Atractylodes
AsteraceaeAtractylodes macrocephala
Also known as: Bai Zhu, White Atractylodes, Largehead Atractylodes
clinical_notes Clinical Summary
Atractylodes macrocephala (Bai Zhu) is a foundational TCM Qi tonic with 2000 years of clinical use for Spleen deficiency, digestive weakness, and dampness.
Modern research validates gastroprotective, immunomodulatory and anti-inflammatory actions driven by atractylenolides and polysaccharides.
It is a deputy herb in the classical Si Jun Zi Tang formula and is still among the most commonly prescribed herbs in East Asia.
Pregnancy Safety
Traditionally used in TCM to 'calm the fetus' within formulas, but modern toxicity data are limited. Use only under a qualified practitioner.
Lactation Safety
Insufficient modern safety data in lactation; traditional use suggests compatibility but caution advised.
warning Contraindications
- Yin deficiency with heat signs (caution)Theoretical
- Asteraceae/Compositae allergy (caution)Theoretical
vital_signs Clinical Profile
Primary Indications
- check_circle Spleen Qi deficiency
- check_circle Chronic diarrhea
- check_circle Loss of appetite
- check_circle Abdominal distension
- check_circle Edema
- check_circle Spontaneous sweating
- check_circle Threatened miscarriage
- check_circle Fatigue
- check_circle IBS
Therapeutic Actions
System Affinities
- check_circle Digestive
- check_circle Immune
- check_circle Hepatic
- check_circle Renal
labs Active Constituents
Atractylenolide I
Atractylenolide II
Atractylenolide III
Atractylon
Sesquiterpenoids
Atractylodes polysaccharides
Polyacetylenes
beta-eudesmol
history_edu Traditional Use
Traditional Chinese Medicine (TCM)
白术 (Bai Zhu)
Nature: warm
- Spleen Qi deficiency
- Dampness accumulation
- Spontaneous sweating
- Restless fetus
One of the most widely used Qi tonics in TCM; cornerstone of Spleen-tonifying formulas with nearly 2000 years of documented use.
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.
Tonifies Spleen Qi, dries dampness, stops sweating, calms the fetus; used in chronic diarrhea, edema, and threatened miscarriage.
Deputy herb in foundational Si Jun Zi Tang formula.
Byakujutsu — used in digestive weakness, edema, and as tonic in decoctions such as Ninjin-yoei-to.
Integrated into Japanese Kampo pharmacopoeia.
spa Parts Used
root
- Spleen Qi deficiency
- Diarrhea
- Edema
Dried rhizome is the official medicinal part; often dry-fried (chao bai zhu) to enhance spleen-tonifying action, or stir-fried with earth to stop diarrhea.
shield Safety
Contraindications — Evidence Basis
Yin deficiency with heat signs
Its warm, drying nature can aggravate dryness and heat in patterns of true Yin deficiency.
Asteraceae/Compositae allergy
Cross-reactivity possible in individuals allergic to ragweed, chrysanthemums, marigolds, daisies.
Toxicity
No acute toxicity reported at normal therapeutic doses (3-12 g crude herb/day).
Rare: GI upset, dry mouth, allergic reaction in Asteraceae-sensitive individuals.
Discontinue use; supportive care.
Adverse Effects
CYP Metabolism
Limited CYP data. Atractylenolides show modulation of CYP3A4 and P-gp in preclinical studies; clinical significance unclear.
swap_horiz Interactions
Diuretics (furosemide, hydrochlorothiazide, spironolactone)
Class: Diuretic
Atractylodes macrocephala (Bai Zhu) has documented mild diuretic activity in traditional and modern pharmacological studies, attributed to atractylenolides and polysaccharide constituents. Combined with loop or thiazide diuretics this may produce additive diuresis, volume depletion, and electrolyte disturbances (hypokalemia, hyponatremia).
Monitor serum electrolytes (especially K+ and Na+) and renal function (SCr, BUN) when Atractylodes is combined with prescription diuretics. Counsel on hydration and watch for orthostatic symptoms. Dose adjustment of diuretic may be required.
CYP3A4 substrates (midazolam, atorvastatin, tacrolimus)
Class: CYP3A4 substrates
Preclinical studies show atractylenolides I, II, and III modulate CYP3A4 activity and can inhibit P-glycoprotein efflux. This may increase plasma exposure of sensitive CYP3A4/P-gp substrates. Clinical pharmacokinetic studies in humans are lacking, so the exact magnitude is uncertain.
For patients on narrow-therapeutic-index CYP3A4 substrates (tacrolimus, cyclosporine, sirolimus), monitor trough drug levels when starting or stopping Atractylodes-containing Chinese herbal formulas. Be alert for dose-related drug toxicities.
P-glycoprotein substrates (digoxin, dabigatran, colchicine)
Class: P-gp substrates
Atractylenolide III and related sesquiterpenoids from Atractylodes macrocephala have shown P-gp inhibitory activity in preclinical studies, potentially increasing systemic exposure to P-gp substrate drugs such as digoxin, dabigatran, and colchicine.
In patients on digoxin, monitor serum digoxin levels and watch for signs of toxicity (nausea, visual disturbances, arrhythmias) if initiating Atractylodes. For dabigatran, monitor for bleeding. Avoid combination with colchicine where narrow therapeutic window and high P-gp dependence make interactions particularly risky.
Immunosuppressants (cyclosporine, tacrolimus, methotrexate, biologics)
Class: Immunosuppressant
Atractylodes polysaccharides have documented immunomodulatory activity, including stimulation of T-cell proliferation, macrophage activation, and cytokine production (IL-2, IFN-γ, TNF-α). This may antagonize the therapeutic immunosuppression intended with calcineurin inhibitors and biologic DMARDs.
Avoid Atractylodes supplements in organ transplant recipients and in patients on biologic therapy for autoimmune conditions unless reviewed by prescribing specialist. Monitor for signs of rejection (transplant) or disease flare (autoimmune). Report all herbal supplement use to the transplant/rheumatology team.
Anticoagulants (warfarin, heparin)
Class: Anticoagulant
Atractylodes macrocephala essential oil and atractylenolide components have shown mild antithrombotic and antiplatelet effects in preclinical models. Clinical evidence of INR impact is limited but a theoretical risk of additive bleeding exists with pharmaceutical anticoagulants.
Monitor INR in warfarin patients who initiate Atractylodes-containing formulas. Avoid high-dose Atractylodes extracts in patients on triple antithrombotic therapy or with additional bleeding risk factors. Discontinue 1-2 weeks before elective surgery.
hub Combinations
Synergistic pairings can enhance therapeutic outcomes, while knowing suitable substitutes helps when specific herbs are unavailable or contraindicated.
Classical Formulas
3Licorice Root
Traditional UsePart of Si Jun Zi Tang; licorice harmonizes formula and supports Qi.
Long traditional use; supports Qi tonic action.
Panax Ginseng
Moderate EvidenceClassic pairing in Si Jun Zi Tang; ginseng is chief Qi tonic, atractylodes is deputy reinforcing Spleen and drying dampness.
Multiple clinical trials of Si Jun Zi Tang and derivative formulas show benefit in Spleen Qi deficiency patterns including chronic gastritis and IBD.
Poria
Moderate EvidenceSynergistic in Si Jun Zi Tang and Shen Ling Bai Zhu San; poria drains dampness through urination while atractylodes dries dampness in the middle jiao.
Shen Ling Bai Zhu San RCTs show improvement in ulcerative colitis and chronic diarrhea.
Synergistic Combinations
1Astragalus
Traditional UseBoth strong Qi tonics; combined in Bu Zhong Yi Qi Tang for central Qi deficiency, prolapse, and fatigue.
Classical formula widely used clinically; supportive data for fatigue and immune modulation.
science Studies
Efficacy and safety of Atractylodes macrocephala-containing traditional Chinese medicine combined with neoadjuvant chemotherapy in the treatment of advanced gastric cancer: a systematic evaluation and meta-analysis
Meta-AnalysisThis systematic review and meta-analysis evaluated Atractylodes macrocephala-containing TCM preparations used alongside neoadjuvant chemotherapy (NAC) in advanced gastric cancer, drawing from 8 databases up to September 2023. Compared to NAC alone, Atractylodes-containing TCM significantly improved objective response rate (RR 1.41, 95% CI 1.27-1.57), disease control rate (RR 1.20), and quality of life (RR 1.43). The combination also increased CD3+, CD4+, CD8+ T-cell proportions and reduced adverse effects of chemotherapy. Atractylodes appeared to enhance immune function while mitigating chemotherapy-associated toxicity. These results support the use of Atractylodes-based formulations as immunomodulatory adjuncts to conventional cancer treatment.
The traditional uses, phytochemistry, and pharmacology of Atractylodes macrocephala Koidz.: A review
Systematic ReviewThis comprehensive review synthesizes the botany, traditional uses, phytochemistry, pharmacology, and toxicology of Atractylodes macrocephala (Baizhu), a key tonic herb in East Asian medicine. Over 79 chemical compounds have been identified, including sesquiterpenoids (atractylenolides), polysaccharides, and polyacetylenes. Documented pharmacological effects include immunomodulatory, gastrointestinal-regulatory, anti-inflammatory, anti-tumor, anti-osteoporotic, and neuroprotective activities. Traditional applications include gastrointestinal dysfunction, cancer adjunct therapy, osteoporosis, obesity, and fetal irritability. The authors highlight that most pharmacological data comes from preclinical models, with more rigorous clinical studies needed to validate these applications.
medication Dosing
decoction
6-12 g dried rhizome
1-2x/day
Decoct 20-30 min; standard TCM dose.
powder
1-3 g
2-3x/day
Often formulated in multi-herb patent formulas (e.g., Shen Ling Bai Zhu San).
tincture
2-4 mL (1:5, 45% ethanol)
2-3x/day
Western herbal adaptation.
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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