Effective Use Of Mild Acting Herbs V. Codonopsis (Dang Shen)
by Subhuti Dharmananda
Codonopsis refers to the roots of Codonopsis pilosula, recognized as a common substitute for ginseng (Panax ginseng). The botanical name derives from the plant’s bell-like flowers and the hairy character of its young growing parts. The Chinese name given to this herb, Dang Shen, indicates that it was considered to be a ginseng-like plant (ginseng is renshen) from the Shan Dang region of Shan Xi Province, which had been the principal source for ginseng in ancient times. Codonopsis didn’t appear in any of the herbals prior to the Qing Dynasty; it was first mentioned in the Ben Cao Cong Xin (by Wu Yiluo; 1751) and in the Bencao Gangmu Shiyi (by Zhao Xuemin 1765). Though codonopsis originates in east Asia and is found growing wild, nearly all the modern supply comes from cultivation. The roots are harvested in autumn after three years growth for use as a medicinal; they have a mild, sweet taste and are used in some Chinese food therapy recipes; for example, chicken soup may be prepared with codonopsis, astragalus, lotus seed, lycium fruit, and other mild herbs to make a good tasting qi tonic. The root of the related plant Codonopsis lanceolata is seasoned with salt and pepper, and used as a food in Korea, called todok.
Figure 1. Leaves and flowers of Codonopsis pilosula.
After the Chinese Revolution of 1949, codonopsis became the standard replacement for ginseng in nearly all traditional herb medicine formulas. Ginseng, cultivated for centuries in north-eastern China with great difficulty, was reserved for export. Chinese doctors came to think of codonopsis as a milder version of ginseng and spoke of using at least three times the dosage in order to get about the same potency. For decoctions, this meant replacing 3-10 grams of ginseng with 9-30 grams of codonopsis. In Oriental Materia Medica (Hsu et. al. 1986), it is noted that the dosage range for codonopsis in prescription is 12-30 grams/day. For making pills, there was rarely the option to get so much more codonopsis into a formulation that would formerly have called for ginseng (since the high codonopsis proportion would lead to substantially reducing the quantity of other ingredients), so it was often substituted one to one for ginseng and assumed to have little contribution to the effect of the formula. Patent medicines produced in China during the latter part of the 20th century had codonopsis in place of ginseng even if ginseng was still indicated as an ingredient on the label. Many manufacturers have simply continued this practice, despite the fact that ginseng is now more readily available; there is a dramatic price difference between ginseng and codonopsis (more than 10:1).
Figure 2. Roots of Codonopsis lanceolata.
Very little is known about the active components of codonopsis. Some chemical substances have been isolated; one can find a long listing in Chinese Materia Medica: Chemistry, Pharmacology, and Applications (Zhu 1998), but their quantitative analysis remains to be undertaken, so that it is not possible to know if they contribute significantly to the effects. It has been stated that the herb contains saponins (e.g., codonoposides), alkaloids, and polysaccharides, but few of these components have been identified.
Thus, for example, the only alkaloid described up to now is perlolyrine (a â-carboline alkaloid; see general structure left); its function, if any, is unknown. Saponins are most likely the primary active component; the plant family to which codonopsis belongs, the Campanulaceae, yields other Chinese root materials, including adenophora (nanshashen) and platycodon (Jie Geng), which have saponin ingredients that are believed to be the principle ones conferring their therapeutic actions. Codonopsis also contains polysaccharides, at about 1% of the dried weight of the root, but it is not known if these are medicinally active.
Figure 3. Structure of â-carbonline alkaloids, such as perlolyrine, the alkaloid identified in codonopsis.
Codonopsis versus Ginseng
A lengthy explanation of the difference between ginseng and codonopsis is offered in the book Chinese Herbal Medicines: Comparisons and Characteristics (Yang 2002), as follows:
Ginseng is the most important herb for tonifying the qi. It can tonify the original qi, therefore it is able to rescue collapsed yang. It can also strongly tonify the spleen qi, which is considered as the foundation of life and the source of qi and blood. However, although ginseng is an excellent herb for tonifying the qi and promoting the functions of all the internal organs, it is very expensive if good quality products are required; therefore, it is only used in severe cases. In most cases of qi deficiency, and especially in chronic disorders, a large dosage of codonopsis is often used as an effective substitute for ginseng. Codonopsis is sweet, neutral, and enters the spleen and lung meridians. However, since it does not enter the kidney meridian, it has no function in tonifying the original qi and so cannot be used in critical conditions. In acute yang collapse condition, therefore, ginseng must be used. However, codonopsis is effective for tonifying the spleen qi and the lung qi, and its action is much gentler than that of ginseng. The strong point of this herb is that it is not heavy and sticky, it does not generate heat and dryness in the body, and so it is more suitable for many chronic diseases with spleen qi and lung qi deficiency. It can also generate the yin and body fluids, so is also used for deficiency of both qi and yin. In addition, a large dosage of codonopsis (i.e., at least six times the dosage of ginseng) can be used as a substitute for ginseng in treating severe deficiency of the spleen qi and lung qi.
In the Advanced Textbook of Traditional Chinese Medicine and Pharmacology (State Administration of Traditional Chinese Medicine 1995), little is said about codonopsis, but it is indicated as a substitute for ginseng with the precaution that its “ability to replenish qi is much weaker....so in critical cases of collapse [ginseng] should be applied.” Jiao Shude, an herb specialist, has described what one should do in such cases if ginseng is not available (Jiao 2003): “Use 30–50 grams of codonopsis with 6–9 grams of aconite, and 15–30 grams of white atractylodes; decoct and administer quickly....” Here, the large amount of codonopsis serves as the primary substitute for ginseng (in emergency cases, ginseng is utilized in doses of 9–30 grams for a single dose), while white atractylodes adds its qi boosting properties and aconite takes the role of providing for ginseng’s yang restoring effect. Ginseng is itself supplemented by these herbs in some cases, such as in the well-known Zhenwu Tang (Vitality Combination), which has been used for cardiac insufficiency.
One of the recent developments in China is making pills with the concentrated extract of two mild qi tonic herbs: codonopsis plus astragalus, typically called Shen Qi Wan (Dang Shen plus Huang Qi Pills). These are often used as a type of “recovery pill” to aid those who are weakened by disease, surgery or other medical therapy, blood loss or other injury, or childbirth (Fratkin 2001). Via the mechanism of tonifying the spleen qi and raising sinking qi (a property attributed to astragalus), these pills are thought to help one return to normality. By focusing on only the two ingredients, one can consume a substantial dosage of these mild herbs, though the number of pills to be taken may be large, depending upon their size. For the typical “tea pills,” doses of 8–12 pills each time, three times daily, are recommended, with 12 pills per day the more suitable amount. To get a dose equivalent to 30 grams of each herb—using the 10:1 extract product most often produced—one would need to take 6 grams of the extract. If only a small amount of binding agent is used to make the product (e.g., about 5%), with Chinese tea pills usually being 175 mg total weight, 36 pills is about right for a daily dose of the two herbs (12 pills/dose x three doses/day x 175 mg/pill = 6.3 grams of finished product per day; 6 grams of extract and 0.3 grams of binder). One can use smaller amounts of the pills for less critical cases (which might be treated over a long period).
An example of a modern decoction formula using codonopsis is presented in a recent medical report (Liu 2007) that described treatment of severe uterine bleeding associated with menopausal hormone imbalance. The large formulation (which could be modified by adding additional herbs as needed for particular syndromes) included 30 grams each of codonopsis, astragalus, and cornus fruit; 15 grams each of psoralea and fried white peony; 10 grams each of white atractylodes, dipsacus, agrimony, carbonized schizonepeta, and sepia bone; plus 6 grams each of cimicifuga and baked liquorice. The concept of this formula’s action, aside from the direct action of hemostatic herbs, is to tonify and lift the original qi (with codonopsis, atractylodes, baked liquorice, astragalus, and cimicifuga taking that role).
Advice for Using Codonopsis
To make best use this mild-acting herb, the following should be considered:
- In making a decoction, use 9–30 grams codonopsis for most applications; 30 grams is utilized for conditions in which prompt results are considered important.
- In using pills, such as Shen Qi Wan, consume about 6 grams of the pills each day if prompt effects are required; for pills made with a more complex formulation with codonopsis as a key ingredient, even higher doses may be necessary.
- Since ginseng is readily available in the West, use ginseng rather than codonopsis in cases where there is severe deficiency, especially for “collapse” of original qi and yang. Also, use ginseng in formulations where the amount of herb to be used must be limited (as in many complex formulas in pill, capsule, or tablet form), because ginseng can usually be employed at lower dosages.
- When a patient is concerned about the effects of ginseng (e.g., is worried about adverse reactions), codonopsis can be substituted, but attention should be given to its dosage; the effect of codonopsis may be improved by incorporating white atractylodes (Bai Zhu) and aconite (Fu Zi) in the formulation.
Chinese doctors have concluded that codonopsis is especially useful in cases of weak spleen qi leading to loose stool and diarrhoea or to other instances of descending qi, and for cases of blood deficiency that may be secondary to qi deficiency. Thus, traditional formulas for restoring the spleen qi (e.g., Ren Shen Yang Rong Tang—Ginseng Nutritive Combination; Gui Pi Tang—Ginseng and Lon Gan Combination; and Bu Zhong Yi Qi Tang—Ginseng and Astragalus Combination) might be made with codonopsis instead of ginseng and retain good effects. In the three formulations mentioned, astragalus, atractylodes, tang-kuei, and citrus are included. In particular, astragalus may be an important adjunct to codonopsis in getting the desired improvements in spleen qi. Astragalus has saponins and polysaccharides among its active component.
Fratkin, J. (2001). Chinese Herbal Patent Medicine: The Clinical Desk Reference. Boulder: Shya Publications.
Hsu, H. et al. (1986). Oriental Materia Medica: A Concise Guide. Long Beach: Oriental Healing Arts Institute.
Jiao, S. (2003). Ten Lectures on the use of Medicinals. Brookline: Paradigm Publications.
Liu, X. (2007). ‘TCM treatment for severe climacteric dysfunctional uterine bleeding—a report of 43 cases’, Journal of Traditional Chinese Medicine; 27(1): 46–48.
State Administration of Traditional Chinese Medicine. (1995). Advanced Textbook on Traditional Chinese Medicine and Pharmacology, (vol. 2). Beijing: New World Press.
Yang, Y. (2002). Chinese Herbal Medicines Comparisons and Characteristics. Edinburgh: Churchill Livingstone.
Zhu, Y. (1998). Chinese Materia Medica: Chemistry, Pharmacology, and Applications. Amsterdam: Harwood Academic Publishers.