Dong Chong Xia Cao
StarOphiocordyceps sinensis (Berk.) G.H. Sung, J.M. Sung, Hywel-Jones & Spatafora
Traditionally used for
- Cough & breathing
- Fertility & vitality
- Energy & fatigue
Cautions & contraindications
- Toxic — professional use only
☯ TCM Properties
Tonifies Kidney Yang; Nourishes Lung Yin; Stops Bleeding; Resolves Phlegm; Stops Cough and Calms Wheezing
Traditional Chinese Uses
Dong Chong Xia Cao (cordyceps) is one of the most precious tonic substances in Chinese medicine — a fungus-caterpillar hybrid that simultaneously supplements Kidney Yang and nourishes Lung Yin, making it uniquely applicable to both deficiency patterns. It is used for chronic cough, wheezing, and respiratory weakness from Lung deficiency; for impotence, spermatorrhea, and lower back weakness from Kidney deficiency; and as a general restorative tonic for fatigue and debility after illness. Its broad tonic application has made it globally famous as an adaptogen and performance herb.
Western Herbalism Properties
Pharmacological Effects
- Immunologic: Natural and cultured C. sinensis enlarged spleen, protected immune organs against cyclophosphamide, activated macrophages; ethanolic crystalline preparation (CS-Cr) raised T-helper cells and Th/Ts ratio in mice; ethanolic extract augmented NK activity in mice and human PBMCs; polysaccharide was immunostimulating.
- Antineoplastic: Methanolic fractions (not cordycepin or polysaccharides) inhibited several tumor cell lines; extracts reduced B16 melanoma lung colonies and prolonged survival in EAC, Meth A and EL4 lymphoma-bearing mice, apparently via immunomodulation.
- Antiarrhythmic: 65% ethanolic extract counteracted aconitine- or BaCl2-induced arrhythmia in rats and raised ouabain arrhythmic dose in guinea pigs; hot water extract negatively inotropic and antiplatelet.
- Hypoglycemic: Crude polysaccharides and neutral polysaccharide CS-F30 (50 mg/kg orally) lowered glucose in normal and diabetic mice without changing insulin; CS-F30 raised hepatic glucokinase/hexokinase and lowered triglycerides and cholesterol.
- Erythropoietic: CS-Cr i.p. in mice increased hematopoietic stem cells and erythroid progenitors (max at 150 mg/kg) and protected them against harringtonine.
- Experimental nephritis: A preparation mainly of the herb, 50 mg/kg orally in rats, prevented passive Heymann nephritis.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 614.
Relationships
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Botanical Description
Ophiocordyceps sinensis (Berk.) G.H. Sung, J.M. Sung, Hywel-Jones & Spatafora (Ophiocordycipitaceae) is an entomopathogenic fungus endemic to the alpine meadows and shrublands of the Tibetan Plateau and adjacent Himalayan ranges between 3000 and 5000 m. Its ascospores infect the subterranean larvae of ghost moths (Thitarodes spp.); mycelium gradually consumes the caterpillar, mummifying it inside its burrow. In late spring a single, slender, dark-brown, club-shaped stroma 4-10 cm long emerges from the head of the dead larva above the soil surface, bearing perithecia near its apex. The intact complex of fungus-plus-host (Dong Chong Xia Cao, literally winter-worm summer-grass) is the medicinal material, used in TCM to tonify kidney yang and lung yin and to consolidate essence.
Active Constituents
Adenosine
Purine nucleosideConcentration: low in wild fruiting bodies; reported around 2.6 mg/g in cultured/fermented mycelium, i.e. considerably higher than in natural material
Adenosine is the marker nucleoside used to standardise Cordyceps drugs and preparations, and acts at adenosine receptors with vasodilatory, negative chronotropic and anti-inflammatory effects. Because content is higher in fermented mycelial products than in wild caterpillar fungus, a nucleoside-standardised extract is not chemically equivalent to the whole wild drug.
Cordycepic acid (D-mannitol)
Sugar alcohol (polyol)Concentration: roughly 6.7-11.7% of the dried drug; mannitol has been reported at about 9.9-11.5% in wild material and at less than half that in cultured mycelium
The bulk small-molecule constituent of the drug, an osmotic polyol rather than a receptor-active compound. Its abundance means a large share of a Cordyceps decoction's dry weight is osmotically active sugar alcohol, and it is a convenient marker for distinguishing wild from cultured material.
Cordyceps polysaccharides (galactomannan-type)
PolysaccharideConcentration: roughly 4.2-10.4% of the dried drug, with cultured mycelium at the upper end of that range
The fraction most consistently linked to the immunomodulatory and antioxidant activity reported for Cordyceps in preclinical work. Polysaccharides are water-extractable, so they are present in decoctions, but they are structurally heterogeneous between wild and cultured material, which limits how far activity data can be transferred between the two.
Ergosterol
SterolConcentration: roughly 4.7-7.1 mg/g of the dried drug
The characteristic fungal membrane sterol, and a useful confirmation that a sample really is fungal biomass rather than a fabricated or largely mineral-filled imitation. It carries no established clinical activity at dietary intakes.
Cordycepin (3'-deoxyadenosine)
Nucleoside analogueConcentration: not detectable; absent from this species
Cordycepin is the compound most often advertised for Cordyceps products, but genome and metabolite work published in 2017 showed that the cordycepin biosynthesis cluster cns1-cns4 is absent from Ophiocordyceps sinensis, which does not make the compound. Cordycepin belongs to Cordyceps militaris, which has been reported to contain roughly 29 to 90 times more of it than wild O. sinensis; a product sold as Dong Chong Xia Cao that assays high for cordycepin should be suspected of being C. militaris or a militaris-fortified blend.
Arsenic (arsenite, arsenate and traces of methylarsonic acid)
Metalloid contaminantConcentration: total arsenic measured at 9.70 ± 0.62 mg/kg in wild Qinghai material (13.47 ± 0.84 mg/kg in the caterpillar body), with about 8.7% of it inorganic and about 64% bioaccessible
Wild caterpillar fungus accumulates arsenic from alpine soils to concentrations well above the 2 mg/kg limit applied to most Chinese herbal drugs, mostly as organoarsenicals but with a measurable inorganic fraction. The same study measured lead at 1.44 ± 0.46 mg/kg, copper at 15.21 ± 1.10 mg/kg, cadmium at 0.11 ± 0.02 mg/kg and mercury at 0.06 ± 0.02 mg/kg. This is a property of genuine wild material, not only of adulterated material, and is the reason long-term high-dose use is regulated in China.
⚠ Drug Interactions
Cyclosporine (ciclosporin A) and other calcineurin inhibitors
In randomised trials in kidney transplant recipients, adding Cordyceps to a cyclosporine-based regimen was associated with significantly lower cyclosporine doses and trough concentrations from about two to twelve months post-transplant, and with less calcineurin-inhibitor nephrotoxicity and hepatotoxicity. A 2015 Cochrane review of five studies (447 participants) and a 2017 meta-analysis of nine studies found this pattern but rated all the included trials at unclear or moderate risk of bias, so the size of the effect is not established.
Clinical note: Do not start or stop Cordyceps in a transplant recipient without telling the transplant team. If it is used, check cyclosporine or tacrolimus trough levels within one to two weeks of any change and again after a month.
Cordyceps militaris sold or substituted as Dong Chong Xia Cao
Caterpillar fungus is one of the most valuable drugs in the world and supply is a small fraction of demand, so substitution is routine. Documented substitutes and adulterants include Cordyceps militaris, Cordyceps gunnii, Cordyceps cicadae, Cordyceps liangshanensis and Ophiocordyceps nutans, as well as conidial fermentation mycelia sold in place of the wild drug. C. militaris carries cordycepin at roughly 29 to 90 times the level of wild O. sinensis and about 7.7-fold the adenosine, so a substituted product is pharmacologically a nucleoside-analogue preparation rather than the classical drug. Species-specific ITS PCR primers, DNA barcoding with high-resolution melting, and HPTLC or LC-MS nucleoside profiling all distinguish the genuine drug from these adulterants.
Clinical note: Buy only from suppliers who can produce a species identification (ITS barcode or validated PCR) for the batch. Treat any product whose label or certificate of analysis boasts a high cordycepin content as not being O. sinensis.
Lead-weighted or heavy-metal-contaminated caterpillar fungus
Because the drug is sold by weight at prices comparable to gold, specimens are deliberately weighted, and lead has been used for this. Two case reports from a blood-lead surveillance programme identified Cordyceps powder containing lead at up to 20,000 ppm; one patient was symptomatic at a blood lead of 130 micrograms/dL and required chelation, the other was asymptomatic at 46 micrograms/dL, and both normalised after stopping the product. Separately, genuine wild material carries high native arsenic (about 9.7 mg/kg total in Qinghai samples), which is why the manufacture and sale of Cordyceps health-food products has been tightly regulated in China since 2016.
Clinical note: Reject unusually heavy, dense or gritty specimens and any powder of unknown provenance. In a patient on long-term Cordyceps who develops anaemia, abdominal pain or neuropathy, check a blood lead level before attributing symptoms elsewhere, and require heavy-metal certificates of analysis for any product used for months at a time.
Immunosuppressive and immunomodulatory therapy generally (azathioprine, mycophenolate, biologic agents)
Cordyceps polysaccharides are immunomodulatory in preclinical models, and trials comparing Cordyceps-based with azathioprine-based maintenance regimens reported comparable rejection rates with fewer infections in the Cordyceps arms, alongside a rise in serum IL-10. The direction of effect in a patient on a modern biologic or antimetabolite has not been studied, and no pharmacokinetic interaction data exist for these agents.
Clinical note: Treat concurrent use as unstudied. Where immunosuppression is the therapeutic goal, do not substitute Cordyceps for a prescribed agent, and monitor for both rejection and infection if it is added.
Conservation and legal status of wild-harvested material
Ophiocordyceps sinensis is assessed as Vulnerable on the IUCN Red List, on the grounds of overharvesting driven by prices at or above that of gold, with 95% of harvesters reporting declining availability and 67% describing current harvesting as unsustainable. It is not listed on any CITES Appendix, because no fungi are currently CITES-listed; the controls on it are national rather than treaty-based. It has been in the Chinese Pharmacopoeia since 1964 and has been listed under China's second class of state protection since 1999, and trade was legalised in Nepal in 2001 while remaining illicit elsewhere in its range.
Clinical note: Where a Kidney-and-Lung tonic effect is the aim, cultivated fermented mycelium preparations are the sustainable option and are what most of the clinical trial evidence actually used. Do not describe this drug to patients as CITES-listed; it is not, though it is a threatened species under national protection in China.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 3–9 g | Daily | — | — | 中国药典 2020 【用法与用量】3～9g。 【注意】久服宜慎。 【性味与归经】甘，平。归肺、肾经。 — Chinese Pharmacopoeia 2020, quoted verbatim; route and cautions preserved. Replaces a cleared category-filler value. |
Evidence Tier
Strong evidence · 9 studiesRecorded studies by study design, strongest design at the top. This is a study-design tier only, not a GRADE rating: it does not weigh risk of bias, consistency or precision.
Systematic review / meta-analysis
5
0 verified · 5 unverified
Show 5 studies
- Cordyceps sinensis (a traditional Chinese medicine) for treating chronic kidney disease
- Cordyceps sinensis (a traditional Chinese medicine) for kidney transplant recipients
- Efficacy of Cordyceps sinensis as an adjunctive treatment in kidney transplant patients: A systematic-review and meta-analysis
- Effectiveness and Safety of Oral Cordyceps sinensis on Stable COPD of GOLD Stages 2–3: Systematic Review and Meta-Analysis
- Use of bailing capsules (cordyceps sinensis) in the treatment of chronic kidney disease: a meta-analysis and network pharmacology
Randomized controlled trial
0
Other clinical trial
0
Observational / case report
1
0 verified · 1 unverified
In vitro / animal
3
0 verified · 3 unverified
Show 3 studies
- Bioaccessibility and risk assessment of heavy metals, and analysis of arsenic speciation in Cordyceps sinensis
- Fungal Cordycepin Biosynthesis Is Coupled with the Production of the Safeguard Molecule Pentostatin
- Detection of Ophiocordyceps sinensis and Its Common Adulterates Using Species-Specific Primers
Other / unclassified
0
Verified: design read from PubMed for a DOI that resolves to the cited paper Unverified: taken from the study's recorded description
Clinical Studies
Cordyceps sinensis (a traditional Chinese medicine) for treating chronic kidney disease
Twenty-two randomised or quasi-randomised trials with 1746 participants. In non-dialysis chronic kidney disease, Cordyceps preparations added to conventional care reduced serum creatinine by 60.76 micromol/L (95% CI -85.82 to -35.71, 14 studies), increased creatinine clearance by 9.22 mL/min (95% CI 3.10 to 15.34, 6 studies) and reduced 24-hour proteinuria by 0.15 g (95% CI -0.24 to -0.05, 4 studies). Risk of bias was high in four studies and unclear in eighteen, and the authors concluded that no definitive conclusion could be drawn because of the low quality of the evidence.
Cordyceps sinensis (a traditional Chinese medicine) for kidney transplant recipients
Five studies (six reports, 447 participants) of Cordyceps as adjuvant immunosuppression after kidney transplantation. Against azathioprine, Cordyceps showed no difference in graft or patient survival but better graft function, possibly fewer acute rejection episodes, and improvement in anaemia, leucopenia and liver function. Cordyceps plus low-dose cyclosporine versus standard-dose cyclosporine showed no difference in survival, graft loss, rejection or allograft function, with low-quality evidence of less calcineurin-inhibitor nephrotoxicity and hepatotoxicity. All studies were at unclear risk of bias and follow-up was three months to one year.
Efficacy of Cordyceps sinensis as an adjunctive treatment in kidney transplant patients: A systematic-review and meta-analysis
Nine randomised trials of natural and fermented Cordyceps preparations after kidney transplantation, all at moderate risk of bias from poor reporting. Cordyceps-based therapy gave acute rejection, graft survival and patient survival comparable to azathioprine-based therapy, with better kidney function and lower rates of hyperuricaemia, hyperlipidaemia, hyperglycaemia and liver injury. Combined with cyclosporine A it produced less treatment-induced nephrotoxicity than cyclosporine A alone, and proteinuria fell significantly at 6 to 12 months. Adverse events were not monitored or poorly documented in most trials.
Effectiveness and Safety of Oral Cordyceps sinensis on Stable COPD of GOLD Stages 2–3: Systematic Review and Meta-Analysis
Fourteen randomised trials with 1238 participants, all conducted in China, using fermented Cordyceps capsules (Bailing, Jinshuibao) in six studies and Cordyceps-containing formulae in eight. Added to conventional treatment, Cordyceps preparations increased FEV1 percent predicted by 6.25% (95% CI 4.51 to 7.99) and the FEV1/FVC ratio by 7.02% (95% CI 5.19 to 8.85), reduced St George's Respiratory Questionnaire scores by 5.87 points for the formulae (95% CI -6.96 to -4.77, exceeding the 4-point clinically meaningful threshold) and reduced annual exacerbations. No study was placebo-controlled or of high methodological quality, sample sizes were at most 90, and no serious adverse events were reported.
Use of bailing capsules (cordyceps sinensis) in the treatment of chronic kidney disease: a meta-analysis and network pharmacology
Meta-analysis of randomised trials of Bailing capsules, a fermented Ophiocordyceps sinensis mycelium preparation, used alone or added to conventional therapy in chronic kidney disease, combined with a network-pharmacology analysis of candidate targets. It is the most recent pooled analysis of this preparation in chronic kidney disease and covers the same body of largely Chinese-language trial literature whose methodological quality earlier Cochrane reviews rated as low.
Lead poisoning caused by contaminated Cordyceps, a Chinese herbal medicine: two case reports
Two cases detected through a laboratory-based blood-lead surveillance programme. One patient had anorexia and anaemia with a blood lead of 130 micrograms/dL; the other was asymptomatic at 46 micrograms/dL. Lead in the implicated Cordyceps powder reached 20,000 ppm. Blood lead normalised after the product was stopped, with chelation in the symptomatic case. This remains the primary documentation of deliberate lead weighting of caterpillar fungus causing clinical poisoning.
Bioaccessibility and risk assessment of heavy metals, and analysis of arsenic speciation in Cordyceps sinensis
Three batches of wild Qinghai material were analysed by ICP-MS with simulated gastrointestinal extraction. Total arsenic averaged 9.70 ± 0.62 mg/kg (13.47 ± 0.84 mg/kg in the caterpillar body), lead 1.44 ± 0.46 mg/kg, copper 15.21 ± 1.10 mg/kg, cadmium 0.11 ± 0.02 mg/kg and mercury 0.06 ± 0.02 mg/kg. Only 8.69% of the arsenic was inorganic in dilute nitric acid extracts and 2.33% in simulated gastrointestinal fluid. Bioaccessibility was 64.46% for arsenic, 40.11% for lead, 81.14% for cadmium, 41.29% for copper and 18.91% for mercury.
Fungal Cordycepin Biosynthesis Is Coupled with the Production of the Safeguard Molecule Pentostatin
Identified a four-gene cluster (cns1-cns4) in Cordyceps militaris that jointly produces cordycepin and the adenosine deaminase inhibitor pentostatin that protects it. Genome surveys found no homologues of these genes in Ophiocordyceps sinensis or related fungi, and cordycepin could not be detected as a product of O. sinensis. This is the direct evidence that cordycepin is not a constituent of Dong Chong Xia Cao and that cordycepin-based claims for the drug are misattributed from C. militaris.
Detection of Ophiocordyceps sinensis and Its Common Adulterates Using Species-Specific Primers
Developed a PCR test for O. sinensis based on a 146-bp segment of the ITS region, short enough to amplify from processed material with fragmented DNA. Primers were designed from 89 samples of O. sinensis and its potential adulterants plus GenBank sequences for 41 Ophiocordyceps and 26 Cordyceps species. The DCF4/DCR4 pair amplified from O. sinensis stromata but not from adulterants, and companion primer pairs were validated for detecting the common adulterants Cordyceps gunnii, Cordyceps cicadae, Cordyceps militaris, Cordyceps liangshanensis and Ophiocordyceps nutans.
⚠ Safety & Contraindications
- Toxic — professional use only
Contraindications
It is not suitable for patients with exterior pathogen.
Source: Xi S, Gong Y. Essentials of Chinese Materia Medica and Medical Formulas. Academic Press/Elsevier, 2017, pp. 344–356.
Side Effects
- Macerate extract is of low toxicity; toxic signs in mice were depression then stimulation, spasm and respiratory inhibition. Large i.v./s.c. doses in rabbits and mice caused rapid respiration and pulse and death from spasm. Boiled extract was nontoxic.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 614.
Historical Texts
Ben Cao Cong Xin
Qing dynasty (Wu Yiluo, 1757)Ben Cao Gang Mu Shi Yi
Qing dynasty (Zhao Xuemin, 1765)References
- Yi Liu, Jihui Wang, Wei Wang, Hanyue Zhang, Xuelan Zhang, Chunchao Han. The Chemical Constituents and Pharmacological Actions of Cordyceps sinensis . Evidence-Based Complementary and Alternative Medicine (2015) [DOI]
- Zhu-Liang Yang. Ophiocordyceps sinensis . The IUCN Red List of Threatened Species (2020)
This information is for educational purposes only and is not intended to replace professional medical advice. Always consult a qualified healthcare provider before using any herbal remedy, especially if you are pregnant, nursing, or taking medications.
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