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Bai zhu

Also known as: Bai zhu, Rhizoma Atractylodis Macrocephalae, Atractylodes macrocephala

Overview

Bai zhu refers to the dried rhizome of *Atractylodes macrocephala* Koidz., a plant belonging to the Asteraceae family. It is a fundamental ingredient in Traditional Chinese Medicine (TCM), primarily valued for its spleen-tonifying and dampness-eliminating properties. Its main bioactive constituents include atractylenolides and polysaccharides, which contribute to its pharmacological effects. Historically, Bai zhu has been used to address various gastrointestinal disorders, such as chronic diarrhea and ulcerative colitis. More recently, research has explored its potential benefits in conditions like chronic obstructive pulmonary disease (COPD), often when integrated into complex herbal formulas like Shenling Baizhu San (SBS). Pharmacologically, Bai zhu exhibits anti-inflammatory, immunomodulatory, and gastrointestinal protective effects, aligning with its traditional uses. While research is ongoing, much of the evidence for its efficacy comes from studies on multi-herb formulas rather than isolated Bai zhu.

Benefits

Bai zhu, predominantly used within multi-herb formulas, demonstrates several evidence-based benefits. In patients with stable Chronic Obstructive Pulmonary Disease (COPD), modified Shenling Baizhu San (SBS), which contains Bai zhu, has been shown to improve exercise endurance and quality of life scores. It also indicates potential improvements in pulmonary function parameters like FEV1/FVC and maximal voluntary ventilation (MVV), as reported in systematic reviews and meta-analyses. For gastrointestinal issues, particularly chronic diarrhea and irritable bowel syndrome with diarrhea, SBS has been found to significantly reduce diarrhea frequency, abdominal pain, and improve stool consistency compared to conventional treatments. In a 12-week trial, SBS was even superior to mesalamine in managing diarrhea and abdominal pain in ulcerative colitis. These benefits are often observed within weeks to a few months of treatment. While the exact effect sizes vary due to study heterogeneity, meta-analyses consistently report statistically significant improvements in symptom scores and quality of life measures, with no significant increase in adverse effects compared to conventional treatments.

How it works

Bai zhu's therapeutic effects are primarily mediated by its bioactive compounds, particularly atractylenolides and polysaccharides. These compounds exert anti-inflammatory actions by modulating cytokine production and immune responses, specifically targeting inflammatory mediators such as TNF-α, IL-6, and NF-κB signaling pathways. In the digestive system, Bai zhu enhances gastrointestinal motility and helps protect mucosal integrity, which contributes to its efficacy in reducing diarrhea and improving absorption. Its immunomodulatory properties are relevant to both gastrointestinal and pulmonary conditions, helping to regulate the body's inflammatory response. While the polysaccharides and atractylenolides are absorbed, their bioavailability can be influenced by formulation and combination with other herbs, suggesting synergistic effects within traditional formulas.

Side effects

Bai zhu is generally considered safe when used in traditional doses as part of herbal formulas. Clinical trials and meta-analyses have reported a favorable safety profile, with no significant adverse effects commonly observed. Mild gastrointestinal discomfort, such as slight nausea, is possible but uncommon. Rare reports of allergic reactions have been noted, but serious adverse events are not documented in high-quality studies. However, specific contraindications exist within TCM principles, such as cases of spleen deficiency with dryness or yin deficiency. From a Western medicine perspective, specific contraindications are not well-established. Caution is advised regarding potential drug interactions, particularly when combined with immunosuppressants or anticoagulants, due to limited data on herb-drug interactions. The safety of Bai zhu during pregnancy and lactation is not well-established, and its use in these populations should be approached with caution.

Dosage

The recommended dosage for Bai zhu typically ranges from 6-12 grams per day when used in decoction or formula form, depending on the specific condition and formulation. In clinical trials, particularly those involving Shenling Baizhu San (SBS), Bai zhu has been administered at doses equivalent to 6 grams of the raw herb, taken three times daily. The maximum safe dose is not precisely defined, but traditional use and clinical studies suggest that doses up to 12 grams daily are generally well-tolerated. Bai zhu is usually taken before or after meals to optimize its gastrointestinal effects. Most of the evidence for its efficacy comes from its use within multi-herb formulas, such as decoctions or granule formulations, where its bioavailability may be enhanced by the presence of other herbs. It is often combined with other herbs like ginseng and poria for synergistic therapeutic effects.

FAQs

Is Bai zhu effective alone or only in formulas?

Most clinical evidence supports Bai zhu's efficacy as part of multi-herb formulas like Shenling Baizhu San, rather than as a standalone herb. Its benefits are often observed through synergistic interactions with other ingredients.

Is it safe for long-term use?

Traditional use suggests Bai zhu is safe for long-term consumption within recommended doses. However, long-term randomized controlled trial data specifically on isolated Bai zhu are limited, and caution is advised.

How soon can benefits be expected?

Improvements in symptoms and quality of life, particularly for gastrointestinal issues and COPD, typically become noticeable within a few weeks to a few months of consistent treatment.

Are there any known drug interactions?

Data on drug interactions are limited. Caution is advised when combining Bai zhu with immunosuppressive drugs or anticoagulants due to potential, though unconfirmed, interactions.

Research Sources

https://pubmed.ncbi.nlm.nih.gov/33607201/ – This systematic review and meta-analysis of 11 RCTs involving 770 stable COPD patients found that modified Shenling Baizhu San (containing Bai zhu) improved exercise endurance and quality of life, with potential benefits for pulmonary function. The study noted moderate methodological quality and heterogeneity among trials.
https://journals.sagepub.com/doi/10.1177/15347354221081214 – This systematic review and meta-analysis investigated acupuncture plus SBS for irritable bowel syndrome with diarrhea. It concluded that SBS, either alone or combined with conventional therapy, significantly improved diarrhea frequency, abdominal pain, and stool consistency, without increasing adverse effects.
https://ascopost.com/issues/december-25-2022/traditional-chinese-medicine-herbal-formula-shen-ling-bai-zhu-san-for-chronic-diarrhea/ – This article discusses findings related to Shenling Baizhu San (SBS) for chronic diarrhea, highlighting its effectiveness in reducing symptoms like diarrhea and abdominal pain. It references studies showing SBS's superiority over conventional treatments in certain gastrointestinal conditions like ulcerative colitis.
https://onlinelibrary.wiley.com/doi/10.1155/2014/925069 – This systematic review analyzed 176 clinical studies on herbal medicine, including Bai zhu, for COPD. It found that herbal medicine adjuncts improved symptoms and quality of life but did not significantly affect FEV1% or FVC compared to conventional medicine alone, emphasizing the need for more rigorous, large-scale RCTs.
https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2024.1501990/full – This systematic review on Qiwei Baizhu San (a Bai zhu-containing formula) showed efficacy in reducing blood glucose in type 2 diabetes mellitus patients. The study, involving 80 patients over 30 days, indicated significant improvement in 2-hour postprandial glucose, suggesting broader metabolic benefits of Bai zhu-containing formulas.