HG et al. · 2006In vitroCordycepin inhibits lipopolysaccharide-induced inflammation by the suppression of NF-kappaB through Akt and p38 inhibition in RAW 264.7 macrophage cells — in vitroView study →}.

In animals it reduces pain and joint damage in osteoarthritis models, and shifts macrophages from the M1 to the M2 type, limiting organ damage in septic mice ^{13,14Reference 13Ashraf S et al. · 2019AnimalThe polyadenylation inhibitor cordycepin reduces pain, inflammation and joint pathology in rodent models of osteoarthritis — in vivo (rodent)View study →Reference 14Zhang Y et al. · 2022AnimalCordycepin induces M1/M2 macrophage polarization to attenuate the liver and lung damage and immunodeficiency in immature mice with sepsis via NF-κB/p65 inhibition — in vivo (mouse)View study →}. It acts as a polyadenylation inhibitor, which gives it broad effects on inflammatory gene expression.

Every result is in vitro or in animals. No human trial has taken inflammation as a primary endpoint, and the preclinical doses often exceed what oral supplements deliver.

Meta-analyses report that Bailing capsule added to standard therapy improves FEV₁, exercise tolerance and quality of life in stable COPD ^{15Reference 15Ma G · 2024Meta-analysisTherapeutic efficacy and pharmacological mechanism of Bailing capsule on chronic obstructive pulmonary disease: a meta-analysis and network pharmacology — meta-analysisView study →}. A 2025 multi-centre trial of 240 patients over 24 weeks found that Yong Chong Cao capsule reduced acute exacerbations compared with Bailing, with no difference in lung function ^{16Reference 16Li S et al. · 2025RCTThe Effectiveness of Yong Chong Cao Capsule in Patients With Mild to Severe COPD: A Multi-Center, Randomized, Active-Controlled Trial — multi-center randomised controlled trialView study →}.

A broader review of Chinese herbal medicine for stable COPD points the same way, with widespread risk-of-bias problems ^{17Reference 17Chen X et al. · 2014Systematic reviewOral Chinese herbal medicine combined with pharmacotherapy for stable COPD: a systematic review of effect on BODE index and six minute walk test — systematic reviewView study →}.

Almost all of these trials give cordyceps together with other herbs or drugs, which makes its own contribution hard to isolate.

A 2024 systematic review and meta-analysis of 12 RCTs (928 patients) found that C. sinensis added to conventional lung-cancer treatment improved tumour response rate, immune markers and performance status, and reduced some treatment side effects ^{18Reference 18Wang C et al. · 2024Meta-analysisAdjuvant treatment with Cordyceps sinensis for lung cancer: A systematic review and meta-analysis of randomized controlled trials — systematic review and meta-analysisView study →}.

In cancer cell lines and xenografts, cordycepin induces apoptosis and cell-cycle arrest through AMPK activation and EGFR/ERK inhibition, and can reverse cisplatin resistance in non-small-cell lung cancer models ^{19,20Reference 19Wei C et al. · 2019AnimalCordycepin Inhibits Drug-resistance Non-small Cell Lung Cancer Progression by Activating AMPK Signaling Pathway — in vivo (mouse)View study →Reference 20Hwang JH et al. · 2017In vitroCordycepin induces human lung cancer cell apoptosis by inhibiting nitric oxide mediated ERK/Slug signaling pathway — in vitroView study →}.

No cordyceps trial has shown a survival benefit. The human evidence concerns supportive endpoints during conventional treatment, and the direct anti-tumour data is preclinical.

Cordyceps polysaccharides and cordycepin scavenge free radicals and raise endogenous antioxidant enzymes (SOD, catalase, glutathione peroxidase) in cell assays and animal models. Structurally defined C. militaris polysaccharide fractions show dose-dependent radical-scavenging activity ^{11,21Reference 11Bi S et al. · 2018In vitroStructural elucidation and immunostimulatory activity of a new polysaccharide from Cordyceps militaris — in vitroView study →Reference 21Zhang X et al. · 2021In vitroStructure analysis and antioxidant activity of polysaccharide-iron (III) from Cordyceps militaris mycelia — in vitroView study →}.

The data are chemical-assay and animal only, and vary widely by species, strain and extraction method. No human biomarker trial of the whole fungus exists.

⚠ A 2004 RCT in 22 trained male cyclists found that C. sinensis (CordyMax Cs-4, 3 g/day for 5 weeks) did not improve VO₂peak, ventilatory threshold or time-trial performance ^{22Reference 22Parcell AC et al. · 2004RCTCordyceps Sinensis (CordyMax Cs-4) supplementation does not improve endurance exercise performance — randomised, placebo-controlled trialView study →}.

A 2010 double-blind trial in 20 healthy adults aged 50–75 found that Cs-4 raised the metabolic threshold by 10.5% and the ventilatory threshold by 8.5% after 12 weeks, with no change in VO₂max ^{23Reference 23Chen S et al. · 2010RCTEffect of Cs-4 (Cordyceps sinensis) on exercise performance in healthy older subjects: a double-blind, placebo-controlled trial — randomised, double-blind, placebo-controlled trialView study →}. A 2017 RCT of a C. militaris mushroom blend showed small improvements in high-intensity exercise tolerance ^{24Reference 24Hirsch KR et al. · 2017RCTCordyceps militaris Improves Tolerance to High-Intensity Exercise After Acute and Chronic Supplementation — randomised, double-blind, placebo-controlled trialView study →}.

A 2025 meta-analysis of fungal supplements in athletes found modest, inconsistent effects ^{25Reference 25Shu MY et al. · 2025Meta-analysisEffects of fungal supplementation on endurance, immune function, and hematological profiles in adult athletes: a systematic review and meta-analysis — systematic review and meta-analysisView study →}.

Gap: the best-controlled trial in trained athletes was negative. Benefits appear mainly in older or untrained people, often from multi-ingredient formulas rather than cordyceps alone.

Cordyceps polysaccharides and cordycepin lower blood glucose in diabetic rodents. A C. militaris polysaccharide fraction improved high blood sugar by remodelling the gut microbiota and down-regulating the TLR4/NF-κB pathway, and cordycepin prevented high blood sugar in alloxan-diabetic mice ^{26,27Reference 26Zhao H et al. · 2023AnimalCordyceps militaris polysaccharide alleviates diabetic symptoms by regulating gut microbiota against TLR4/NF-κB pathway — in vivo (mouse)View study →Reference 27Ma L et al. · 2015AnimalCordycepin from Cordyceps militaris prevents hyperglycemia in alloxan-induced diabetic mice — in vivo (mouse)View study →}.

No human blood-sugar trial of cordyceps on its own exists. The diabetic-kidney-disease trials measured kidney endpoints, not blood sugar.

C. sinensis inhibited liver fibrosis in a rat model of carbon-tetrachloride and ethanol injury, reducing collagen deposition and hepatic stellate-cell activation ^{28Reference 28Liu YK · 2003AnimalInhibitive effect of cordyceps sinensis on experimental hepatic fibrosis and its possible mechanism — in vivo (rat)View study →}.

Much of the later liver-fibrosis evidence comes from multi-herb formulas, such as Fuzheng Huayu, in which cordyceps mycelium is one of several components.

No single-herb human liver data exists.

Cordycepin lowered serum lipids in hyperlipidaemic hamsters and rats, and water extracts of cultured C. sinensis reduced serum lipid peroxides and cholesterol deposits in the aorta of atherosclerotic mice ^{29,30Reference 29Gao J et al. · 2011AnimalLipid-lowering effect of cordycepin (3’-deoxyadenosine) from Cordyceps militaris on hyperlipidemic hamsters and rats — in vivo (rodent)View study →Reference 30Yamaguchi Y et al. · 2000AnimalInhibitory effects of water extracts from fruiting bodies of cultured Cordyceps sinensis on raised serum lipid peroxide levels and aortic cholesterol deposition in atherosclerotic mice — in vivo (mouse)View study →}. Related work maps polysaccharide effects on cholesterol handling in macrophages (PPARγ–LXRα–ABCA1/G1).

The work is entirely in rodents, with no human lipid trial.

C. militaris mycelium improved sperm quantity and quality in subfertile boars, and cordyceps preparations enhance steroid-hormone production and protect the blood-testis barrier in rodent models ^{31Reference 31Lin WH et al. · 2007AnimalImprovement of sperm production in subfertile boars by Cordyceps militaris supplement — in vivo (animal)View study →}.

No human fertility or libido trial exists.

Cordycepin and C. sinensis extracts reduce airway hyperresponsiveness, eosinophil infiltration and Th2 cytokine signalling (through NF-κB blockade) in ovalbumin-sensitised mouse and rat models of allergic asthma ^{32Reference 32Yang X et al. · 2015AnimalCordycepin alleviates airway hyperreactivity in a murine model of asthma by attenuating the inflammatory process — in vivo (mouse)View study →}.

The work is preclinical, with no clinical asthma trial. It is separate from the COPD evidence, which is human but uses fermented multi-component preparations.

Tolerability. Cordyceps is generally well tolerated, with occasional mild digestive upset or dry mouth. No serious toxicity was reported in the kidney and immune trials that make up its main human evidence ^{3,4,5,10Reference 3Zhang HW et al. · 2014Systematic reviewCordyceps sinensis (a traditional Chinese medicine) for treating chronic kidney disease — systematic reviewView study →Reference 4Hong T et al. · 2015Systematic reviewCordyceps sinensis (a traditional Chinese medicine) for kidney transplant recipients — systematic reviewView study →Reference 5Ong BY · 2017Meta-analysisEfficacy of Cordyceps sinensis as an adjunctive treatment in kidney transplant patients: A systematic-review and meta-analysis — systematic review and meta-analysisView study →Reference 10Kang HJ et al. · 2015RCTCordyceps militaris Enhances Cell-Mediated Immunity in Healthy Korean Men — randomised, placebo-controlled trialView study →}.

Immunosuppressive drugs. In transplant patients, cordyceps has been studied as a monitored add-on to calcineurin-inhibitor therapy, where it appeared to help ^{4,5,9Reference 4Hong T et al. · 2015Systematic reviewCordyceps sinensis (a traditional Chinese medicine) for kidney transplant recipients — systematic reviewView study →Reference 5Ong BY · 2017Meta-analysisEfficacy of Cordyceps sinensis as an adjunctive treatment in kidney transplant patients: A systematic-review and meta-analysis — systematic review and meta-analysisView study →Reference 9Xu F et al. · 1995RCTAmelioration of cyclosporin nephrotoxicity by Cordyceps sinensis in kidney-transplanted recipients — randomised controlled trialView study →}. Taken without supervision alongside immunosuppressants, its immune effects could upset that balance. The same applies in autoimmune disease.

Blood sugar. Animal studies consistently show blood-glucose lowering ^{26,27Reference 26Zhao H et al. · 2023AnimalCordyceps militaris polysaccharide alleviates diabetic symptoms by regulating gut microbiota against TLR4/NF-κB pathway — in vivo (mouse)View study →Reference 27Ma L et al. · 2015AnimalCordycepin from Cordyceps militaris prevents hyperglycemia in alloxan-induced diabetic mice — in vivo (mouse)View study →}, so an additive effect with antidiabetic drugs is possible.

Anticoagulants. The caution about added bleeding risk with anticoagulant and antiplatelet drugs is traditional and has not been tested in trials.

Product quality. Adulterants are often found in processed products sold as wild cordyceps, and arsenic testing is now a routine check on wild material ^{39Reference 39Guo LX et al. · 2018Novel Arsenic Markers for Discriminating Wild and Cultivated Cordyceps — analyticalView study →}. Buying from a supplier that tests its products matters more here than with most herbs.

Interactions. No dedicated pharmacokinetic or CYP450 interaction study has been done.