Ling Zhi

Five randomised trials met inclusion criteria. Patients given G. lucidum alongside chemotherapy or radiotherapy were more likely to respond than those on chemo/radiotherapy alone (RR 1.50, 95% CI 0.90 to 2.51), while G. lucidum alone did not produce comparable tumour regression. It raised CD3, CD4 and CD8 percentages by 3.91%, 3.05% and 2.02% respectively, and four studies reported improved quality of life. No trial recorded long-term survival. The reviewers judged the methodological quality of the primary studies generally unsatisfactory and concluded there is not sufficient evidence to use it as a first-line cancer treatment, though it may serve as an adjunct. One study recorded minor side effects (nausea, insomnia) with no significant haematological or hepatological toxicity.

Five trials with 398 participants, most with type 2 diabetes, comparing 1.4 to 3 g per day of G. lucidum with placebo over 12 to 16 weeks. There was no statistically or clinically significant reduction in HbA1c (WMD -0.10%), total cholesterol, LDL cholesterol or BMI, no improvement in fasting plasma glucose, and no difference in blood pressure or triglycerides. Post-prandial glucose results were inconsistent and of unclear clinical significance. Participants on G. lucidum were 1.67 times more likely to report an adverse event, none serious. Risk of bias was low in only one of the five studies. The reviewers concluded the evidence does not support its use for cardiovascular risk factors.

One hundred and thirty-two patients with ICD-10 neurasthenia were randomised to a G. lucidum polysaccharide extract (Ganopoly) 1,800 mg three times daily or placebo for eight weeks; 123 were assessable. The Clinical Global Impression severity score fell 15.5% and the sense of fatigue 28.3% from baseline on Ganopoly versus 4.9% and 20.1% on placebo, and 51.6% versus 24.6% were rated more than minimally improved (p = 0.002). Treatment was well tolerated. This remains the most directly relevant trial to the traditional indication of calming the spirit and tonifying deficiency, though it tests a single proprietary polysaccharide extract rather than the crude herb.

Eighty-eight men over 49 with slight to moderate lower urinary tract symptoms were randomised to a G. lucidum ethanol extract 6 mg once daily or placebo for 12 weeks. Total IPSS fell by 2.1 points, significantly better than placebo (mean difference -1.18 points, 95% CI -1.74 to -0.62, p < 0.0001), but there was no change in quality of life score, peak or mean urinary flow, residual urine, prostate volume, PSA or testosterone. Treatment was well tolerated with no severe adverse effects. The symptom benefit was small and unaccompanied by any objective urodynamic change.

A 47-year-old man presented with headache and abdominal pain after consuming Reishi mushroom powder together with alcohol, and was found to have acute hepatitis with significant transaminitis. He was managed conservatively with N-acetylcysteine and intravenous fluids, and follow-up bloods at two weeks showed complete resolution. The authors note how little is known about the systemic effects of mushroom supplements taken with other substances. The case is reported under the name Ganoderma lingzhi, which is the East Asian taxon now usually separated from the European Ganoderma lucidum sensu stricto, an identity distinction that runs through much of this literature.

Two patients who had taken traditionally boiled Lingzhi without any toxic effect, alongside other therapeutic agents, developed hepatotoxicity one to two months after switching to Lingzhi in powdered form. One survived; the second died of fulminant hepatic failure. The authors call for close monitoring of powdered Lingzhi in particular, especially in combination with other drugs. It is the most serious published harm attributed to this herb and the reason the powdered dose form deserves separate consideration from the decoction.

A case of intraoperative bleeding in a patient who had been taking Ganoderma lucidum supplements before surgery, consistent with the fungus's documented platelet aggregation inhibitors. It is a single case in a low-profile journal and should be weighted accordingly, but it is the clinical counterpart to the well-characterised antiplatelet chemistry and supports stopping the supplement before elective procedures.