White atractylodes is a Spleen qi tonic. In TCM, a primary role of the Spleen is to convert the food and drink we consume into energy (qi) and fluids and to transport these around the body. When this organ system is weak, qi becomes depleted and fluid metabolism impeded. This commonly results in fatigue, weakness (particularly in the limbs as these are governed by the Spleen in TCM), diarrhoea, bloating, poor appetite, vomiting and fluid accumulation in the body —  “dampness” — often manifesting as oedema and urinary dysfunction.  

White atractylodes has the ability to strengthen the Spleen, thereby boosting qi production, support digestion, facilitate the proper dissemination of fluids in the body and dry dampness, often via diuresis (increased urine excretion).

It has a long history of treating diarrhoea specific to Spleen qi deficiency, bearing in mind that in TCM one symptom or pathology can have a variety of underlying causes. Spleen qi deficiency-diarrhoea may be differentiated by its nature and accompanying symptoms; frequent loose stools, worse when tired, after exertion and after specific foods (e.g. raw foods that require a robust digestive system to digest them), abdominal distension that is better for pressure and warmth, fatigue, weak limbs and poor appetite. This specific pattern of digestive pathology often presents as inflammatory bowel disease (IBD) and diarrhoea-predominant irritable bowel syndrome, as well as food allergies and sensitivities, candida, coeliac disease, malabsorption syndrome, childhood nutritional impairment and eating disorders. White atractylodes will invariably be used in TCM herbal formulae to address such conditions where Spleen qi xu (deficiency) is at the root.

In TCM, there is a clear and established link between the gut and brain and white atractylodes is a commonly used herb in formulae addressing forgetfulness, poor concentration, anxiety and insomnia with a compromised digestive system at its essence; an ability reflected in modern research findings of its modulating effect on gut microbiota.

It is also used to strengthen the immune system (wei qi) and “stabilise the exterior”, for cases where qi deficiency has compromised the immune system and the correct functioning of the pores of the skin leading to spontaneous sweating.

These are the obvious applications of white atractylodes, however, in clinical practice it is utilised for any condition with spleen qi deficiency at its root which are many and varied; from bloody noses, rheumatism, painful urination, threatened miscarriage and dermatological conditions. 

Modern day applications include cancer support, osteoporosis and obesity with emerging research also suggesting possible benefits for diabetes management and neuroprotection as well as a focus on its anti-inflammatory, anti-tumour and antioxidant potential. (1,2)

White atractylodes is an integral herb in TCM, one that no practitioner would be without. Bitter, sweet and warm in nature, it supports the Earth element; the digestive organs of the Spleen and Stomach which, in TCM, are responsible for the transformation and transportation of food and fluids and are a primary source of qi (energy) production. In traditional Chinese herbal medicine, the bitter flavour has a draining and drying effect, while the sweet flavour, especially when paired with an energetic warmth, is tonifying and harmonising. Such energetic qualities make white atractylodes a wonderful, nourishing support for those with weak digestions and an excess of fluids in the body. Its primary actions of tonifying the Spleen and drying dampness make this herb a great example of a medicine which addresses both the root (Spleen qi deficiency) and branch (dampness) of a pathology.  

The various methods of preparation for this herb can enhance specific properties and actions as needed; raw atractylodes (sheng bai zhu) is best for “drying dampness” and promoting urination, stir-frying (chao bai zhu) enhances its energetic warmth making it better for tonifying the Spleen and qi and frying until blackened (bai zhu tan) enhances its astringent effect making it preferable for stopping diarrhoea.

Atractylodes root was first recorded in the Shen Nong Ben Cao Jing (Classic of the Materia Medica), TCM’s earliest text detailing individual herbs, in the 2nd century CE where A. macrocephala (bai zhu) was not differentiated from other, now distinct, herbs from the same species. It was recorded for use in the treatment of “wind–cold–dampness” arthralgia, muscle necrosis, spasm, deep-rooted ulcer, excessive internal heat and indigestion. It was also suggested that frying it into cakes and consuming it long-term could “prolong life and satisfy hunger”.(3) 

It was not until the Song Dynasty (circa 1100CE) that bai zhu received an entry in its own right in the classical herbal text, Ben Cao Yan Yi (Extended Ideas on Materia Medica).  

As with all TCM herbs, white atractylodes is typically prescribed within a synergistic herbal formula. It is present in countless formulae and perhaps one of the most commonly used herbs in TCM.

Its primary action, to tonify Spleen qi, is an invaluable one for modern times. Overwork, over-thinking, poor eating habits, overconsumption of “damp” (eg. high-sugar, fried or fatty foods) or difficult to digest foods can all lead to a depleted Spleen. This in turn results in qi deficiency and the generation of dampness in the body, leaving us in the all-too-common state of suffering from lowered vitality, foggy-headedness, digestive difficulties, lowered immunity and so on.    

Si Jun Zi Tang (four gentlemen decoction)— comprised of ginseng (ren shen), white atractylodes (bai zhu), poria (fu ling) and licorice (gan cao) — is the classic TCM formula for tonifying Spleen qi and is used widely in clinical practice on its own and combined with other formulas as a tonifying adjunct for a wide variety of conditions with qi deficiency and dampness at their heart. In this formula, as in many, white atractylodes is a deputy herb — meaning that it supports and compliments the actions of the chief herb, in this case ginseng — reinforcing the tonic properties of the chief medicinal while addressing the root and branch of the symptoms by drying dampness.         

Research into the bioactive constituents of white atractylodes in recent decades has revealed pharmacological functions congruent with the traditional uses for this herb, notably its ability to support gastrointestinal and immune function. Sesquiterpenoids — compounds found in A. macrocephala — in particular, have displayed, amongst other effects, anti-inflammatory, immunomodulatory, antiemetic and antioxidant activities. (1,2,4,5) Recent research has also shown ethanol extracts, polysaccharides and volatile oils from this herb help to modulate gut bacteria. (6–9) 

The combination of gut flora balancing, inflammation reduction and immune system modulation may go some way to explain the beneficial effects White atractylodes has for sufferers of inflammatory bowel diseases (IBDs) such as ulcerative colitis. Shen Ling Bai Zhu San (ginseng, poria and atractylodes powder), a popular 10-herb TCM formula named after three of its chief herbs, is the primary formula for Spleen qi deficiency with dampness in the form of diarrhoea and one of the most common prescriptions for chronic diarrhoea, including IBD. While sample sizes have been small, a number of clinical trials have shown that Shen Ling Bai Zhu San can enhance the efficacy of treatment and reduce the recurrency rate of ulcerative colitis, though larger, more rigorous studies are required. (10) This formula is also used in east Asia for post-surgery recovery from colon cancer.

Gastrointestinal

A recent review of 11 pre-clinical studies found that A. macrocephala polysaccharides boost gastrointestinal function, regulate the intestinal microbiota and help to repair gastrointestinal mucosal damage. (11–13) 

Studies suggest the gastroprotective function of these polysaccharides is achieved via the regulation of intestinal flora and related signalling pathways as well as from the production of gastrointestinal hormones and neurotransmitters and inhibition of the oxidative stress response. (8,9)

A 2023 in vivo study of the effect of volatile oil from A. macrocephala found that it alleviated symptoms of colitis and colon damage and positively altered the gut microbiome by increasing beneficial bacteria and decreased potentially harmful bacteria. The authors posited that A. macrocephala volatile oil could serve as a prebiotic for ulcerative colitis sufferers. (7) 

Earlier in vivo studies found that extract of A. macrocephala was more effective than sulfasalazine (a common medicine for IBD in preventing a relapse of colitis and the suppression of inflammation was achieved via the inhibition of macrophage and T-lymphocyte expression (14) and that an ethanolic extract of fried A. macrocephala significantly inhibited weight loss, diarrhoea, pathological changes in colon tissue and, again, significantly inhibited the levels of potentially pathogenic bacteria and increased those of beneficial bacteria. (6)

Pre-clinical studies have also shown that A. macrocephala extracts and preparations benefit IBD and irritable bowel syndrome (IBS) by improving gut motility, improving intestinal hypersensitivity and having a protective effect on intestinal epithelial cells. (14–16)  

In a small-scale randomised control trial pilot, Shen Ling Bai Zhu San — one of the most common TCM formulas for ulcerative colitis, irritable bowel syndrome and other digestive complaints, containing A. macrocephala as a lead herb — improved symptoms of diarrhoea-predominant IBS (abdominal pain and frequency and stool form) when given alongside the antispasmodic drug, otilonium bromide, as compared to taking the drug alone and with fewer adverse events. (17)   

Immune

Polysaccharides from A. macrocephala have been studied at length in pre-clinical studies for their immunomodulatory effects and the potential mechanisms for these. A 2022 review of 12 such studies concluded that A. macrocephala polysaccharides can activate the immune system by binding with macrophage-specific cell receptors, stimulating lymphocyte, cytokine and antibody production, influencing the related messenger signalling pathways, increasing the weight of the spleen and thymus and inhibiting damage to immune organs. (9)

Anti-tumour

A 2019 in vitro study found that essential oils from crude A. macrocephala and atractylone (a sesquiterpenoid compound from the essential oil) exhibited significant anti-tumor activity with human gastric, liver and colon cancer cells (16). An earlier study investigating the cytoxic potential of sesquiterpenoids (atractylon and atractylenolides I, II, and III) from A. macrocephala, found that atractylone displayed significant cytotoxic abilities with human and mouse leukemia cells in a dose-dependent manner and with no impact on healthy cell lines. Atractylenolides I also induced apoptosis (cell death) on these cell lines at a higher dosage and longer duration. (18)

Anti-inflammatory

In an early in vitro study, sesquiterpenoids found in A. macrocephala (atractylenolides I and III) decreased tumour necrosis factor alpha (TNF-α — an inflammatory chemical messenger (cytokine)) levels in activated macrophages (immune cells involved in the activation and sustainment of inflammation) in a dose-dependent manner by inhibiting TNF-α mRNA (a molecule involved in protein synthesis) expression. (19)

A later study also found that three compounds from A. macrocephala (one quinone compound and two polyacetylenes) inhibited the production of nitrous oxide (NO; an inflammatory mediator) and prostaglandin E2 (PE2; another inflammation mediator associated with pain) in a concentration-dependent manner in activated macrophages. (20)

Black atractylodes (A. lancea), or cang zhu in Mandarin, is another common TCM herb from the Atractylodes genus. Once used interchangeably and somewhat similar in function, it is distinct in its properties and applications; it is warm, acrid, bitter, aromatic and has a stronger ability than white atractylodes to “dry dampness” and induce perspiration to alleviate external pathogens.

Grows widely in China (especially Zhejiang, Anhui, Hubei, Hunan, Jiangxi and Fujian provinces) Korea, Japan and Vietnam in pastures, wastelands, forests and grasslands at altitudes of 600 to 2800 m.

The atractylodes species is not listed on the International Union for Conservation of Nature (IUCN) Red List of Threatened Species.

Atractylodes sesquiterpene lactones (atractylenolides) -I, -II and -III and atractylon, a sesquiterpene compound, are some of the primary biomarkers of quality for A. macrocephala.

• Sow seeds in spring and cover lightly with soil.
• Transplant seedlings the following spring/ early summer to well-drained soil with partial sun.
• Grows best at around 20 degrees but can also grow well at temperatures as low as five degrees and may tolerates sub-zero temperatures. 
• Water regularly, particularly in the early stages of growth.
• Bud removal directs nutrition to the roots.

Atractylodes is typically prepared as a decoction. Learn how to make a decoction.

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