Related Terms

• 3'-Deoxyadenosine, adenine, adenosine, alkenoic acids, amino acids, aweto, beta-sitosterol, caoor, caterpillar fungus, Chinese caterpillar fungus, chongcao, Clavicipitaceae, cordycepic acid, cordycepin, Cordyceps cicadae, Cordyceps militaris, cordyceps mushroom, Cordyceps nipponica, Cordyceps ophioglossoides, Cordyceps pseudomilitaris, Cordyceps sinensis, Cordyceps sinensis (Berk.) Succ., Cordyceps sinensis mycelium, Cordyceps sinensis Sacc., Cordyceps spp., Cordyceps subsessilis (Tolypocladium inflatum), Cordyceps tuberculata, CordyMax™, Cs4, CS-4, deer fungus parasite, D-mannitol, donchunghacho, dong chong xia cao, dong chong zia cao, dong zhong chang cao, ergosterol, fungus, galactomannan, hsia ts'ao tung ch'uung, Isaria sinclairii, jinshuibao, linoleic acid, manganese, mannitol, mummio, nucleosides, oleic acid, oligosaccharides, phosphorus, polysaccharides, potassium, selenium, semitake, shilajit, Sphaeria sinensis, sterols, summer grass winter worm, summer-plant winter-worm, tochukaso, tryptophan, uracil, uridine, vegetable caterpillar, vegetable worm, vitamin B1, vitamin B2, vitamin E, winter worm summer grass, yarsha gumba, yartsa gunbu, yatsa gunbu, zinc.

• Combination product examples: CUF2 (Astragalus mongholicus Bunge, Cordyceps sinensis Sacc., radix Stemonae, bulbus Fritillariae cirrhosae, and Radix Scutellariae), Fuzheng huayu (semen Persicae, cordyceps, Salviae miltiorrhizae, pollen pini, etc.).

Background

• Cordyceps sinensis is the Cordyceps species most widely used as a dietary supplement. Cordyceps sinensis is a fungus that naturally grows on the back of caterpillars. The Cordyceps fungus replaces the caterpillar tissue, eventually growing on the top of the caterpillar. The remaining structures of the caterpillar along with the fungus are dried and sold as the dietary supplement cordyceps.

• Commonly known as dong chong xia cao (summer-plant, winter-worm) in Chinese, cordyceps has been used as a food supplement and tonic beverage among the rich because of its short supply. Cordyceps is also an ingredient in soups and foods used traditionally in Chinese medicine to help people recover from illness.

• The fungus became popular in 1993 when two female Chinese athletes, who used cordyceps supplements, beat the world records in the track and field competition at the Stuttgart World Championships. The women were drug-tested for any banned substances such as steroids and were negative. Their coach attributed the performance to the cordyceps supplementation.

Scientific Evidence

Tradition/Theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

• Addiction (opiates), adrenal cortex function, Alzheimer's disease, anemia, anti-inflammatory, antimicrobial, antioxidant, antiviral, bone marrow production, circulation (capillary level), cough, diabetes, fatigue, fertility, heart disease, hematopoiesis (formation of blood cells), hemorrhage, high blood pressure, HIV, insecticidal, inhibition of platelet aggregation, lower back pain, malaria, memory, menstruation irregularities, mucilage, nephritis (inflammation of kidneys), neurodegeneration, night sweats, promoting healing, ringing in the ears, senility (weakness), stress, systemic lupus erythematosus (SLE), tonic, tranquilizer, tuberculosis, urinary incontinence (nocturia), vascular problems.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

• The manufacturers of CordyMax® suggest taking two capsules, 2-3 times daily. The traditional suggestion is to include 3-9 grams daily in a hot tea or cooled meal. Up to nine grams daily of fermented cordyceps has been used.

• For anti-aging, three grams of CS-4 extract has been taken by mouth daily for three months.

• For asthma, cordyceps (dong chong xia cao) capsules have been taken by mouth.

• For exercise performance enhancement, three grams of CordyMax® tablets has been taken by mouth daily for up to six weeks. 999 milligrams of CordyMax® has been taken by mouth three times daily for 12 weeks.

• For high cholesterol, 999 milligrams (three 333-milligram capsules) have been taken three times daily by mouth for 4-8 weeks.

• For immune suppression, Cordyceps sinensis mycelia capsules (exact dose unknown), in addition to cyclosporin A and prednisone, have been taken. A dose of one gram of cordyceps three times daily by mouth (Bailing capsule) was taken in combination with prednisone, mycophenolate mofetil, and cyclosporin A for over one year. A Bailing capsule containing two grams of cordyceps has been taken by mouth twice daily for nine months.

• For kidney failure, 3-5 grams of cordyceps daily has been taken by mouth.

• For kidney toxicity, three grams of cordyceps has been taken by mouth daily for 15 days.

• For liver disease, 4.5 grams of cordyceps has been taken by mouth daily.

• For respiratory disorders, Cordyceps CS-4 strain (1,000 milligrams three times daily) has been taken by mouth for 40 days. A dose of three grams daily has been taken by mouth for 2-12 weeks.

• For sexual dysfunction, three capsules (each containing 333 milligrams of CS-4 or 333 milligrams of natural cordyceps) have been taken by mouth three times daily for 40 days.

Children (younger than 18 years)

• There is no proven safe or effective dose for cordyceps in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

• Avoid in individuals with a known allergy or sensitivity to Cordyceps species, their parts, or members of the Clavicipitaceae family, as well as other molds or fungi.

• A drug allergy occurred after an oral dose of cordyceps (five jinshuibao capsules, three times daily) in a 54 year-old male suffering from chronic bronchitis (lung disease). Tightness in the chest, skin rash, wheezing, dizziness, and heart palpitations were reported. The patient improved after being given an antihistamine (allergy medicine).

• Five cases of food allergy to Cordyceps sinensis were reported that showed a cross-reactivity with silkworm.

Side Effects and Warnings

• Cordyceps from known sources is likely safe when used up to three grams daily, based on studies lasting for up to one year. Doses of up to five grams have also been studied.

• Cordyceps may lower blood sugar levels. Caution is advised in people with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.

• Cordyceps may cause low blood pressure. Caution is advised in people taking drugs or herbs and supplements that lower blood pressure.

• Cordyceps may increase the risk of bleeding. Caution is advised in people with bleeding disorders or those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

• Drowsiness or sedation may occur. Use caution if driving or operating heavy machinery.

• Use cautiously in patients with an abnormal heart rate, bleeding disorders, diabetes, heart or lung disorders, high or low blood pressure, hormonal disorders, or intestine or stomach disorders. Use cautiously in children and pregnant and breastfeeding women, due to a lack of safety data.

• Use cautiously in people taking alcohol, sedatives or tranquilizers, agents altering the immune system, agents for abnormal heart rate, agents that affect blood pressure or blood vessel widening, agents that reduce blood clots and platelet aggregation, antidepressants, and hormonal agents.

• Avoid use when cordyceps from an unknown source is used, due to possible contamination with lead, as well as adulteration with other cordyceps species.

• Avoid in individuals with a known allergy or sensitivity to Cordyceps species, their parts, or members of the Clavicipitaceae family, as well as other molds or fungi. Avoid in people with myelogenous-type cancer.

• Cordyceps may also cause amnesia, appetite loss, diarrhea, dizziness, dry mouth, heart palpitations, increased corticosteroid production, increased red blood cell production, increased sex hormone production, inhibited monoamine oxidase type B (interference with depression medication), inhibited platelet activity, lead poisoning, nausea, rash, tightness in the chest, and wheezing.

Pregnancy and Breastfeeding

• There is a lack of sufficient data on the use of cordyceps during pregnancy or lactation. Cordyceps may be possibly unsafe in pregnant women, as it may affect steroid hormone levels.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

• Cordyceps may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

• Cordyceps may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare provider. Medication adjustments may be necessary.

• Cordyceps may lower blood pressure. Caution is advised when using medications that may also lower blood pressure. Patients taking drugs for blood pressure, such as ACE inhibitors, should be monitored closely by a qualified healthcare professional, including a pharmacist.

• Cordyceps may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery.

• Cordyceps may also interact with agents for aging, allergy, asthma, and abnormal heart rate; agents for cancer, depression, inflammation, and malaria; agents for the brain, heart, intestines, lung, skin, and stomach; agents that alter the immune system; agents that reduce blood clots and platelet aggregation; agents that widen blood vessels; agents toxic to the liver or kidneys; alcohol; aminoglycosides (type of antibiotic); antibiotics; athletic performance enhancers; cholesterol-lowering agents; corticosteroids; enalapril; gentamicin; hormonal agents; monoamine oxidase inhibitors (MAOIs; depression medication); sexual performance agents; steroids; and Thymoglobulin® (organ transplant medicine).

Interactions with Herbs and Dietary Supplements

• Cordyceps may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

• Cordyceps may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

• Cordyceps may cause low blood pressure. Caution is advised in people taking herbs or supplements that lower blood pressure.

• Cordyceps may increase the amount of drowsiness caused by some herbs or supplements.

• Cordyceps may also interact with antibacterials; antioxidants; athletic performance enhancers; cholesterol-lowering herbs and supplements; herbs and supplements for aging, allergy, asthma, and abnormal heart rate; herbs and supplements for cancer, depression, inflammation, and malaria; herbs and supplements for the brain, heart, intestines, lung, and stomach; herbs and supplements that alter the immune system; herbs and supplements that reduce blood clots and platelet aggregation; herbs and supplements that widen blood vessels; herbs and supplements toxic to the liver or kidneys; hormonal herbs and supplements; monoamine oxidase inhibitors (MAOIs; depression medication); probiotics; sexual performance herbs and supplements; and steroids.

Author Information

• This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. Chen, S., Li, Z., Krochmal, R., Abrazado, M., Kim, W., and Cooper, C. B. Effect of Cs-4 (Cordyceps sinensis) on exercise performance in healthy older subjects: a double-blind, placebo-controlled trial. J Altern.Complement Med 2010;16(5):585-590. View Abstract

2. Choi, G. S., Shin, Y. S., Kim, J. E., Ye, Y. M., and Park, H. S. Five cases of food allergy to vegetable worm (Cordyceps sinensis) showing cross-reactivity with silkworm pupae. Allergy 2010;65(9):1196-1197. View Abstract

3. Das, S. K., Masuda, M., Sakurai, A., and Sakakibara, M. Medicinal uses of the mushroom Cordyceps militaris: current state and prospects. Fitoterapia 2010;81(8):961-968. View Abstract

4. Ding, C., Tian, P. X., Xue, W., Ding, X., Yan, H., Pan, X., Feng, X., Xiang, H., Hou, J., and Tian, X. Efficacy of Cordyceps sinensis in long term treatment of renal transplant patients. Front Biosci (Elite.Ed) 2011;3:301-307. View Abstract

5. Ding, C. G., Tian, P. X., and Jin, Z. K. [Clinical application and exploration on mechanism of action of Cordyceps sinensis mycelia preparation for renal transplantation recipients]. Zhongguo Zhong.Xi.Yi.Jie.He.Za Zhi. 2009;29(11):975-978. View Abstract

6. Huang, J. C., Li, J. H., and Liu, T. X. [Effect of combined therapy with hypha Cordyceps and ginkgo leaf tablet on micro-inflammation in patients undergoing maintenance hemodialysis]. Zhongguo Zhong.Xi.Yi.Jie.He.Za Zhi. 2008;28(6):502-504. View Abstract

7. Kunwar RM, Nepal BK, Kshhetri HB, et al. Ethnomedicine in Himalaya: a case study from Dolpa, Humla, Jumla and Mustang districts of Nepal. J Ethnobiol Ethnomedicine 2006;2:27. View Abstract

8. Li FH, Liu P, Xiong WG, Xu GF. [Effects of Cordyceps sinensis on dimethylnitrosamine-induced liver fibrosis in rats]. Zhong Xi Yi Jie He Xue Bao 2006;4(5):514-517. View Abstract

9. Li SP, Zhang GH, Zeng Q, et al. Hypoglycemic activity of polysaccharide, with antioxidation, isolated from cultured Cordyceps mycelia. Phytomedicine 2006;13(6):428-433. View Abstract

10. Li, Y., Xue, W. J., Tian, P. X., Ding, X. M., Yan, H., Pan, X. M., and Feng, X. S. Clinical application of Cordyceps sinensis on immunosuppressive therapy in renal transplantation. Transplant.Proc. 2009;41(5):1565-1569. View Abstract

11. Wang NQ, Jiang LD, Zhang XM, et al. [Effect of dongchong xiacao capsule on airway inflammation of asthmatic patients]. Zhongguo Zhong Yao Za Zhi 2007;32(15):1566-1568. View Abstract

12. Wong, E. L., Sung, R. Y., Leung, T. F., Wong, Y. O., Li, A. M., Cheung, K. L., Wong, C. K., Fok, T. F., and Leung, P. C. Randomized, double-blind, placebo-controlled trial of herbal therapy for children with asthma. J Altern.Complement Med 2009;15(10):1091-1097. View Abstract

13. Wu WC, Hsiao JR, Lian YY, et al. The apoptotic effect of cordycepin on human OEC-M1 oral cancer cell line. Cancer Chemother Pharmacol 2007;60(1):103-111. View Abstract

14. Yoo, H. S., Yoon, J., Lee, G. H., Lee, Y. W., and Cho, C. K. Best case series program supportive cases of Cordyceps militaris- and panax notoginseng-based anticancer herbal formula. Integr Cancer Ther 2011;10(4):NP1-NP3. View Abstract

15. Zhang, Z. H., Zhang, W. D., and Yao, K. [Treatment of chronic allograft nephropathy with combination of enalapril and bailing capsule]. Zhongguo Zhong.Xi.Yi.Jie.He.Za Zhi. 2008;28(9):806-809. View Abstract