Codonopsis: Medicine and Food

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Background: the herb and its constituents

Codonopsis refers to the roots of Codonopsis pilosula, utilized primarily as a substitute for ginseng (Panax ginseng). The botanical name derives from the plant’s bell-like flowers and the hairy character of its young growing parts. The Chinese name given to this herb, dangshen, indicates that it was deemed a ginseng-like plant (ginseng is renshen) from the Shandang region of Shanxi Province, which had been the principal source for ginseng in ancient times. It has been argued that the ginseng plant of ancient texts was actually codonopsis, rather than Panax ginseng, though the botanical source materials are difficult to trace back historically. Codonopsis didn’t appear in any of the herbals prior to the Qing Dynasty; it was first mentioned in the Bencao Congxin (by Wu Yiluo; 1751) and in the Bencao Gangmu Shiyi (by Zhao Xuemin; 1765). Though the genus Codonopsis originates in East Asia and is found growing wild, the modern supply of the medicinal plant comes from cultivation. The roots are harvested in autumn after three years growth; they have a mild, sweet taste and are used in some Chinese food therapy recipes; for example, chicken soup may be prepared with codonopsis, astragalus, lotus seed, lycium fruit, and other mild herbs to make a good tasting qi tonic. In Korea, the root of the related plant Codonopsis lanceolata is called todok; it is seasoned with salt and hot peppers, and used as a food (see sample recipe in the appendix).

After the Chinese Revolution of 1949, codonopsis became the standard replacement for ginseng in nearly all traditional herb medicine formulas. Ginseng, cultivated for centuries in northeastern China with great difficulty, was reserved for export. Chinese doctors came to think of codonopsis as a milder version of ginseng and spoke of using at least three times the dosage in order to get about the same potency. For decoctions, this meant replacing 3-10 grams of ginseng with 9-30 grams of codonopsis. In Oriental Materia Medica (1), it is noted that the dosage range for codonopsis in prescription is 12-30 grams/day. For making pills, there was rarely the option to get so much more codonopsis into a formulation that would formerly have called for ginseng (since the high codonopsis proportion would lead to substantially reducing the quantity of other ingredients), so it was often substituted one to one for ginseng and assumed to have little contribution to the effect of the formula. Patent medicines produced in China during the latter part of the 20^th century had codonopsis in place of ginseng even if ginseng was still indicated as an ingredient on the label. Many manufacturers have simply continued this practice, despite the fact that ginseng is now more readily available; there remains a dramatic price difference between ginseng and codonopsis (more than 10:1).

Little is known about the active components of codonopsis. Some chemical substances have been isolated; one can find a long listing in Chinese Materia Medica: Chemistry, Pharmacology, and Applications (2), but their quantitative analysis remains to be undertaken, so that it is not possible to know if they contribute significant activity. It has been stated that the herb contains saponins (e.g., codonoposides), alkaloids, and polysaccharides, but few of these components have been identified. Thus, for example, the only alkaloiddescribed is perlolyrine (a β-carboline alkaloid; see general structure left); its function, if any, is unknown. Saponins are most likely the primary active component; the plant family to which codonopsis belongs, the Campanulaceae, yields other Chinese medicinal roots, including adenophora (nanshashen) and platycodon (jiegeng), which have saponins that are believed to be the principle ones conferring their therapeutic actions. Codonopsis containspolysaccharides, at about 1% of the dried weight of the root, but it is not known if these are medicinally active.

Codonopsis versus Ginseng

A lengthy explanation of the difference between ginseng and codonopsis is offered in the book Chinese Herbal Medicines: Comparisons and Characteristics (3), as follows:

Ginseng is the most important herb for tonifying the qi. It can tonify the original qi, therefore it is able to rescue collapsed yang. It can also strongly tonify the spleen qi, which is considered as the foundation of life and the source of qi and blood. However, although ginseng is an excellent herb for tonifying the qi and promoting the functions of all the internal organs, it is very expensive if good quality products are required; therefore, it is only used in severe cases. In most cases of qi deficiency, and especially in chronic disorders, a large dosage of codonopsis is often used as an effective substitute for ginseng. Codonopsis is sweet, neutral, and enters the spleen and lung meridians. However, since it does not enter the kidney meridian, it has no function in tonifying the original qi and so cannot be used in critical conditions. In acute yang collapse condition, therefore, ginseng must be used. However, codonopsis is effective for tonifying the spleen qi and the lung qi, and its action is much gentler than that of ginseng. The strong point of this herb is that it is not heavy and sticky, it does not generate heat and dryness in the body, and so it is more suitable for many chronic diseases with spleen qi and lung qi deficiency. It can also generate the yin and body fluids, so is also used for deficiency of both qi and yin. In addition, a large dosage of codonopsis (i.e., at least six times the dosage of ginseng) can be used as a substitute for ginseng in treating severe deficiency of the spleen qi and lung qi.

In the Advanced Textbook of Traditional Chinese Medicine and Pharmacology (4), little is said about codonopsis, but it is indicated as a substitute for ginseng with the precaution that its “ability to replenish qi is much weaker....so in critical cases of collapse [ginseng] should be applied.” Jiao Shude, an herb specialist, has described what one should do in such cases if ginseng is not available (5): “Use 30–50 grams of codonopsis with 6–9 grams of aconite, and 15–30 grams of white atractylodes; decoct and administer quickly....” Here, the large amount of codonopsis serves as the primary substitute for ginseng (in emergency cases, ginseng is utilized in doses of 9–30 grams for a single dose), while white atractylodes adds its qi boosting properties and aconite takes the role of providing for ginseng’s yang restoring effect. Ginseng is itself supplemented by these herbs in some cases, such as in the well-known Zhenwu Tang (Vitality Combination), which has been used for cardiac insufficiency.

One of the recent developments in China is making pills with the concentrated extract of two mild qi tonic herbs: codonopsis plus astragalus, typically called Shen Qi Wan (Dangshen plus Huangqi Pills, not to be confused with Jin Gui Shen Qi Wan, the Rehmannia Eight Formula). These are often used as a type of “recovery pill” to aid those who are weakened by disease, surgery or other medical therapy, blood loss or other injury, or childbirth (6). Via the mechanism of tonifying the spleen qi and raising sinking qi (a property attributed to astragalus), these pills are thought to help one return to normality. By focusing on only the two ingredients, one can consume a substantial dosage of these mild herbs, though the number of pills to be taken may be large, depending upon their size. For the typical “tea pills,” doses of 8–12 pills each time, three times daily, are recommended, with 12 pills per day the more suitable amount. To get a dose equivalent to 30 grams of each herb—using the 10:1 extract product most often produced—one would need to take 6 grams of the extract. If only a small amount of binding agent is used to make the product (e.g., about 5%), with Chinese tea pills usually being 175 mg total weight, 36 pills is about right for a daily dose of the two herbs (12 pills/dose x three doses/day x 175 mg/pill = 6.3 grams of finished product per day; 6 grams of extract and 0.3 grams of binder). One can use smaller amounts of the pills for less critical cases (which might be treated over a long period). Note: ITM produced a version of Shen Qi Wan called Astragalus Extract Tablets, with 75% astragalus and 25% codonopsis (rather than equal parts), and 525 mg of the extract in one tablet; 12 tablets per day provides 6.3 grams of the extract.

An example of a modern decoction formula using codonopsis is presented in a recent medical report (7) that described treatment of severe uterine bleeding associated with menopausal hormone imbalance. The large formulation (which could be modified by adding additional herbs as needed for particular syndromes) included 30 grams each of codonopsis, astragalus, and cornus fruit; 15 grams each of psoralea and fried white peony; 10 grams each of white atractylodes, dipsacus, agrimony, carbonized schizonepeta, and sepia bone; plus 6 grams each of cimicifuga and baked licorice. The concept of this formula’s action, aside from the direct action of hemostatic herbs, is to tonify and lift the original qi (with codonopsis, atractylodes, baked licorice, astragalus, and cimicifuga taking that role).

Advice for Using Codonopsis

To make best use this mild-acting herb, the following should be considered:

In making a decoction, use 9–30 grams codonopsis for most applications; 30 grams is utilized for conditions in which prompt results are considered important.
In using pills, such as Shen Qi Wan, consume about 6 grams of the pills each day if prompt effects are required; for pills made with a more complex formulation and with codonopsis as a key ingredient, even higher doses may be necessary.
Since ginseng is readily available in the West, use ginseng rather than codonopsis in cases where there is severe deficiency, especially for “collapse” of original qi and yang. Also, use ginseng in most formulations where the amount of herb to be used must be limited (as in many complex formulas in pill, capsule, or tablet form), because ginseng can usually be employed at lower dosages.
When a patient is concerned about the effects of ginseng (e.g., is worried about adverse reactions), codonopsis can be substituted, but attention should be given to its dosage; the effect of codonopsis may be improved by incorporating white atractylodes (baizhu) and aconite (fuzi) in the formulation.

Chinese doctors have concluded that codonopsis is especially useful in cases of weak spleen qi leading to loose stool and diarrhea or to other instances of descending qi, and for cases of blood deficiency that may be secondary to qi deficiency. Thus, traditional formulas for restoring the spleen qi (e.g., Renshen Yangrong Tang—Ginseng Nutritive Combination; Guipi Tang—Ginseng and Longan Combination; and Buzhong Yiqi Tang—Ginseng and Astragalus Combination) might be made with codonopsis instead of ginseng and retain good effects. In the three formulations mentioned, astragalus, atractylodes, tang-kuei, and citrus are included. In particular, astragalus may be an important adjunct to codonopsis in getting the desired improvements in spleen qi. Astragalus has saponins and polysaccharides among its active component to complement the similar ingredients present in codonopsis.

REFERENCES

Hsu HY, et al., Oriental Materia Medica: A Concise Guide, 1986 Oriental Healing Arts Institute, Long Beach, CA.
Zhu YP, Chinese Materia Medica: Chemistry, Pharmacology, and Applications, 1998 Harwood Academic Publishers, Amsterdam.
Yang Yifan (2002), Chinese Herbal Medicines Comparisons and Characteristics, Churchill Livingstone, London.
State Administration of Traditional Chinese Medicine, Advanced Textbook on Traditional Chinese Medicine and Pharmacology, (vol. 2), 1995 New World Press, Beijing.
Jiao Shude, Ten Lectures on the use of Medicinals, 2003 Paradigm Publications, Brookline, MA.
Fratkin JP, Chinese Herbal Patent Medicine: The Clinical Desk Reference, 2001 Shya Publications, Boulder, CO.
Liu Xianming (2007), TCM treatment for severe climacteric dysfunctional uterine bleeding—a report of 43 cases, Journal of Traditional Chinese Medicine; 27(1): 46–48.

Appendix: Codonopsis as food and beverage

A popular recipe in Korea is Broiled Todok (Todok Kui), which is made with roots of Codonopsis lanceolata (known as todok) commonly found in Korean markets. These roots look quite similar to those of ginseng (see photo, right).

Ingredients:

15 Todok roots

2 tablespoons red pepper paste

1/2 tablespoon red pepper powder

2 tablespoons soy sauce

1 tablespoon chopped garlic

2 tablespoons chopped green onion

1 tablespoon sugar

1 tablespoon sesame salt

2 tablespoons sesame oil

Preparation: After soaking and peeling the todok, remove their bitterness by soaking them in salted water; then pat them dry. Slice the todok thinly and pound it flat with a mallet. Mix the red pepper paste with the soy sauce, green onion, garlic, sesame salt and sesame oil. Simmer the mixture until thickened. Broil the todok on a grill and baste it with the red pepper paste and other seasonings as desired.

Codonopsis lanceolata is also made into a beverage wine in Korea, using the roots as a flavoring for saki (rice wine; pictured left). It is described as having a soft, full-bodied taste with unique Codonopsis lanceolata taste and smell. The herb roots are also prepared as a beverage juice (pictured right and below). The promotion of these products is based primarily on their claimed health benefits, attributed to saponin components.

June 2007