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Traditional Chinese medicine

AstragalusAstragalus mongholicus (syn. A. membranaceus)

Astragalus root (huang qi) has no gut trial on its own; a 13-trial meta-analysis of an astragalus formula in atrophic gastritis gave RR 1.24.

Botanical name
Astragalus mongholicus (syn. A. membranaceus)
Part used
root, sliced and dried; used raw or honey-fried
Also called
pinyin Huang qi (黄芪 / 黄耆); Milk vetch root, Astragali radix, Hwanggi (Korean), Ogi (Japanese)
Used in
Traditional Chinese medicine
Taken for
Appetite, Loose stools and diarrhea
Sold as
decoction, granule extract, capsules, powder, dried slices

What is meant by astragalus

Astragalus, or huang qi in Chinese, is the dried root of a perennial legume. The Chinese Pharmacopoeia accepts Astragalus mongholicus (also written as A. membranaceus var. mongholicus) and A. membranaceus itself, and the root is among the most widely used herbs in Chinese medicine. It is sold as long, pale, fibrous slices that are simmered in decoctions, and also as powder, granule extract and capsules.

Two preparations matter for the gut. Raw root (sheng huang qi) and honey-fried root (mi zhi huang qi) are both used, and the traditional texts treat them as distinct preparations with somewhat different uses. Astragalus is not one of the classic spleen herbs in familiar formulas such as Si Jun Zi Tang, but it is the lead herb in Huangqi Jianzhong Tang and in Bu Zhong Yi Qi Tang, both of which are used for digestive complaints in the tradition.

In the traditions

Traditional Chinese medicine (about TCM)

In the standard English materia medica, huang qi is sweet and slightly warm and enters the spleen and lung channels; its listed actions are strengthening the spleen, raising what the tradition calls the clear yang qi, supporting the defensive qi at the body’s surface, promoting urination and expelling pus. For the gut, the texts use it for what they call spleen qi deficiency: poor appetite, tiredness after eating, loose stools, and a feeling of sinking or prolapse. In Huangqi Jianzhong Tang it sits on top of the Xiao Jian Zhong Tang base (peony, cinnamon twig, licorice, ginger, jujube and maltose) for what the tradition describes as cold and weakness in the middle with abdominal pain. Spleen qi deficiency and the other pattern names here belong to the tradition’s diagnostic language and do not describe measured physiology.

What the plant contains

A review in Phytotherapy Research counted more than 100 compounds in the root, including flavonoids, saponins (the astragalosides), polysaccharides and amino acids. The review summarizes laboratory reports of immune-stimulating, antioxidant and other activities for the root’s compounds. In one rat study of experimental colitis, astragalus polysaccharide at 800 mg per kg reduced markers of neutrophil extracellular traps and eased the colitis. That is animal evidence, not a finding in people.

What has been tested in people

We could not find a randomized trial of astragalus root on its own with a gut outcome. The US National Center for Complementary and Integrative Health states that there is not sufficient reliable evidence to know whether astragalus is useful for any health condition, and its gut-specific data are all on formulas that contain it.

The closest is Huangqi Jianzhong decoction, an astragalus-led formula. A meta-analysis of 13 trials with 1,269 participants who had chronic atrophic gastritis found a higher total effective rate than control treatments (RR 1.24, 95% CI 1.18 to 1.30), a higher Helicobacter pylori clearance rate (RR 1.20, 1.05 to 1.38) and lower recurrence (RR 0.15, 0.04 to 0.66), with no difference in adverse reactions (RR 1.07, 0.53 to 2.17). The authors themselves describe the scientific evidence behind the formula as limited.

A second review looked at herbal formulas added to chemotherapy for colorectal cancer. Across 22 trials with 1,995 patients, formulas reduced chemotherapy-related digestive toxicity overall (RR 0.78, 0.72 to 0.84), but the effect was not significant in the trials that were double-blind. Astragalus, atractylodes, codonopsis, licorice and tangerine peel were the five herbs that stood out in a sensitivity analysis; that is an association across mixed formulas and says nothing about astragalus alone.

Not tested: astragalus alone versus placebo for any digestive symptom, a standardized dose, or use in irritable bowel syndrome or ulcerative colitis in people.

StudyDoseWhat it found
Meta-analysis of 13 trials, 1,269 people with chronic atrophic gastritis (Huangqi Jianzhong decoction, a formula) PMID 37727729Decoction; doses varied by trialTotal effective rate RR 1.24 (95% CI 1.18 to 1.30); H. pylori clearance RR 1.20; adverse reactions RR 1.07 (0.53 to 2.17)
Meta-analysis of 22 trials, 1,995 colorectal cancer patients on chemotherapy (mixed herbal formulas, several containing astragalus) PMID 33869014Various formulasDigestive toxicity RR 0.78 (0.72 to 0.84); not significant in double-blind trials
Animal study: TNBS colitis in rats given astragalus polysaccharide (not a human trial) PMID 42575036200, 400 or 800 mg per kg800 mg per kg eased colitis and reduced neutrophil trap markers

Doses used in trials and traditional preparations

No gut trial of the root alone gives a dose. The Huangqi Jianzhong trials in the meta-analysis used the formula as a water decoction, and the dose differed from trial to trial. In the traditional preparation the sliced root is simmered in water with the other herbs of the formula and the strained liquid is drunk. The US National Center for Complementary and Integrative Health reports that doses up to 60 grams a day for up to 4 months produced no apparent adverse effects in the studies it reviewed, which is a safety statement and not a trial dose for any digestive symptom.

Treat these figures as a record of what was studied. Whether any amount of astragalus suits a particular person is a question for a clinician or pharmacist who knows their history.

Safety

The US National Center for Complementary and Integrative Health says astragalus may be safe when taken by mouth, adds that a thorough safety evaluation has not been done, and reports no apparent adverse effects at up to 60 grams a day for as long as 4 months. It says little is known about use in pregnancy or breastfeeding, that animal research suggests the root can be toxic to the fetus, and that astragalus might worsen autoimmune disease. On product quality, a survey of 334 raw Chinese herb samples from 126 species found at least one of five heavy metals in every sample and more contamination in wild-collected plants than in cultivated ones; the authors judged only 3 samples (1 percent) likely to add to background exposure at expected intakes. It is a survey of raw herbs in general and not of astragalus products.

Drug interactions

The US National Center for Complementary and Integrative Health states that astragalus may interact with medicines that suppress the immune system, and advises talking with a health care provider before combining it with any medicine. We could find no controlled interaction study in people, so the statement rests on caution about the herb’s reported immune effects. Astragalus is also described as possibly worsening autoimmune disease, which is why the same page tells people with those conditions to avoid it.

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Related herbs

TCM Codonopsis Codonopsis pilosula TCM Atractylodes Atractylodes macrocephala (bai zhu); A. lancea (cang zhu) TCM Ginseng Panax ginseng TCM Jujube Ziziphus jujuba

Common questions

Is astragalus used for digestion?

In Chinese medicine, yes: the texts list it for loose stools, tiredness after eating and poor appetite, which they group as spleen qi deficiency. In human research, the digestive data are on formulas that contain it, not on the root alone.

What is Huangqi Jianzhong Tang?

It is a classical formula that adds astragalus to a peony, cinnamon, licorice, ginger and jujube base. A meta-analysis of 13 trials in chronic atrophic gastritis found a total effective rate of RR 1.24, with the authors noting the evidence is limited.

Does astragalus have a Western research history for the gut?

Mostly laboratory work. A rat colitis study reported that astragalus polysaccharide eased inflammation, but we could not find a human trial of the root or its extracts for digestive symptoms.

Is astragalus safe with immune-suppressing medicines?

The US National Center for Complementary and Integrative Health says it may interact with medicines that suppress the immune system. We could not find a controlled study, so the statement rests on mechanism and caution.

Is astragalus the same as the astragalus in some supplements?

Some supplements sell extracts rather than the sliced root, which is a different preparation from the root simmered in a decoction. The formula trials above used the traditional decoction or granule formula, not these extracts.

Sources