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)

• Less toxicity among people with stage 3B or 4 non-small cell lung cancer treated with paclitaxel-based chemotherapy and Aidi injection (Mylabris phalerata, Radix astragalus, Radix ginseng, and Acanthopanax senticosus) compared to chemotherapy alone in a 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 42 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 effects¹⁸Wang J, Li G et al. Aidi injection plus platinum-based chemotherapy for stage IIIB/IV non-small cell lung cancer: A meta-analysis of 42 RCTs following the PRISMA guidelines. Journal of Ethnopharmacology. 2018 Jul 15;221:137-150.

Colorectal cancer: modest evidence of fewer blood-related side effects from chemotherapy among people with colorectal cancer treated with herbal mixtures containing astragalus

• 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-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 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 quality¹⁹Lin 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 RCTs²⁰Chen 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.
• 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 RCTs²¹Zhang 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

• 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 quality²²Wang 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.
• Lower risk of blood toxicity among people with advanced non-small cell lung cancer treated with chemotherapy and Aidi injection compared to chemotherapy alone in a meta-analysis of 31 RCTs²³Xiao Z, Wang C et al. Clinical efficacy and safety of Aidi injection plus paclitaxel-based chemotherapy for advanced non-small cell lung cancer: A meta-analysis of 31 randomized controlled trials following the PRISMA guidelines. Journal of Ethnopharmacology. 2019 Jan 10;228:110-122.
• Moderately less myelosuppressiona condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets and neutropenia during radiation therapy among people with lung cancer treated with Aidi injection compared to controls in a meta-analysis of 16 RCTs²⁴Xiao 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 trials²⁵Zhang 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 studies²⁶Jiang 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.

Stomach cancer: modest evidence of fewer blood-related side effects from chemotherapy among people with stomach cancer treated with herbal mixtures containing astragalus

• Lower incidence of leukopenia among people with stomach cancer treated with FOLFOX regimen and astragalus compared to FOLFOX alone in meta-analyses of 81 and 38 RCTs of generally insufficient quality²⁷Zhang 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; Wang 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.

• 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-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 17 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 moderate quality²⁸Wang 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.
• Better appetite among people with advanced metastatic cancers, including breast, colorectal, head and neck, liver, lung, pancreas, and stomach, treated with intravenous (IV) astragalus polysaccharides 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 design²⁹Huang WC, Kuo KT, Bamodu OA, 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).

• Substantially less fatigue 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-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 17 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 moderate quality³⁰Wang 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 fatigue among people with advanced metastatic cancers, including breast, colorectal, head and neck, liver, lung, pancreas, and stomach, treated with intravenous (IV) astragalus polysaccharides compared to baseline, and with larger effects at a higher dose in an 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 design³¹Huang WC, Kuo KT, Bamodu OA, 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).

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-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 16 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 effects³²Xiao 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 trials³³Zhang 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 studies³⁴Jiang 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

• 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 RCTs³⁵Lin 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 among people with colorectal cancer treated with chemotherapy and Huangqi compounds containing astragalus compared to chemotherapy alone in a meta-analysis of 4 RCTs of low quality³⁶Taixiang 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 RCTs³⁷Huang 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.

Paclitaxel-based chemotherapy: modest evidence of less paclitaxel-based gastrointestinal toxicity among people with lung cancer treated with Aidi injection

• Less gastrointestinal toxicity among people with stage 3 or 4 non-small cell lung cancer treated with paclitaxel-based chemotherapy and Aidi injection (astragalus, Eleutherococcus senticosus, ginseng, and cantharis) compared to controls in a meta-analysis of 31 RCTs³⁸Xiao Z, Wang C et al. Clinical efficacy and safety of Aidi injection plus paclitaxel-based chemotherapy for advanced non-small cell lung cancer: a meta-analysis of 31 randomized controlled trials following the PRISMA guidelines. Journal of Ethnopharmacology. 2019 Jan 10;228:110-122.

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 quality³⁹Wang 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 quality⁴⁰Chen 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.

FOLFOX regimen: modest evidence of less gastrointestinal toxicity due to FOLFOX regimen among people with stomach cancer treated with astragalus polysaccharides injections

• 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 quality⁴¹Wang 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.

Liver dysfunction

Modest evidence of less liver dysfunction related to chemotherapy among people treated with an herbal mixture 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 quality⁴²Huang 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.
• Less liver injury in people with stage 3 or 4 non-small cell lung cancer treated with paclitaxel-based chemotherapy and Aidi injection (astragalus, Eleutherococcus senticosus, ginseng and cantharis) compared to chemotherapy alone in a meta-analysis of 31 RCTs⁴³Xiao Z, Wang C et al. Clinical efficacy and safety of Aidi injection plus paclitaxel-based chemotherapy for advanced non-small cell lung cancer: A meta-analysis of 31 randomized controlled trials following the PRISMA guidelines. Journal of Ethnopharmacology. 2019 Jan 10;228:110-122.

• Less peripheral neurotoxicity among people treated with oxaliplatin chemotherapy and Huangqi injection containing astragalus compared to chemotherapy alone in a network analysis of 25 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 effects⁴⁴Wei 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 medication⁴⁵Hao 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 among people with cancer treated with oxaliplatin and herbal mixtures containing astragalus combined with western therapies compared to oxaliplatin 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 15 RCTs⁴⁶Deng 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 RCTs⁴⁷Deng 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 neuropathydamage to the peripheral nerves outside the brain and spinal cord among people with cancer treated with oxaliplatin, Western medications, and herbal mixtures containing astragalus compared to oxaliplatin and Western medications alone in a small RCT⁴⁸Deng 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 RCT⁴⁹Deng 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 quality⁵⁰Lin 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.

• 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 quality⁵¹Guo 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, including breast, colorectal, head and neck, liver, lung, pancreas, and stomach, using intravenous (IV) astragalus polysaccharides compared to baseline, and with larger effects at a higher dose in an 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 design⁵²Huang WC, Kuo KT, Bamodu OA, 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).

• 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 RCTs⁵³Zhu 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 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 81⁵⁴Zhang 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 RCTs⁵⁵Wang 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 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 22,⁵⁶Lin 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. 4,⁵⁷Taixiang 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 RCTs⁵⁸Huang 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 treatment with paclitaxel among people with non-small cell lung cancer treated with and Aidi injection (astragalus, Eleutherococcus senticosus, ginseng and cantharis) compared to controls in a meta-analysis of 31 RCTs⁵⁹Xiao Z, Wang C et al. Clinical efficacy and safety of Aidi injection plus paclitaxel-based chemotherapy for advanced non-small cell lung cancer: a meta-analysis of 31 randomized controlled trials following the PRISMA guidelines. Journal of Ethnopharmacology. 2019 Jan 10;228:110-122.
• 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 RCT of moderate quality⁶⁰Guo 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 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 RCTs⁶¹Xiao 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 trials⁶²Zhang 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.

• Better sleep among people with advanced metastatic cancers, including breast, colorectal, head and neck, liver, lung, pancreas, and stomach, treated with intravenous (IV) astragalus polysaccharides compared to baseline, and with larger effects at a higher dose in an 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 design⁶³Huang WC, Kuo KT, Bamodu OA, 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).

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

• 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 RCTs⁶⁴Xiao 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 trials⁶⁵Zhang 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 studies⁶⁶Jiang 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.

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 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 quality⁶⁷Zhu 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.

Preliminary evidence 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 confound⁶⁸Yu 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.

• 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 design⁶⁹Yang 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.