Astragalus
FabaceaeAstragalus membranaceus
Also known as: Huang Qi, Milk Vetch Root, Membranous Milk Vetch
clinical_notes Clinical Summary
Astragalus membranaceus (Huang Qi) is one of the most widely prescribed herbs in Traditional Chinese Medicine, revered for over 2,000 years as the premier Qi tonic and immunomodulator.
Its astragalosides, polysaccharides, and flavonoids exert immunostimulant, adaptogenic, anti-inflammatory, and cardioprotective effects, with recent meta-analyses confirming clinical benefit in chronic kidney disease, diabetes (as adjunct to metformin), and immune function.
Practitioners must exercise caution regarding drug interactions with immunosuppressants (tacrolimus, cyclosporine), CYP3A4-dependent drugs, and antidiabetics; it is contraindicated during pregnancy based on animal data suggesting fetal toxicity.
Pregnancy Safety
Animal studies suggest potential fetal toxicity. Human safety data are lacking. Avoid during pregnancy pending further evidence.
Lactation Safety
Insufficient human data on safety during breastfeeding. Avoid until safety is established.
warning Contraindications
- Immunosuppressant therapy (cyclosporine, tacrolimus, azathioprine, biologics) (avoid)Clinically Proven
- Autoimmune diseases (lupus, MS, RA, IBD) (caution)Theoretical
- Acute infection or high fever (caution)Theoretical
- Pregnancy (avoid)Theoretical
vital_signs Clinical Profile
Primary Indications
- check_circle immune deficiency
- check_circle chronic fatigue
- check_circle allergic rhinitis
- check_circle asthma
- check_circle chronic kidney disease
- check_circle heart failure
- check_circle type 2 diabetes
- check_circle upper respiratory infections
- check_circle cancer support
- check_circle proteinuria
- check_circle membranous nephropathy
- check_circle post-viral fatigue
Therapeutic Actions
System Affinities
- check_circle immune system
- check_circle cardiovascular
- check_circle kidney
- check_circle respiratory
- check_circle spleen
- check_circle adrenal
labs Active Constituents
astragalosides I-IV
astragaloside IV
polysaccharides
flavonoids
cycloastragenol
beta-sitosterol
history_edu Traditional Use
Traditional Chinese Medicine (TCM)
黄芪 (Huáng Qí)
Nature: warm
- Tonify Spleen and Lung Qi
- Consolidate Wei Qi (Defensive Qi)
- Raise Yang Qi
- Promote urination and alleviate edema
- Promote tissue generation and discharge pus
- Tonify blood
Huang Qi is one of the 50 fundamental herbs in TCM and is considered the premier Qi tonic. Classified as a superior herb in the Shennong Bencao Jing, it has been used since the Han Dynasty (206 BCE–220 CE). Sweet taste and warm nature make it ideally suited for Spleen and Lung deficiency patterns. Honey-prepared (Mi Zhi Huang Qi) is preferred for tonifying Qi and Blood.
Traditional Uses Across Healing Systems
While many herbs lack controlled clinical trials, centuries of traditional practice across cultures provide valuable insight into their therapeutic applications.
Premier Qi tonic used to tonify Spleen and Lung Qi, strengthen Wei Qi (defensive Qi), raise sinking Yang, promote urination, and facilitate wound healing. Core herb in formulas for chronic fatigue, spontaneous sweating, and recurrent infections.
One of the 50 fundamental herbs in TCM. Often combined with Dang Gui (Angelica sinensis) for Qi and Blood tonification.
Adaptogen and immunomodulator used to increase resistance to stress, prevent recurrent upper respiratory infections, and support recovery from chronic illness and cancer treatment.
Frequently used as an adjunctive agent alongside cancer chemotherapy to mitigate immunosuppression.
Lakota tribe chewed Astragalus root for back pain and cough; Lakota women consumed roots to increase breast milk production; Cheyenne tribe used root steam inhalations for respiratory diseases.
Members of the Lakota tribe used closely related North American Astragalus species medicinally.
spa Parts Used
root
- immune deficiency
- chronic fatigue
- chronic kidney disease
- heart failure
- diabetes
- allergic rhinitis
- post-viral fatigue
- cancer support
Dried sliced root used in decoctions, soups, and teas. Honey-fried root (Mi Zhi Huang Qi) preferred in TCM for Qi tonification. Root quality assessed by cylindrical shape, white-yellow cross-section, and sweet flavor. Harvest from 4-5 year old plants. TCM decoction: 10-15g (up to 60g) simmered 30-60 min.
shield Safety
Contraindications — Evidence Basis
Immunosuppressant therapy (cyclosporine, tacrolimus, azathioprine, biologics)
Astragalus immunostimulant activity directly antagonizes immunosuppressant drugs. A case report documented near-halving of tacrolimus blood levels in an 8-year-old transplant recipient consuming Astragalus root preparation, increasing risk of rejection. Avoid concurrent use without close monitoring.
Autoimmune diseases (lupus, MS, RA, IBD)
Immunostimulant properties may exacerbate autoimmune conditions by overstimulating the immune response. NCCIH specifically advises people with autoimmune diseases to avoid astragalus.
Acute infection or high fever
High doses may suppress regulatory T cells and promote excessive inflammatory response during acute infection. Traditional TCM texts advise against use during active external pathogen invasion.
Pregnancy
Animal studies suggest Astragalus may be toxic to the fetus. NCCIH advises avoidance during pregnancy. Safety in humans has not been established.
Monitoring Parameters
Monitor during use, especially with prolonged or high-dose therapy.
Blood glucose / HbA1c
Baseline and every 3 months in diabetic patientsAstragalus may lower blood glucose levels. Additive hypoglycemic effects are possible in patients on antidiabetic medications, increasing risk of hypoglycemia.
flagThreshold: Blood glucose <70 mg/dL or symptomatic hypoglycemia requires dose adjustment
Blood pressure
Baseline and at 4 weeks in patients on antihypertensivesAstragalus has demonstrated natriuretic and blood-pressure-lowering effects in healthy volunteers; additive hypotension possible with antihypertensive drugs.
flagThreshold: Systolic BP <90 mmHg or symptomatic hypotension requires dose review
Tacrolimus / Cyclosporine blood levels
Weekly for first 4 weeks if patient initiates Astragalus while on immunosuppressantsCase report documents near-halving of tacrolimus levels in a transplant patient consuming Astragalus, likely via CYP3A4/P-gp modulation, risking organ rejection.
flagThreshold: Any significant change from target therapeutic trough level requires review
Toxicity
Doses >28 g/day not recommended; no additional benefit and possible immune suppression. Up to 60 g/day for 4 months appears safe in adults.
Case report of elevated CA19-9, reversible liver and kidney cysts with 1 month daily use. Fatigue, malaise, and headache reported with sublingual extract.
Discontinue herb; supportive care; monitor hepatic and renal function if cyst formation suspected
Adverse Effects
CYP Metabolism
Astragalus root has been documented to inhibit CYP450 enzymes including CYP3A4 via P-glycoprotein modulation, with a clinical case showing ~50% reduction in tacrolimus levels in a transplant recipient. An astragalus extract mixture also showed CYP2B6 inhibition in vitro (IC50 10.62 µg/mL). Clinical significance of CYP modulation remains understudied; caution warranted with narrow therapeutic window drugs.
swap_horiz Interactions
Tacrolimus (Calcineurin Inhibitor)
Class: Immunosuppressant
Astragalus constituents inhibit CYP3A4 and P-glycoprotein. A pediatric case report documented approximately 50% reduction in tacrolimus blood concentrations in a renal transplant patient receiving a preparation containing Astragalus membranaceus root, despite unchanged tacrolimus dosing.
Avoid combination in transplant recipients. If unavoidable, monitor tacrolimus trough levels at minimum weekly and adjust doses accordingly. Educate all transplant patients to disclose all herbal supplement use.
Immunosuppressants (Cyclosporine, Azathioprine, Mycophenolate, Corticosteroids)
Class: Immunosuppressant
Astragalus strongly stimulates immune function via Toll-like receptor 4 (TLR4) activation, enhancing NK cell activity, T-lymphocyte proliferation, and pro-inflammatory cytokine production. This pharmacodynamic immunostimulation directly opposes therapeutic immunosuppression, potentially precipitating allograft rejection or autoimmune flares.
Contraindicated in organ transplant recipients on immunosuppressive therapy. Astragalus should not be used in patients with autoimmune diseases receiving immunosuppressive treatment. Immunostimulation can precipitate acute allograft rejection.
Warfarin / Anticoagulants (Heparin, Apixaban, Rivaroxaban, Clopidogrel)
Class: Anticoagulant
Astragalus exhibits antiplatelet and mild anticoagulant activity through inhibition of thromboxane synthesis and modulation of platelet aggregation. Co-administration with warfarin or other anticoagulants may potentiate anticoagulation, increasing the risk of bleeding.
Monitor INR closely if combination is used. Warn patients about signs of bleeding. Discontinue Astragalus at least 1-2 weeks before elective surgery.
Antihypertensive Agents (ACE Inhibitors, ARBs, Beta-Blockers, Calcium Channel Blockers)
Class: Antihypertensive
Astragalus polysaccharides and flavonoids produce vasodilatory and mild antihypertensive effects through nitric oxide pathway activation and calcium channel modulation. Co-administration with antihypertensive drugs may produce additive blood pressure lowering, potentially resulting in symptomatic hypotension.
Monitor blood pressure regularly when co-administered with antihypertensive medications. Educate patients about symptoms of hypotension. Dose adjustment of antihypertensives may be required.
Chemotherapy Agents (Cyclophosphamide, Cisplatin, Doxorubicin, Oxaliplatin)
Class: Antineoplastic
Astragalus polysaccharides have demonstrated reversal of cyclophosphamide-induced immunosuppression and bone marrow suppression. Meta-analyses show Astragalus-based formulas improve survival and quality of life as adjunctive therapy with platinum-based chemotherapy in NSCLC. However, immune stimulation may theoretically oppose immunosuppressive chemotherapy effects.
Use only under direct oncological supervision. Astragalus may be beneficial as adjunctive supportive therapy alongside certain chemotherapy regimens but should not be initiated without oncologist approval.
CYP3A4 Substrates (Midazolam, Simvastatin, Atorvastatin, Nifedipine, Cyclosporine)
Class: CYP3A4 Substrate
Astragalus membranaceus demonstrated significant inhibition of CYP3A4 activity in human liver microsomes in vitro studies. This pharmacokinetic inhibition can increase plasma AUC of CYP3A4 substrate drugs, potentially causing enhanced drug effects or toxicity for narrow-therapeutic-index agents.
Monitor for increased drug effects or toxicity of CYP3A4-metabolized medications when co-administered with Astragalus. Clinical significance at therapeutic doses requires further confirmation in human pharmacokinetic studies.
hub Combinations
Synergistic pairings can enhance therapeutic outcomes, while knowing suitable substitutes helps when specific herbs are unavailable or contraindicated.
No combination data available yet.
science Studies
Efficacy and safety of astragalus polysaccharides in patients with malignant tumors: A systematic review and meta-analysis
Meta-AnalysisThis systematic review and meta-analysis analyzed 31 RCTs involving 2,648 malignant tumor patients receiving Astragalus polysaccharide (APS) supplementation alongside conventional oncology treatments. APS supplementation was associated with significantly improved objective response rates, elevated CD3+ and CD4+ T cell counts, and an improved CD4+/CD8+ ratio compared to controls, indicating enhanced immune function. No meaningful difference in CD8+ T cells was detected. The adverse effect profile was favorable with low incidence of serious reactions, supporting APS as a promising adjunctive immunomodulatory intervention in cancer care, though the authors caution that future research should focus on specific cancer subtypes.
Astragalus membranaceus formula for moderate-high risk idiopathic membranous nephropathy: A meta-analysis
Meta-AnalysisThis meta-analysis of 50 RCTs involving 3,423 patients with moderate-to-high risk idiopathic membranous nephropathy (IMN) evaluated the adjunctive use of Astragalus membranaceus preparations combined with supportive care or immunosuppressive therapy. AM significantly improved complete remission rate (RR=1.63), partial remission rate (RR=1.13), serum albumin, and reduced 24-hour urinary protein, serum creatinine versus conventional therapy alone. These findings suggest clinically meaningful renoprotective effects. The authors noted that most included studies were Chinese and of moderate quality, and called for well-designed international RCTs to confirm results.
medication Dosing
decoction
10-15 g dried root (up to 30-60 g for larger TCM doses)
1-2x/day
Traditional TCM decoction; simmer sliced root 30-60 min. Honey-fried root (Mi Zhi Huang Qi) preferred for Qi tonification. Often combined with other TCM herbs.
capsule
250-500 mg standardized extract (standardized to astragalosides)
2-3x/day
Standardized extract preferred for consistent astragaloside content. Take with or without food. Doses up to 60 g/day (crude equivalent) for up to 4 months appear safe.
tincture
2-4 mL (1:5 in 30% ethanol)
3x/day
Liquid extract; can be added to water or juice. Less concentrated than standardized extracts.
tea
3-6 g dried root per cup
2-3x/day
Simmer 3-6 g sliced root in 2 cups water for 30 minutes; strain and drink. Root slices can also be added to soups and broths in Asian cuisine. Mild, slightly sweet flavor.
Disclaimer: This information is largely AI-generated and reviewed by human experts at Evara Health. It is intended for educational and clinical reference purposes only and should not replace professional medical advice.
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