Codonopsis has long been thought of as a deeply nutritive medicine and food in China. It is a herb that raises vital energy or qi’. This means that it deeply nourishes and supports systemic health. In traditional Chinese medicine (TCM), it is used as an anti-ageing medicine that can increase longevity and vitality. It is sometimes referred to as a gentler option to ginseng (Panax ginseng).

Codonopsis is known as a blood tonic in TCM as it nourishes and regenerates the blood, making it excellent for people of all ages. It is also a fantastic herb for those who are in the convalescent stages of illness.

Codonopsis has powerful immunological effects which are best applied for those who are chronically run down, or suffering from fatigue, rather than for use during acute viral illness (for which it is not recommended). It is packed with energy-rich polysaccharides, which are known to have many benefits in the immune system and also in cellular regeneration (1,2).

Codonopsis is one of the top adaptogenic herbs in the materia medica. Adaptogens are herbs that increase the body’s resilience to stress. They protect the body from the negative effects of excess stress hormones and provide support during times of stress.

Codonopsis regulates the hormonal systems associated with the stress response. It also supports digestive health as a prebiotic, as it effectively nourishes the gastrointestinal biota. Codonopsis may be used in the short term for fatigue and burn out symptoms following periods of heightened stress and tension (3,4,5).

Codonopsis is one of the most renowned and widely used traditional Chinese tonic medicines. From a TCM perspective, codonopsis tonifies the Spleen and Lung channels. With this combined action the vital force or qi is replenished.

Energetically, codonopsis is sweet, cooling and damp. It is also a deeply nourishing blood tonic, helping to stimulate blood flow and treat Blood deficiency. It is understood to increase secretions or moisten and soothe dry and inflamed tissues. This is particularly true to its effects in the lungs and throughout the digestive system (6).

TCM has its own unique philosophy and understanding of bodily systems and herbal qualities that has been built up over thousands of years of observation, much of which is now being explored through scientific methods (3,6).

Codonopsis is sweet, neutral, and enters the Spleen and Lung meridians. It is used in cases of qi deficiency where the vital energy is low on a systemic level. Symptoms of qi deficiency include fatigue, shortness of breath, weakness, low energy and low motivation. In qi deficiency the pulse may be weak and the tongue pale or swollen. The skin is often pale and there is a deep coldness in the body. Qi deficiency is seen especially in chronic illness.

A large dose of codonopsis is often used as an effective substitute for Chinese ginseng (Panax ginseng) for qi deficiency. Ginseng has a number of sustainability issues as well as being an expensive choice, therefore codonopsis is a more desirable alternative.

Codonopsis has a long history of medicinal use in China, dating back to the Qing dynasty. It has long been used to strengthen the spleen and tonify the lung meridians, as well as nourish the blood and increase secretions in cases of  dry, inflamed tissues (1).

Endocrine system

Codonopsis is a primary adaptogen. It is a diverse medicine with many different applications, as it helps to regulate endocrine, nervous system, immune, digestive, and cardiovascular function (4). Adaptogens are defined as medicines that enhance the ‘state of nonspecific resistance’ in stress. This effect is due to their effect on a number of neuroendocrine–immune processes. 

The stress protective activity of adaptogens is associated with regulation of homeostasis via several mechanisms linked with the hypothalamic–pituitary–adrenal axis as well as the regulation of key mediators of the stress response (7).

The high levels of polysaccharides in codonopsis play an important role in codonopsis’ effects on the endocrine and immune systems (4).

Nervous system

Codonopsis has been shown to enhance neuronal regeneration in neurodegenerative diseases. A herbalist may also use it as part of an approach for nerve damage and other nervous system disorders (8).

Digestive system

Codonopsis has been found to effectively support gut health. These effects have been linked to three inulin-type fructans found in codonopsis. These have been shown to stimulate the growth of Bifidobacterium longum, a probiotic bacteria. The fructans are also believed to be responsible for codonopsis’ antiulcerogenic activity, through the modulation of antioxidant and anti-inflammatory effects (8).

Metabolism

Codonopsis has a high number of antioxidant compounds, which can mitigate damage from oxidative stress. This makes it an excellent medicine for general cellular health. Antioxidants also aid in the protection and strengthening of the immune system.

As well as supporting systemic health, codonopsis also improves lipid metabolism and reduces blood sugar levels. Codonopsis’ hypoglycemic action is believed to be a result of its polysaccharides and likely the synergistic effect of its other active compounds (4).

Immune system

Codonopsis has a number of different effects on the immune system as a result of its polysaccharides. Polysaccharides are well understood to exert immune moderating actions. 

Codonopsis may be used in combination with other immune moderating herbs and cancer specific interventions as an adjuvant and also as an antimetastatic. Research has confirmed that codonopsis helps to restore immunity postoperatively in patients after chemotherapy (9).

Respiratory system

There is also some support for codonopsis being beneficial for chronic obstructive pulmonary disease (COPD) (4). Herbalists may use codonopsis to improve the condition of the lung tissues, particularly in cases of dryness and inflammation.

A number of studies have been carried out to investigate the medicinal effects of codonopsis and its medicinal compounds. A review of studies which evaluated a number of studies, scientific journals and reports confirmed that codonopsis exhibits extensive pharmacological activity, including immune modulation, hematopoiesis improvement, cardiovascular protection, neuroprotection, gastrointestinal function regulation, endocrine function regulation, cytotoxic, antibacterial, anti-aging and antioxidation effects (1).

Further to this impressive review a number of in vitro studies have been included below to help gain more understanding of the mechanism of action for codonopsis’ pharmacological effects.

Respiratory system

A systematic review and meta-analysis was carried out to assess the efficacy and safety of codonopsis for the treatment of chronic obstructive pulmonary disease (COPD). 

A total of 48 randomised controlled trials were included, to evaluate lung function, forced expiratory volume and quality of life. This was compared with conventional pharmacotherapy and with placebo. The codonopsis group was observed to have experienced significant improvements in all clinical signs and symptoms. Codonopsis also increased the distance walked in six minutes and reduced both frequency and occurrence of COPD exacerbations (11).

Immune system

 A study evaluated the proliferative and migratory effects of codonopsis on Schwann cells (a type of cell surrounding the neurons). Various molecular signalling pathways were examined including  survival signaling, IGFs-IGFIR-Akt-Bcl2 and proliferative signaling, cell cycle factors and MAPK pathways; and migrate and anti-scar signaling, FGF-2-uPA-MMPs. Different doses of codonopsis were used (20 μg/ml, 40 μg/ml, 60 μg/ml, 80 μg/ml, and 100 μg/ml) and a dose-dependant effect was observed on proliferation. It was also found to stimulate protein expressions of IGF-I pathway regulators, cell cycle controlling proteins and excites the MAPK signaling pathway regulators ERK and P38. These results show that codonopsis, when combined with biomedical treatment, is effective in enhancing neuronal regeneration (12). 

A study was carried out to investigate the actions of codonopsis on treating the condition of Spleen deficiency in TCM. The study used 16S rRNA gene sequencing and targeted metabolomics, and found that the polysaccharides in codonopsis improved organ indexes, D-xylose absorption, gastrointestinal hormone levels, and goblet cell counts. Codonopsis was also found to enrich the beneficial Lactobacillus bacteria whilst reducing the harmful bacteria Enterococcus and Shigella in the gut. It was also found to regulate metabolic pathways by altering chemicals, including amino acids and fatty acids (13). 

Digestive system 

An in vitro study was carried out to investigate the effects of three inulin-type fructans isolated from the roots of codonopsis. The prebiotic activity of these compounds was evaluated by detecting growth stimulation on Bifidobacterium longum. B. longum is a healthy bacteria found in the gut which has been shown to reduce the symptoms of colitis and relieve chronic inflammation. This study clearly demonstrated that the three fructans at a concentration of 2.0 g/L exhibited significant growth stimulation on Bifidobacterium longum in a time-dependent manner. The data indicated that inulin-type fructans in Codonopsis have positive potential as probiotic agents (13).

Codonopsis is native to Asia especially in the Shanxi and Szechuan provinces where it grows in forests, meadows, and scrub (1).

Due to the rise in popularity of codonopsis as medicine, coupled with environmental factors, the species is in decline and quality can also be affected. It is advised to source this from a reputable supplier (15,16). 

Habitat loss and over-harvesting from the wild are two of the biggest threats faced by medicinal plant species. There are an increasing number of well-known herbal medicines at risk of extinction. We must, therefore, ensure that we source our medicines with sustainability in mind.

The herb supplement industry is growing at a rapid rate and until recent years a vast majority of medicinal plant produce in global trade was of unknown origin. There are some very real and urgent issues surrounding sustainability in the herb industry. These include environmental factors that affect the medicinal viability of herbs, the safety of the habitats that they are taken from, as well as the welfare of workers in the trade.

The botanical supply chain efforts for improved visibility (transparency and traceability) into verifiably sustainable production sites around the world is now certificated through the emergence of credible international voluntary sustainability standards (VSS). 

Read our article on Herbal quality and safety: What to know before you buy and Sustainable sourcing of herbs to learn more about what to look for and questions to ask suppliers about sustainability.

Herbal medicines are often very safe to take; however, their safety and efficacy can be jeopardised by quality issues. So, it is important to buy herbal medicines from a reputable supplier, from sources known to test their herbs to ensure there is no contamination, adulteration or substitution with incorrect plant matter, as well as ensuring that recognised marker compounds are at appropriate levels in the herbs.

Some important quality assurances to look for are certified organic labelling, the correct scientific/botanical name, and the availability of information from the supplier about ingredient origins. A supplier should be able to tell you where the herbs have come from, what contaminants are not in the herb, and what the primary compounds are.

Codonopsis prefers a well-drained fertile light, slightly acidic soil in full sun. For the best chances of success plant in full sun and ensure that the soil remains moist during the growing season.

Seeds are best sown in the early spring, late autumn or early winter. They benefit from a cold spell to break their dormancy. When the seedlings are big enough to handle, prick them out and pot them up, overwintering them in the greenhouse for their first winter and planting them out in mid spring to give them the best chance.

During the early colder phase of spring when there is still a chance of frost, it is best to grow the plants in a position sheltered from the early morning sun as the fast thawing of its leaves may cause damage to the plant. They are otherwise quite cold-hardy when dormant, the young growth in spring, even on mature plants, is frost-tender.

The plant does not tolerate root disturbance and should be planted out into its permanent position as soon as possible.

Plants are very susceptible to the ravages of slugs. The young shoots in spring are particularly at risk, though older growth is also eaten.

Water twice to three times a week during dry spells, these plants are not drought tolerant (17).

Adaptogenic immune recovery tea

This tea can be brewed and drunk as part of a recovery from illness or during the winter to increase immunity and nourish the blood. It can also be frozen into ice cubes and added to broths and soups over the winter. 

Ingredients

• 10 g codonopsis root 
• 10 g angelica root 
• 10 g astragalus root 
• 10 g jujube dates
• 1 litre of water

Method

• Add all the roots into a large pot and add the water 
• Bring to the boil and cover 
• Simmer gently for 20–30 minutes 
• Drink a up to three cups a day or add to soup and stews

1. Gao SM, Liu JS, Wang M, et al. Traditional uses, phytochemistry, pharmacology and toxicology of Codonopsis: A review. Journal of Ethnopharmacology. 2018;219:50-70. https://doi.org/10.1016/j.jep.2018.02.039 
2. Guo H, Lou Y, Hou X, et al. A systematic review of the mechanism of action and potential medicinal value of codonopsis pilosula in diseases. Frontiers in Pharmacology. 2024;15. https://doi.org/10.3389/fphar.2024.1415147 
3. Shi Q, Chen Z, Yang J, et al. Review of biological activities: A plant of traditional Chinese tonic. Journal of Ethnopharmacology. 2024;332:118334. https://doi.org/10.1016/j.jep.2024.118334 
4. Mcintyre A. Complete Herbal Tutor : The Definitive Guide to the Principles and Practices of Herbal Medicine (Second Edition). Aeon Books Limited; 2019.
5. Thomsen M. Phytotherapy Desk Reference. 6th ed. Aeon Books; 2022.
6. Dong J, Yexin Na, Hou A, et al. A review of the botany, ethnopharmacology, phytochemistry, analysis method and quality control, processing methods, pharmacological effects, pharmacokinetics and toxicity of codonopsis radix. Frontiers in Pharmacology. 2023;14. https://doi.org/10.3389/fphar.2023.1162036 
7. Panossian A, Wikman G. Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress—Protective Activity. Pharmaceuticals. 2010;3(1):188-224. https://doi.org/10.3390/ph3010188 
8. Li J, Wang T, Zhu Z, Yang F, Cao L, Gao J. Structure Features and Anti-Gastric Ulcer Effects of Inulin-Type Fructan CP-A from the Roots of Codonopsis pilosula (Franch.) Nannf. Molecules. 2017;22(12):2258. https://doi.org/10.3390/molecules22122258 
9. Li J, Zhang X, Cao L, Ji J, Gao J. Three Inulin-Type Fructans from Codonopsis pilosula (Franch.) Nannf. Roots and Their Prebiotic Activity on Bifidobacterium longum. Molecules. 2018;23(12):3123. https://doi.org/10.3390/molecules23123123 
10. Zhejiang Provincial People’s Hospital. Adjuvant Chemotherapy Plus Codonopsis Pilosula Nnannf /Placebo. ctv.veeva.com. Published 2024. Accessed December 29, 2024. https://ctv.veeva.com/study/adjuvant-chemotherapy-plus-codonopsis-pilosula-nnannf-placebo 
11. Shergis JL, Liu S, Chen X, et al. Dang Shen[Codonopsis pilosula(Franch.) Nannf] Herbal Formulae for Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis. Phytotherapy Research. 2014;29(2):167-186. https://doi.org/10.1002/ptr.5248 
12. Chen HT, Tsai YL, Chen YS, et al. Dangshen (Codonopsis pilosula) Activates IGF-I and FGF-2 Pathways to Induce Proliferation and Migration Effects in RSC96 Schwann Cells. The American Journal of Chinese Medicine. 2010;38(02):359-372. https://doi.org/10.1142/s0192415x10007907 
13. Cao L, Du C, Zhai X, et al. Codonopsis pilosula Polysaccharide Improved Spleen Deficiency in Mice by Modulating Gut Microbiota and Energy Related Metabolisms. Frontiers in Pharmacology. 2022;13. https://doi.org/10.3389/fphar.2022.862763 
14. Natural Medicines. Codonopsis. naturalmedicines.therapeuticresearch.com. Published 2024. https://naturalmedicines.therapeuticresearch.com/databases/food 
15. Gang R, Komakech R, Chung Y, et al. In vitro propagation of Codonopsis pilosula (Franch.) Nannf. using apical shoot segments and phytochemical assessments of the maternal and regenerated plants. BMC Plant Biology. 2023;23(1). https://doi.org/10.1186/s12870-022-03950-w 
16. Wang Z, Jia Y, Li P, et al. Study on environmental factors affecting the quality of codonopsis radix based on MaxEnt model and all-in-one functional factor. Scientific Reports. 2023;13(1):20726. https://doi.org/10.1038/s41598-023-46546-6 
17. Heirloom Organics. How to Grow Codonopsis | Guide to Growing Codonopsis. Heirloom-organics.com. Published 2019. Accessed December 30, 2024. http://www.heirloom-organics.com/guide/va/guidetogrowingcodonopsis.html