Astragalus

Our assessments of evidence for each medical benefit fall into one of these categories:

• Strong evidence: consistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analysesa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results
• Good evidence: significant effects in one large or several mid-sized and well-designed clinical studies ( randomized controlled trialsa study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects with an appropriate placebo or other strong comparison control or observational studies that control for confounds)
• Modest evidence: significant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies), or several small studies aggregated into a meta-analysis
• Preliminary evidence: significant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect
• Weak evidence: one or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects
• Insufficient evidence: preclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example)

Learn more about how we research and rate therapies and practices in How We Rate Therapies ›

Bone marrow suppression:

• Lower rates of bone marrow suppression during platinum-based chemotherapy among people with advanced non-small cell lung cancer treated with astragalus injection compared to chemotherapy alone in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 11 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects of low quality²¹Cao A, He H et al. Evidence of Astragalus injection combined platinum-based chemotherapy in advanced nonsmall cell lung cancer patients: a systematic review and meta-analysis. Medicine (Baltimore). 2019 Mar;98(11):e14798.

Leukopenia:

• No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on incidence of leukopenia during standard Western medicine among people with non-small cell lung cancer treated with injected astragalus (Huangqi injection) compared to Western medicine alone in a meta-analysis of 3 RCTs²²Peng C, Chen J et al. Comparative efficacy of various CHIs combined with western medicine for non-small cell lung cancer: a Bayesian network meta-analysis of randomized controlled trials. Frontiers in Pharmacology. 2022 Nov 10;13:1037620.
• Lower incidence of leukopenia among people with stomach cancer treated with FOLFOX regimen and astragalus injection compared to FOLFOX alone in meta-analyses of 81²³Zhang D, Zheng J et al. Comparative efficacy and safety of Chinese herbal injections combined with the FOLFOX regimen for treating gastric cancer in China: a network meta-analysis. Oncotarget. 2017;8(40):68873-68889. and 38 RCTs of generally insufficient quality²⁴Wang J, Tian J, Ge L, Gan Y, Yang K. Which is the best Chinese herb injection based on the FOLFOX regimen for gastric cancer? A network meta-analysis of randomized controlled trials. Asian Pacific Journal of Cancer Prevention. 2014;15(12):4795-4800.

• Better appetite among people with advanced metastatic cancers (breast, colorectal, head and neck, liver, lung, pancreas, and stomach) treated with intravenous astragalus polysaccharides (PG2) compared to baseline, and with larger effects at a higher dose, in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design²⁵Huang WC, Kuo KT et al. Astragalus polysaccharide (PG2) ameliorates cancer symptom clusters, as well as improves quality of life in patients with metastatic disease, through modulation of the inflammatory cascade. Cancers (Basel). 2019;11(8).

• Less fatigue among people with advanced metastatic cancers (breast, colorectal, head and neck, liver, lung, pancreas, and stomach) treated with intravenous astragalus polysaccharides (PG2) compared to baseline, and with larger effects at a higher dose in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design²⁶Huang WC, Kuo KT et al. Astragalus polysaccharide (PG2) ameliorates cancer symptom clusters, as well as improves quality of life in patients with metastatic disease, through modulation of the inflammatory cascade. Cancers (Basel). 2019;11(8).

• Fewer gastrointestinal adverse events during standard Western medicine among people with NSCLC treated with injected astragalus (Huangqi injection) compared to Western medicine alone in an RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects²⁷Peng C, Chen J et al. Comparative efficacy of various CHIs combined with western medicine for non-small cell lung cancer: a Bayesian network meta-analysis of randomized controlled trials. Frontiers in Pharmacology. 2022 Nov 10;13:1037620.
• Less vomiting during platinum-based chemotherapy among people with stage 3 or 4 non-small cell lung cancer treated with astragalus injection compared to chemotherapy alone in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 5 RCTs of low quality²⁸Cao A, He H et al. Evidence of Astragalus injection combined platinum-based chemotherapy in advanced nonsmall cell lung cancer patients: a systematic review and meta-analysis. Medicine (Baltimore). 2019 Mar;98(11):e14798.
• Less nausea and vomiting and fewer undefined gastrointestinal reactions related to FOLFOX regimen among people with stomach cancer treated with astragalus polysaccharides injections compared to controls in meta-analyses 38 and 81 RCTs of generally insufficient quality²⁹Wang J, Tian J, Ge L, Gan Y, Yang K. Which is the best Chinese herb injection based on the FOLFOX regimen for gastric cancer? A network meta-analysis of randomized controlled trials. Asian Pacific Journal of Cancer Prevention. 2014;15(12):4795-4800; Zhang D, Zheng J et al. Comparative efficacy and safety of Chinese herbal injections combined with the FOLFOX regimen for treating gastric cancer in China: a network meta-analysis. Oncotarget. 2017;8(40):68873-68889.

• Lower incidence of infection after remission-induction chemotherapy among children with acute lymphoblastic leukemia treated with injected astragalus (Huangqi injection) compared to chemotherapy alone in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects³⁰Zhang XJ, Yan M, Liu Y, Wang XM, Nuriding H. [Effects of Huangqi injection on infection factors in children with acute lymphoblastic leukemia]. Zhongguo Dang Dai Er Ke Za Zhi. 2014 Feb;16(2):147-51. Chinese.

• Less pain among people with advanced non-small cell lung cancer treated with vinorelbine and cisplatin and astragalus polysaccharides compared to vinorelbine and cisplatin alone in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects of moderate quality³¹Guo L, Bai SP, Zhao L, Wang XH. Astragalus polysaccharide injection integrated with vinorelbine and cisplatin for patients with advanced non-small cell lung cancer: effects on quality of life and survival. Medical Oncology. 2012 Sep;29(3):1656-62.
• Less pain among people with advanced metastatic cancers (breast, colorectal, head and neck, liver, lung, pancreas, and stomach) treated with intravenous astragalus polysaccharides (PG2) compared to baseline, and with larger effects at a higher dose in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design³²Huang WC, Kuo KT et al. Astragalus polysaccharide (PG2) ameliorates cancer symptom clusters, as well as improves quality of life in patients with metastatic disease, through modulation of the inflammatory cascade. Cancers (Basel). 2019;11(8).

• Higher performance status (Karnofsky Performance Status scores) during platinum-based chemotherapy among people with non-small cell lung cancer treated with astragalus injection compared to chemotherapy alone in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 7 studies of low quality³³Cao A, He H et al. Evidence of Astragalus injection combined platinum-based chemotherapy in advanced nonsmall cell lung cancer patients: a systematic review and meta-analysis. Medicine (Baltimore). 2019 Mar;98(11):e14798.
• Better quality of life and physical function during treatment with vinorelbine and cisplatin among people with stage 3 or 4 non-small cell lung cancer with astragalus polysaccharides integrated compared to controls alone in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects of moderate quality³⁴Guo L, Bai SP, Zhao L, Wang XH. Astragalus polysaccharide injection integrated with vinorelbine and cisplatin for patients with advanced non-small cell lung cancer: effects on quality of life and survival. Medical Oncology. 2012 Sep;29(3):1656-62.
• Greater quality of life (QOL) ratings during chemotherapy treatment among people with advanced non-small cell lung cancer treated with astragalus injections compared to those treated with chemotherapy alone in a small RCT³⁵Zou YH, Liu XM. [Effect of astragalus injection combined with chemotherapy on quality of life in patients with advanced non-small cell lung cancer]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2003 Oct;23(10):733-5
• Better performance status and quality of life during treatment with FOLFOX regimen among people with stomach cancer treated with astragalus polysaccharides injection compared to controls in 81³⁶Zhang D, Zheng J et al. Comparative efficacy and safety of Chinese herbal injections combined with the FOLFOX regimen for treating gastric cancer in China: a network meta-analysis. Oncotarget. 2017;8(40):68873-68889. and 38 RCTs³⁷Wang J, Tian J, Ge L, Gan Y, Yang K. Which is the best Chinese herb injection based on the FOLFOX regimen for gastric cancer? A network meta-analysis of randomized controlled trials. Asian Pacific Journal of Cancer Prevention. 2014;15(12):4795-4800. of generally insufficient quality

• Better sleep among people with advanced metastatic cancers (breast, colorectal, head and neck, liver, lung, pancreas, and stomach) treated with intravenous astragalus polysaccharides (PG2) compared to baseline, and with larger effects at a higher dose in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design³⁸Huang WC, Kuo KT et al. Astragalus polysaccharide (PG2) ameliorates cancer symptom clusters, as well as improves quality of life in patients with metastatic disease, through modulation of the inflammatory cascade. Cancers (Basel). 2019;11(8).

Blood-related side effects

Colorectal cancer: modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of fewer blood-related side effects from chemotherapy among people with colorectal cancer treated with herbal mixtures containing astragalus

• Lower rates of leukopenia among people with advanced colorectal cancer treated with FOLFOX (oxaliplatin, 5-fluorouracil and leucovorin) plus astragalus containing CHI’s (Aidi, Shenqifusheng, or kangai) compared to those treated with FOLFOX alone in a network meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of low-quality studies. Those treated with FOLFOX plus Shenqifuzheng (but not Aidi or kangai) also had lower rates of thrombocytopenia compared to those treated with FOLFOX alone³⁹Ge L, Wang YF et al. Network meta-analysis of Chinese herb injections combined with FOLFOX chemotherapy in the treatment of advanced colorectal cancer. Journal of Clinical Pharmacology and Therapeutics. 2016 Aug;41(4):383-91.
• Fewer adverse reactions including neutropenia (low count of white blood cells called neutrophils), anemia, thrombocytopenia (low count of platelets), and leukopenia (low overall white blood cell count) among people with colorectal cancer treated with chemotherapy and herbal mixtures containing astragalus compared to chemotherapy alone in meta-analyses of 22, 28, and and 4 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects of generally insufficient quality⁴⁰Lin S, An X et al. Meta-analysis of astragalus-containing traditional Chinese medicine combined with chemotherapy for colorectal cancer: efficacy and safety to tumor response. Frontiers in Oncology. 2019;9:749; Huang S, Peng W et al. Kangai injection, a traditional Chinese medicine, improves efficacy and reduces toxicity of chemotherapy in advanced colorectal cancer patients: a systematic review and meta-analysis. Evidence-based Complementary and Alternative Medicine. 2019 Jul 15;2019:8423037; Taixiang W, Munro AJ, Guanjian L. Chinese medical herbs for chemotherapy side effects in colorectal cancer patients. Cochrane Database of Systematic Reviews. 2005;(1):CD004540.
• Lower incidence of neutropenia among people with colorectal cancer treated with oxaliplatin and herbal mixtures containing astragalus compared to chemotherapy alone in a meta-analysis of 32 RCTs⁴¹Chen M, May BH et al. Oxaliplatin-based chemotherapy combined with traditional medicines for neutropenia in colorectal cancer: a meta-analysis of the contributions of specific plants. Critical Reviews in Oncology/Hematology. 2016;105:18–34.

Liver cancer: good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of less leukopenia among people with liver cancer treated with a combination of transcatheter hepatic arterial chemoembolization (TACE) and herbal mixtures containing astragalus

• Less leukopenia among people with liver cancer treated with a combination of transcatheter hepatic arterial chemoembolization (TACE) and herbal mixtures containing astragalus compared to TACE alone in a meta-analysis of 105 RCTs⁴²Zhang D, Wang K et al. Comparative efficacy and safety of Chinese herbal injections combined with transcatheter hepatic arterial chemoembolization in treatment of liver cancer: a Bayesian network meta-analysis. Journal of Traditional Chinese Medicine. 2020;40(2):167-187.

Lung cancer: good evidence of fewer blood-related side effects from chemotherapy among people with lung cancer treated with herbal mixtures containing astragalus, with substantial effect sizes in some studies

• 38% lower incidence of leukopenia related to chemotherapy among people with non-small cell lung cancer treated with herbal injections containing astragalus compared to chemotherapy alone in a meta-analysis of 8 RCTs⁴³Yue A, Guo Y-L et al. Astragalus-based Chinese traditional medicine combined with chemotherapy for non-small-cell lung cancer treatment: meta-analysis of randomized trials. International Journal of Clinical and Experimental Medicine. 2016;9(11):20542-20551.
• Substantially less leukopenia during or after gemcitabine and platinum chemotherapy among people with advanced non-small cell lung cancer treated with Aidi injection compared to chemotherapy alone in a network meta-analysis of 20 low-quality RCTs⁴⁴Li J, Zhu GH, Liu TT, Xu BW, Li J. Comparative efficacy of 10 Chinese herbal injections combined with GP regimen chemotherapy for patients with advanced NSCLC a systematic review and network meta-analysis. Journal of Cancer. 2022 Jan 1;13(2):465-480.
• Lower rates of neutropenia, thrombocytopenia, and anemia among people with advanced NSCLC treated with docetaxel-based chemotherapy plus Aidi Injection compared to those treated with docetaxel-based therapy alone in a meta-analysis of low quality studies⁴⁵Xiao Z, Wang C et al. Clinical Efficacy and Safety of Aidi Injection Plus Docetaxel-Based Chemotherapy in Advanced Nonsmall Cell Lung Cancer: A Meta-Analysis of 36 Randomized Controlled Trials. Evidence-based Complementary and Alternative Medicine. 2018 Jun 11;2018:7918258.
• Substantially lower incidence of side effects including anemia, neutropenia, and thrombocytopenia among people with advanced non-small cell lung cancer treated with platinum-based chemotherapy and a botanical therapy containing astragalus compared to chemotherapy alone in a meta-analysis of 17 RCTs of moderate quality⁴⁶Wang SF, Wang Q et al. Astragalus-containing traditional Chinese medicine, with and without prescription based on syndrome differentiation, combined with chemotherapy for advanced non-small-cell lung cancer: a systemic review and meta-analysis. Current Oncology. 2016 Jun;23(3):e188-95.
• Moderately less myelosuppression and neutropenia during radiation therapy among people with lung cancer treated with Aidi injection compared to controls in a meta-analysis of 16 RCTs⁴⁷Xiao Z, Liang R et al. Can Aidi injection alleviate the toxicity and improve the clinical efficacy of radiotherapy in lung cancer?: A meta-analysis of 16 randomized controlled trials following the PRISMA guidelines. Medicine (Baltimore). 2016 Aug;95(35):e4517.
• Substantially less bone marrow suppression during radiotherapy among people with non-small cell lung cancer treated with Aidi injection compared to controls (assumed radiation alone) in a meta-analysis of 6 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial⁴⁸Zhang H, Jiang H, Hu X, Jia Z. Aidi injection combined with radiation in the treatment of non-small cell lung cancer: A meta-analysis evaluation the efficacy and side effects. Journal of Cancer Research and Therapeutics. 2015 Aug;11 Suppl 1:C118-21.
• Moderately less bone marrow suppression during radiotherapy among people with non-small cell lung cancer treated with Shenqi Fuzheng injection compared to controls in a meta-analysis of 7 controlled studies⁴⁹Jiang H, Zhang H, Hu X, Ma J. A meta-analysis of Shenqi Fuzheng combined with radiation in the treatment of nonsmall cell lung cancer. Journal of Cancer Research and Therapeutics. 2015 Aug;11 Suppl 1:C101-3.

Breathlessness and other lung symptoms

Good evidence of less radiation pneumonitis during radiation therapy among people with lung cancer treated with Aidi injection

• Lower rates of radiation induced lung injuries among people with a thoracic tumor treated with radiation plus astragalus containing herbal formulas compared to those treated with radiation alone or radiation plus non-astragalus containing adjunctive treatments in a meta-analysis of 10 RCTs⁵⁰Pang XM, Cai HH et al. Efficacy of astragalus in the treatment of radiation-induced lung injury based on traditional Chinese medicine: a systematic review and meta-analysis of 25 RCTs. Medicine (Baltimore). 2022 Sep 9;101(36):e30478.
• Moderately less radiation pneumonitis during radiation therapy among people with lung cancer treated with Aidi injection compared to controls in a meta-analysis of 16 RCTs⁵¹Xiao Z, Liang R et al. Can Aidi injection alleviate the toxicity and improve the clinical efficacy of radiotherapy in lung cancer?: A meta-analysis of 16 randomized controlled trials following the PRISMA guidelines. Medicine (Baltimore). 2016 Aug;95(35):e4517.
• Substantially less radiation pneumonia during radiotherapy among people with non-small cell lung cancer treated with Aidi injection compared to controls (assumed radiation alone) in a meta-analysis of 4 controlled trials⁵²Zhang H, Jiang H, Hu X, Jia Z. Aidi injection combined with radiation in the treatment of non-small cell lung cancer: A meta-analysis evaluation the efficacy and side effects. Journal of Cancer Research and Therapeutics. 2015 Aug;11 Suppl 1:C118-21.
• Moderately less radiation pneumonia during radiotherapy among people with non-small cell lung cancer treated with Shenqi Fuzheng injection compared to controls in a meta-analysis of 7 controlled studies⁵³Jiang H, Zhang H, Hu X, Ma J. A meta-analysis of Shenqi Fuzheng combined with radiation in the treatment of nonsmall cell lung cancer. Journal of Cancer Research and Therapeutics. 2015 Aug;11 Suppl 1:C101-3.
• Lower rates of radiation-induced lung injuries among people with a thoracic tumor treated with radiation plus astragalus containing herbal formulas compared to those treated with radiation alone or radiation plus non-astragalus containing adjunctive treatments in a meta-analysis of 10 RCTs⁵⁴Pang XM, Cai HH et al. Efficacy of astragalus in the treatment of radiation-induced lung injury based on traditional Chinese medicine: a systematic review and meta-analysis of 25 RCTs. Medicine (Baltimore). 2022 Sep 9;101(36):e30478.

Changes in appetite

Modest evidence of substantially better appetite during treatment among people with advanced non-small cell lung cancer treated with an herbal mixture containing astragalus

• Substantially better appetite among people with advanced non-small cell lung cancer treated with platinum-based chemotherapy and a botanical therapy containing astragalus compared to chemotherapy alone in a meta-analysis of 17 RCTs of moderate quality⁵⁵Wang SF, Wang Q et al. Astragalus-containing traditional Chinese medicine, with and without prescription based on syndrome differentiation, combined with chemotherapy for advanced non-small-cell lung cancer: a systemic review and meta-analysis. Current Oncology. 2016 Jun;23(3):e188-95.

Fatigue

Modest evidence of substantially less fatigue during chemotherapy among people treated with an herbal mixture containing astragalus

• Improvement in fatigue reported in a questionnaire among people with advanced non-small cell lung cancer treated with platinum based chemotherapy and astragalus polysaccharide (APS) compared to those treated with platinum based chemotherapy alone, despite detecting no difference in grade 3 and 4 fatigue events, in a comparative trial of unknown quality⁵⁶Guo L, Bai SP, Zhao L, Wang XH. Astragalus polysaccharide injection integrated with vinorelbine and cisplatin for patients with advanced non-small cell lung cancer: effects on quality of life and survival. Medical Oncology. 2012 Sep;29(3):1656-62.
• Substantially less fatigue during platinum-based chemotherapy among people with advanced non-small cell lung cancer treated a botanical therapy containing astragalus compared to chemotherapy alone in a meta-analysis of 17 RCTs of moderate quality⁵⁷Wang SF, Wang Q et al. Astragalus-containing traditional Chinese medicine, with and without prescription based on syndrome differentiation, combined with chemotherapy for advanced non-small-cell lung cancer: a systemic review and meta-analysis. Current Oncology. 2016 Jun;23(3):e188-95.

Gastrointestinal symptoms 

Esophagitis

Good evidence of less radiation esophagitis during radiation therapy among people with lung cancer treated with Aidi injection or Shenqi Fuzheng injection, herbal mixtures based on astragalus

• Moderately less radiation esophagitis during radiation therapy among people with lung cancer treated with Aidi injection compared to controls in a meta-analysis of 16 RCTs⁵⁸Xiao Z, Liang R et al. Can Aidi injection alleviate the toxicity and improve the clinical efficacy of radiotherapy in lung cancer?: A meta-analysis of 16 randomized controlled trials following the PRISMA guidelines. Medicine (Baltimore). 2016 Aug;95(35):e4517.
• Substantially less radiation esophagitis during radiotherapy among people with non-small cell lung cancer treated with Aidi injection compared to controls (assumed radiation alone) in a meta-analysis of 6 controlled trials⁵⁹Zhang H, Jiang H, Hu X, Jia Z. Aidi injection combined with radiation in the treatment of non-small cell lung cancer: A meta-analysis evaluation the efficacy and side effects. Journal of Cancer Research and Therapeutics. 2015 Aug;11 Suppl 1:C118-21.
• Moderately less radiation esophagitis during radiotherapy among people with non-small cell lung cancer treated with Shenqi Fuzheng injection compared to controls in a meta-analysis of 7 controlled studies⁶⁰Jiang H, Zhang H, Hu X, Ma J. A meta-analysis of Shenqi Fuzheng combined with radiation in the treatment of nonsmall cell lung cancer. Journal of Cancer Research and Therapeutics. 2015 Aug;11 Suppl 1:C101-3.

Nausea, vomiting, or diarrhea

Chemotherapy as a whole: modest evidence of less chemotherapy-induced nausea and vomiting or diarrhea among people treated with astragalus-based Chinese medicines

• Improvement in nausea and vomiting reported in a questionnaire among people with advanced non-small cell lung cancer treated with vinorelbine and cisplatin (VC) chemotherapy and astragalus polysaccharide (APS) compared to those treated with VC chemotherapy alone, despite detecting no difference in grade 3 and 4 nausea and vomiting events, in a comparative trial of unknown quality⁶¹Guo L, Bai SP, Zhao L, Wang XH. Astragalus polysaccharide injection integrated with vinorelbine and cisplatin for patients with advanced non-small cell lung cancer: effects on quality of life and survival. Medical Oncology. 2012 Sep;29(3):1656-62.
• Lower rates of nausea and vomiting among people with advanced NSCLC treated with gemcitabine and platinum chemotherapy (GP) plus the astragalus containing CHI’s Aidi, Kangai, (but no difference with Shenqifuzheng) compared to those treated with GP alone in a network meta-analysis of low-quality studies⁶²Li J, Zhu GH, Liu TT, Xu BW, Li J. Comparative efficacy of 10 Chinese herbal injections combined with GP regimen chemotherapy for patients with advanced NSCLC a systematic review and network meta-analysis. Journal of Cancer. 2022 Jan 1;13(2):465-480.
• Substantially less nausea and vomiting or diarrhea among people with colorectal cancer treated with chemotherapy and astragalus-based Chinese medicines compared to chemotherapy alone in a meta-analysis of 9 RCTs⁶³Lin S, An X et al. Meta-analysis of astragalus-containing traditional Chinese medicine combined with chemotherapy for colorectal cancer: efficacy and safety to tumor response. Frontiers in Oncology. 2019;9:749.
• Fewer experiences of nausea and vomiting during chemotherapy among people with colorectal cancer treated with Huangqi compounds containing astragalus compared to chemotherapy alone in a meta-analysis of 4 RCTs of low quality⁶⁴Taixiang W, Munro AJ, Guanjian L. Chinese medical herbs for chemotherapy side effects in colorectal cancer patients. Cochrane Database of Systematic Reviews. 2005;(1):CD004540.
• Less nausea and vomiting or diarrhea among people with colorectal cancer treated with chemotherapy and Kangai injection containing astragalus compared to chemotherapy alone in a meta-analysis of 28 RCTs⁶⁵Huang S, Peng W et al. Kangai injection, a traditional Chinese medicine, improves efficacy and reduces toxicity of chemotherapy in advanced colorectal cancer patients: a systematic review and meta-analysis. Evidence-based Complementary and Alternative Medicine. 2019 Jul 15;2019:8423037.

Platinum-based chemotherapy: modest evidence of less nausea and vomiting due to platinum-based chemotherapy among people treated with herbal mixtures containing astragalus

• Moderately less nausea and vomiting due to platinum-based chemotherapy and vinorelbine among people with advanced non-small cell lung cancer with an herbal therapy containing astragalus compared to controls in a meta-analysis of 17 RCTs of moderate quality⁶⁶Wang SF, Wang Q et al. Astragalus-containing traditional Chinese medicine, with and without prescription based on syndrome differentiation, combined with chemotherapy for advanced non-small-cell lung cancer: a systemic review and meta-analysis. Current Oncology. 2016 Jun;23(3):e188-95.
• Less nausea and vomiting and better digestive function among people with colorectal cancer treated with oxaliplatin-based chemotherapy and herbal mixtures containing astragalus compared to controls in a meta-analysis of 27 RCTs of generally insufficient quality⁶⁷Chen MH, May BH, Zhou IW, Zhang AL, Xue CC. Integrative medicine for relief of nausea and vomiting in the treatment of colorectal cancer using oxaliplatin-based chemotherapy: a systematic review and meta-analysis. Phytotherapy Research. 2016;30(5):741–753.

Liver dysfunction

Modest evidence of less liver dysfunction or toxicity related to chemotherapy among people treated with herbal mixtures containing astragalus

• Less liver dysfunction among people with advanced colorectal cancer treated with chemotherapy and Kangai injection (containing ginseng, Astragali radix, and kushen) compared to chemotherapy alone in a meta-analysis of 28 RCTs of generally insufficient quality⁶⁸Huang S, Peng W et al. Kangai injection, a traditional Chinese medicine, improves efficacy and reduces toxicity of chemotherapy in advanced colorectal cancer patients: a systematic review and meta-analysis. Evidence-based Complementary and Alternative Medicine. 2019 Jul 15;2019:8423037.
• Lower rates of hepatotoxicity among people with any type of lung cancer treated with any type of chemotherapy plus Aidi injection compared to those treated with chemotherapy alone in a meta-analysis of 78 RCTs of moderate quality⁶⁹Xiao Z, Jiang Y et al. The Hepatorenal Toxicity and Tumor Response of Chemotherapy With or Without Aidi Injection in Advanced Lung Cancer: A Meta-Analysis of 80 Randomized Controlled Trials. Clinical Therapeutics. 2020 Mar;42(3):515-543.e31.

Kidney damage

Modest evidence of less kidney damage among people with any type of lung cancer treated with any type of chemotherapy plus Aidi injection

• Lower rates of nephrotoxicity among people with any type of lung cancer treated with any type of chemotherapy plus Aidi injection compared to those treated with chemotherapy alone in a meta-analysis of 58 RCTs of moderate quality⁷⁰Xiao Z, Jiang Y, et al. The Hepatorenal Toxicity and Tumor Response of Chemotherapy With or Without Aidi Injection in Advanced Lung Cancer: A Meta-Analysis of 80 Randomized Controlled Trials. Clinical Therapeutics. 2020 Mar;42(3):515-543.e31.

Neurological symptoms

Good evidence of less chemotherapy-induced neurotoxicity among people treated with herbal mixtures containing astragalus

• Reduced incidence of grades I-IV neurotoxicity during treatment with oxaliplatin containing chemotherapy among people treated with astragalus injections or astragalus containing CHI’s (with the exception of Kangai) compared to those treated with oxaliplatin containing chemotherapy alone in a network meta-analysis of low-quality studies⁷¹Chen ZY, Liu Y, Wei Y, Deng LY, Zhang Q. Efficacy of traditional Chinese medicine injection in preventing oxaliplatin-induced peripheral neurotoxicity: an analysis of evidence from 3598 patients. Evidence-based Complementary and Alternative Medicine. 2022 Jul 22;2022:6875253.
• Less peripheral neurotoxicity during oxaliplatin chemotherapy among people treated with  astragalus injection compared to chemotherapy alone in a network meta-analysis of 25 RCTs⁷²Wei X, Zhu L, Wang H, Wang C, Deng Q, Li X. Efficacy of traditional Chinese medicines in preventing oxaliplatin-induced peripheral neurotoxicity in cancer patients: a network meta-analysis. Chinese Herb Med. 2017;9(2):161-168.
• Somewhat lower incidence and severity of chemotherapy-induced peripheral neuropathy (CIPN) and better nerve function and functional performance among people with cancer treated with various herbal mixtures containing astragalus compared to no treatment, but not to Western medications, in a review of 7 systematic reviews of RCTs; one study showed added benefit of an herbal mixture with Western medication⁷³Hao J, Zhu X, Bensoussan A. Effects of nonpharmacological interventions in chemotherapy-induced peripheral neuropathy: an overview of systematic reviews and meta-analyses. Integrative Cancer Therapies. Jan-Dec 2020;19:1534735420945027.
• Lower occurrence of peripheral neuropathy during oxaliplatin treatment among people with cancer treated with herbal mixtures containing astragalus combined with western therapies compared to oxaliplatin alone in a meta-analysis of 15 RCTs⁷⁴Deng B, Jia L, Cheng Z. Radix astragali-based Chinese herbal medicine for oxaliplatin-induced peripheral neuropathy: a systematic review and meta-analysis. Evidence-based Complementary and Alternative Medicine. 2016;2016:2421876.
• Substantially lower occurrence of peripheral neuropathy among people with cancer treated with oxaliplatin and herbal mixtures containing astragalus compared to oxaliplatin alone in a meta-analysis of 15 RCTs⁷⁵Deng B, Jia L, Cheng Z. Radix astragali-based Chinese herbal medicine for oxaliplatin-induced peripheral neuropathy: a systematic review and meta-analysis. Evidence-based Complementary and Alternative Medicine. 2016;2016:2421876.
• Moderately lower occurrence of peripheral neuropathy among people with cancer treated with oxaliplatin, Western medications, and herbal mixtures containing astragalus compared to oxaliplatin and Western medications alone in a small RCT⁷⁶Deng B, Jia L, Cheng Z. Radix astragali-based Chinese herbal medicine for oxaliplatin-induced peripheral neuropathy: a systematic review and meta-analysis. Evidence-based Complementary and Alternative Medicine. 2016;2016:2421876.
• Slightly lower occurrence of peripheral neuropathy among people with cancer treated with oxaliplatin and herbal mixtures containing astragalus compared to oxaliplatin and mecobalamin in a small RCT⁷⁷Deng B, Jia L, Cheng Z. Radix astragali-based Chinese herbal medicine for oxaliplatin-induced peripheral neuropathy: a systematic review and meta-analysis. Evidence-based Complementary and Alternative Medicine. 2016;2016:2421876.
• Less neurotoxicity among people with colorectal cancer treated with chemotherapy and herbal mixtures containing astragalus compared to chemotherapy alone in meta-analyses of 22, 4, and 28 RCTs of generally insufficient quality⁷⁸Lin S, An X et al. Meta-analysis of astragalus-containing traditional Chinese medicine combined with chemotherapy for colorectal cancer: efficacy and safety to tumor response. Frontiers in Oncology. 2019;9:749; Taixiang W, Munro AJ, Guanjian L. Chinese medical herbs for chemotherapy side effects in colorectal cancer patients. Cochrane Database of Systematic Reviews. 2005;(1):CD004540; Huang S, Peng W et al. Kangai injection, a traditional Chinese medicine, improves efficacy and reduces toxicity of chemotherapy in advanced colorectal cancer patients: a systematic review and meta-analysis. Evidence-based Complementary and Alternative Medicine. 2019 Jul 15;2019:8423037.

Quality of life and physical function

Good evidence of better quality of life during chemotherapy or radiotherapy among people treated with herbal medicines containing astragalus

• Improved KPS scores during or after treatment with cyclophosphamide plus 5-flourouracil among people with breast cancer treated with (Aidi, Kangai, Shenqifuzheng) compared to those treated with chemotherapy alone in a network meta-analysis of low-quality studies⁷⁹Liu S, Wang H et al. Comparative efficacy and safety of chinese herbal injections combined with cyclophosphamide and 5-fluorouracil chemotherapies in treatment of breast cancer: a Bayesian network meta-analysis. Frontiers in Pharmacology. 2021 Jan 27;11:572396.
• Better KPS scores among people with advanced CRC treated with FOLFOX plus astragalus containing herbal injections (Aidi, Shenqifuzheng, and Kangai) compared to those treated with FOLFOX alone in a network meta-analysis of low-quality studies⁸⁰Ge L, Wang YF et al. Network meta-analysis of Chinese herb injections combined with FOLFOX chemotherapy in the treatment of advanced colorectal cancer. Journal of Clinical Pharmacology and Therapeutics. 2016 Aug;41(4):383-91.
• Improved KPS scores among people with advanced gastric-cancer treated with platinum based chemotherapy and astragalus containing CHI’s compared to those treated with platinum-based chemotherapy alone in a meta-analysis of 14 RCTs of low quality⁸¹Cheng M, Hu J et al. Efficacy and safety of Astragalus-containing traditional Chinese medicine combined with platinum-based chemotherapy in advanced gastric cancer: a systematic review and meta-analysis. Frontiers in Oncology. 2021 Aug 4;11:632168.
• Improved Karnofsky Performance Status (KPS) among people with CRC treated with chemotherapy plus astragalus based chinese herbal medicines (CHI’s) compared to those treated with chemotherapy alone in a meta-analysis of 6 RCTs of low quality⁸²Lin S, An X et al. Meta-analysis of astragalus-containing traditional chinese medicine combined with chemotherapy for colorectal cancer: efficacy and safety to tumor response. Frontiers in Oncology. 2019 Aug 13;9:749.
• Better Karnofsky performance status (KPS) scores during vinorelbine/cisplatin combination treatment (NP) among people treated astragalus containing CHI’s (with the exception of Kangai injection) compared to those treated with with NP alone in a network meta-analysis of low-quality studies⁸³Ni M, Wang H et al. Investigation on the efficiency of Chinese herbal injections for treating non-small cell lung cancer with vinorelbine and cisplatin based on multidimensional Bayesian network meta-analysis. Frontiers in Pharmacology. 2021 Jan 29;11:631170.
• Better quality of life ratings (possibly using the Karnofsky performance scale) during docetaxel and cisplatin combination therapy (DP) among those treated with astragalus containing CHI’s compared to those treated with DP alone in a network meta-analysis of low-quality studies⁸⁴Wen L, Xie L, Gong F, Zhang S, Xi T. Efficacy and safety of Chinese medicine injections in combination with docetaxel and cisplatin for non-small cell lung cancer: a network meta-analysis. Frontiers in Pharmacology. 2023 Dec 11;14:1277284.
• Better quality of life during chemotherapy among people with breast cancer using Chinese herbal medicines mostly containing Astragalus radix compared to chemotherapy alone in a meta-analysis of 33 RCTs⁸⁵Zhu L, Li L, Li Y, Wang J, Wang Q. Chinese herbal medicine as an adjunctive therapy for breast cancer: a systematic review and meta-analysis. Evidence-based Complementary and Alternative Medicine. 2016;2016:9469276.
• Better quality of life during chemotherapy among people with colorectal cancer, including advanced cancer, treated with herbal mixtures containing astragalus compared to controls in meta-analyses of 22,⁸⁶Lin S, An X et al. Meta-analysis of astragalus-containing traditional Chinese medicine combined with chemotherapy for colorectal cancer: efficacy and safety to tumor response. Frontiers in Oncology. 2019;9:749. 4,⁸⁷Taixiang W, Munro AJ, Guanjian L. Chinese medical herbs for chemotherapy side effects in colorectal cancer patients. Cochrane Database of Systematic Reviews. 2005;(1):CD004540. and 28 RCTs⁸⁸Huang S, Peng W et al. Kangai injection, a traditional Chinese medicine, improves efficacy and reduces toxicity of chemotherapy in advanced colorectal cancer patients: a systematic review and meta-analysis. Evidence-based Complementary and Alternative Medicine. 2019 Jul 15;2019:8423037. of generally insufficient quality
• Substantially better quality of life during radiation therapy among people with lung cancer treated with Aidi injection compared to controls in a meta-analysis of 16 RCTs⁸⁹Xiao Z, Liang R et al. Can Aidi injection alleviate the toxicity and improve the clinical efficacy of radiotherapy in lung cancer?: A meta-analysis of 16 randomized controlled trials following the PRISMA guidelines. Medicine (Baltimore). 2016 Aug;95(35):e4517.
• Substantially higher quality of life during radiotherapy among people with non-small cell lung cancer treated with Aidi injection compared to controls (assumed radiation alone) in a meta-analysis of 4 controlled trials⁹⁰Zhang H, Jiang H, Hu X, Jia Z. Aidi injection combined with radiation in the treatment of non-small cell lung cancer: A meta-analysis evaluation the efficacy and side effects. Journal of Cancer Research and Therapeutics. 2015 Aug;11 Suppl 1:C118-21.

Skin and tissue side effects

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of better outcomes related to capecitabine-associated hand-foot syndrome among people with breast cancer or colorectal cancer treated with an herbal mixture containing astragalus

• Fewer symptoms, less pain, and higher treatment completion rates among people with breast cancer or colorectal cancer and capecitabine-associated hand-foot syndrome treated with an herbal mixture containing astragalus compared to controls in a small RCT with a potentially serious confound⁹¹Yu R, Wu X, Jia L, Lou Y. Effect of Chinese herbal compound LC09 on patients with capecitabine-associated hand-foot syndrome: a randomized, double-blind, and parallel-controlled trial. Integrative Cancer Therapies. Jan-Dec 2020;19:1534735420928466.

Wound healing

Preliminary evidence of less wound seepage after mastectomy among people treated with an herbal mixture containing astragalus

• Less wound seeping (exudate) after mastectomy with San Huang decoction of Radix astragali, Radix et rhizoma rhei, and Rhizoma curcuma longa (3:1:1, 60% astragalus) compared to controls in a small RCT of moderate quality⁹²Zhu ZY, Xue JX et al. Reducing postsurgical exudate in breast cancer patients by using San Huang decoction to ameliorate inflammatory status: a prospective clinical trial. Current Oncology. 2018 Dec;25(6):e507-e515.

Heart function

Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) of better heart function, better 6-minute walking distance and better scores on quality of life among people with chronic heart failure treated with astragalus

• Better heart function grades (left ventricular ejection fraction)—with stronger effects at higher doses—plus better 6-minute walking distance and better scores on quality of life among people with chronic heart failure treated with 2.25 g, 4.5 g, or 7.5 g astragalus granule orally twice a day and 4 mg perindopril tablet once a day for 30 successive days compared to baseline in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design⁹³Yang QY, Lu S, Sun HR. Clinical effect of astragalus granule of different dosages on quality of life in patients with chronic heart failure. Chinese Journal of Integrative Medicine. 2011 Feb;17(2):146-9.

Kidney function

Preliminary evidence of better markers of kidney function among people with diabetic kidney disease treated with astragalus injections

• Reduced albuminuria, proteinuria, and serum creatinine levels among people with diabetic kidney disease treated with astragalus injections and conventional therapies compared to those treated with conventional therapies alone in this meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 66 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects of low quality⁹⁴Zhang L, Shergis JL et al. Astragalus membranaceus (Huang Qi) as adjunctive therapy for diabetic kidney disease: an updated systematic review and meta-analysis. Journal of Ethnopharmacology. 2019 Jul 15;239:111921.