OVERVIEW

PRODUCT INFORMATION

REPRESENTATIVE TRADE NAMES

Lingzhi – Generic

DRUG CLASS

Herbal and Dietary Supplements

SUMMARY INFORMATION

Fact Sheet at MedlinePlus, NLM

CHEMICAL FORMULA AND STRUCTURE

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DRUG	CAS REGISTRY NUMBER	MOLECULAR FORMULA	STRUCTURE
Ganoderic Acid A	81907-62-2	C30-H44-O7
Beta-Glucan	9012-72-0	C18-H32-O16	Not Available

ANNOTATED BIBLIOGRAPHY

References updated: 05 October 2024

Abbreviations: DILI, drug induced liver injury; HDS, herbal and dietary supplements.

• Zimmerman HJ. Unconventional drugs. Miscellaneous drugs and diagnostic chemicals. In, Zimmerman, HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott,1999: pp. 731-4.

  (Expert review of hepatotoxicity published in 1999; several herbal medications are discussed, but not Reishi or Lingzhi).
• Yuen MF, Ip P, Ng WK, Lai CL. Hepatotoxicity due to a formulation of Ganoderma lucidum (lingzhi). J Hepatol. 2004;41:686-7. [PubMed: 15464254]

  (78 year old Chinese woman who had taken Lingzhi for a year and then switched to a powdered formulation developed fatigue and dark urine one month later [bilirubin 15.8 mg/dL, ALT 306, Alk P 388 U/L, INR normal], improved slowly after stopping and had near normal liver tests 5 months later).
• Wachtel-Galor S, Tomlinson B, Benzie IF. Ganoderma lucidum ("Lingzhi"), a Chinese medicinal mushroom: biomarker responses in a controlled human supplementation study. Br J Nutr. 2004;91:263-9. [PubMed: 14756912]

  (Among 18 healthy Chinese adults treated with Lingzhi [1.44 gm] or placebo daily for 28 days followed after a 4-6 week washout period with crossover to the alternate treatment, serum markers of antioxidant, vitamin, and lipid status did not change significantly in either group, and therapy was well tolerated with no change in blood counts or serum creatinine, ALT and AST levels).
• Tang W, Gao Y, Chen G, Gao H, Dai X, Ye J, Chan E, Huang M, Zhou S. A randomized, double-blind and placebo-controlled study of a Ganoderma lucidum polysaccharide extract in neurasthenia. J Med Food. 2005;8:53-8. [PubMed: 15857210]

  (Among 132 Chinese patients with neurasthenia treated with a polysaccharide extract of Ganoderma lucidum [1800 mg] or placebo capsules 3 times daily for 8 weeks, wellness and fatigue scores improved more with Lingzhi than placebo and therapy was well tolerated and “not associated with hematologic, liver, renal or biochemical toxicity”).
• Wicks SM, Tong R, Wang CZ, O'Connor M, Karrison T, Li S, Moss J, Yuan CS. Safety and tolerability of Ganoderma lucidum in healthy subjects: a double-blind randomized placebo-controlled trial. Am J Chin Med. 2007;35:407-14. [PubMed: 17597499]

  (Among 16 volunteers treated with Lingzhi extract [2 gm] or placebo twice daily for 10 days, there were no significant changes in lymphocyte subsets or in ALT, AST, Alk P or bilirubin levels and “no adverse effects of clinical importance”).
• Wanmuang H, Leopairut J, Kositchaiwat C, Wananukul W, Bunyaratvej S. Fatal fulminant hepatitis associated with Ganoderma lucidum (Lingzhi) mushroom powder. J Med Assoc Thai. 2007;90:179-81. [PubMed: 17621752]

  (47 year old Thai woman developed jaundice and coma 2 months after switching from boiled Lingzhi slices to a powdered form of 200 mg daily [bilirubin 40.4 mg/dL, ALT 276 U/L, AST 280 U/L, Alk P 132 U/L, INR 4.7], with rapid deterioration and death 6 days later, autopsy showing multilobular necrosis).
• Noguchi M, Kakuma T, Tomiyasu K, Kurita Y, Kukihara H, Konishi F, Kumamoto S, et al. Effect of an extract of Ganoderma lucidum in men with lower urinary tract symptoms: a double-blind, placebo-controlled randomized and dose-ranging study. Asian J Androl. 2008;10:651-8. [PubMed: 18097503]

  (Among 50 Chinese male adults with prostate related symptoms treated with Lingzhi [0.6, 6, or 60 mg] or placebo once daily for 8 weeks, symptoms improved slightly with the 6 mg dose but there was no change in prostate size or residual urinary volume, while adverse events were uncommon and there was “no treatment related hematologic, hepatic, or renal toxicity”).
• Noguchi M, Kakuma T, Tomiyasu K, Yamada A, Itoh K, Konishi F, Kumamoto S, Shimizu K, Kondo R, Matsuoka K. Randomized clinical trial of an ethanol extract of Ganoderma lucidum in men with lower urinary tract symptoms. Asian J Androl. 2008;10:777-85. [PubMed: 18097505]

  (Among 88 men with lower urinary tract symptoms treated with Ganoderma lucidum [6 mg] or placebo once daily for 12 weeks, there were no changes in urinary symptoms, prostate size, or residual urinary volume and there was “no treatment related hematologic, hepatic or renal toxicity”).
• Chu TT, Benzie IF, Lam CW, Fok BS, Lee KK, Tomlinson B. Study of potential cardioprotective effects of Ganoderma lucidum (Lingzhi): results of a controlled human intervention trial. Br J Nutr. 2012;107:1017-27. [PubMed: 21801467]

  (Among 26 patients with cardiovascular risk factors treated with Lingzhi [1.44 gm] or placebo daily for 12 weeks in a double-blind cross-over design, body weight, lipids, blood pressure, and fasting glucose levels did not change, while a slight improvement occurred with insulin levels and there were “no adverse effects in laboratory safety parameters”).
• Soares AA, de Sá-Nakanishi AB, Bracht A, da Costa SM, Koehnlein EA, de Souza CG, Peralta RM. Hepatoprotective effects of mushrooms. Molecules. 2013;18:7609-30. [PMC free article: PMC6270077] [PubMed: 23884116]

  (Review of the hepatoprotective activity of mushrooms, focused largely on in vivo studies of Ganoderma lucidum effects in animal models of carbon tetrachloride or galactosamine hepatotoxicity suggesting that the polysaccharides and triterpenoids are the active principles, and stressing the need for clinical trials in humans with acute liver failure).
• Klupp NL, Kiat H, Bensoussan A, Steiner GZ, Chang DH. A double-blind, randomised, placebo-controlled trial of Ganoderma lucidum for the treatment of cardiovascular risk factors of metabolic syndrome. Sci Rep. 2016;6:29540. [PMC free article: PMC4980683] [PubMed: 27511742]

  (Among 84 Australian adults with diabetes and the metabolic syndrome treated with Ganoderma lucidum alone [3 gm] or with Cordyceps [amount not given], or placebo for 16 weeks, there were no significant changes in body weight, blood pressure, or in fasting blood glucose, HbA1c, and serum lipid levels in the 3 groups; side effects were mild and similar to those in patients on placebo).
• Teschke R, Wolff A, Frenzel C, Schulze J, Eickhoff A. Herbal hepatotoxicity: a tabular compilation of reported cases. Liver Int 2012; 32: 1543-56. [PubMed: 22928722]

  (A systematic compilation of all publications on the hepatotoxicity of specific herbal products identified 185 publications on 60 different herbs, herbal drugs and supplements but does not list or mention Reishi or Lingzhi).
• Navarro VJ, Seeff LB. Liver injury induced by herbal complementary and alternative medicine. Clin Liver Dis 2013; 17: 715-35. [PubMed: 24099027]

  (Review of the epidemiology, regulatory status, diagnosis, pathogenesis and causes of liver injury from herbal products with specific discussion of conjugated linoleic acid, ephedra, germander, green tea, usnic acid, flavocoxid, aloe vera, chaparral, greater celandine, black cohosh, comfrey, kava, skullcap, valerian, noni juice, pennyroyal and traditional herbal remedies; no mention of Reishi or Lingzhi).
• Navarro VJ, Barnhart H, Bonkovsky HL, Davern T, Fontana RJ, Grant L, Rleddy KR, et al. Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network. Hepatology 2014; 60: 1399-408. [PMC free article: PMC4293199] [PubMed: 25043597]

  (Among 839 cases of liver injury from drugs collected in the US between 2004 and 2013, 130 were due to HDS products, including 45 from body building agents [probably anabolic steroids] and 85 from diverse HDS products but no case was attributed specifically to Reishi or Lingzhi).
• Brown AC. Liver toxicity related to herbs and dietary supplements: Online table of case reports. Part 2 of 5 series. Food Chem Toxicol 2017; 107: 472-501. [PubMed: 27402097]

  (Description of an online compendium of cases of liver toxicity attributed to HDS products, does not list or discuss Reishi or Lingzhi).
• Medina-Caliz I, Garcia-Cortes M, Gonzalez-Jimenez A, Cabello MR, Robles-Diaz M, Sanabria-Cabrera J, Sanjuan-Jimenez R, et al.; Spanish DILI Registry. Herbal and dietary supplement-induced liver injuries in the Spanish DILI Registry. Clin Gastroenterol Hepatol. 2018;16:1495-1502. [PubMed: 29307848]

  (Among 856 cases of hepatotoxicity enrolled in the Spanish Drug-Induced Liver Injury Registry between 1994 and 2016, 32 were attributed to herbal products, the most frequent cause being green tea [n=8] and Herbalife products [n=6], no mention of Reishi or Lingzhi).
• Wang GH, Wang LH, Wang C, Qin LH. Spore powder of Ganoderma lucidum for the treatment of Alzheimer disease: A pilot study. Medicine (Baltimore). 2018;97:e0636. [PMC free article: PMC5959386] [PubMed: 29742702]

  (Among 42 Chinese patients with Alzheimer disease treated with spore powder of Lingzhi [1000 mg] or placebo 3 times daily for 6 weeks, there were no differences in changes in neuropsychic symptoms or quality of life measures and no differences in adverse events between the two groups; no mention of ALT or AST levels).
• Wang GH, Li X, Cao WH, Li J, Wang LH. A retrospective study of Ganoderma lucidum spore powder for patients with epilepsy. Medicine (Baltimore). 2018;97:e10941. [PMC free article: PMC5999473] [PubMed: 29879039]

  (Among 18 Chinese patients with epilepsy treated with spore powder of Lingzhi [1000 mg] 3 times daily for 8 weeks, there were no significant changes in seizure frequency or quality of life measures and adverse events were generally mild; no mention of ALT levels or hepatotoxicity).
• Qiu Z, Zhong D, Yang B. Preventive and therapeutic effect of Ganoderma (Lingzhi) on liver injury. Adv Exp Med Biol. 2019;1182:217-242. [PubMed: 31777021]

  (Review of studies of the beneficial effects of Lingzhi on liver injury).
• Liu J, Mao JJ, Li SQ, Lin H. Preliminary efficacy and safety of Reishi & Privet Formula on quality of life among non-small cell lung cancer patients undergoing chemotherapy: a randomized placebo-controlled trial. Integr Cancer Ther. 2020;19:1534735420944491. [PMC free article: PMC7450289] [PubMed: 32840126]

  (Among 82 Chinese adults with lung cancer treated with an oral herbal product with Reishi and Privet vs placebo for 6 weeks, there were no significant differences in changes in quality of life scores or in liver related adverse events between the two groups).
• Ahmad R, Riaz M, Khan A, Aljamea A, Algheryafi M, Sewaket D, Alqathama A. Ganoderma lucidum (Reishi) an edible mushroom; a comprehensive and critical review of its nutritional, cosmeceutical, mycochemical, pharmacological, clinical, and toxicological properties. Phytother Res. 2021;35:6030-6062. [PubMed: 34411377]

  (Review of the safety and efficacy of Ganoderma lucidum from the published literature concludes that adequately powered clinical studies are needed to verify the biologic activities of Reishi that have been shown in laboratory and animal studies; mentions that hepatotoxicity has been reported in humans with it use [Wanmuang 2007]).
• Kogure T, Koiwai A, Fukushi D, Satoh M, Murakami K, Hirota M, Endo K, et al. Hypereosinophilia with hepatic nodule formation caused by Ganoderma lucidum. Intern Med. 2021;60:3897-3903. [PMC free article: PMC8758446] [PubMed: 34911873]

  (61 year old Japanese man was found to have mildly abnormal liver tests 6 months after resection of colon cancer leading to discontinuation of his adjunctive cancer chemotherapy, whereupon he started a commercial herbal product containing Reishi and developed nausea and fatigue two months later and was found to have multiple hepatic nodules [ALT 66, AST 45 U/L, Alk P 445 U/L, eosinophils 14,310/μL], which on biopsy showed nodules with intense hypereosinophilia; stopping Reishi was followed by resolution of symptoms, abnormal liver tests and disappearance of hepatic nodules).
• Ballotin VR, Bigarella LG, Brandão ABM, Balbinot RA, Balbinot SS, Soldera J. Herb-induced liver injury: systematic review and meta-analysis. World J Clin Cases. 2021;9:5490-5513. [PMC free article: PMC8281430] [PubMed: 34307603]

  (Systematic review of the literature on HDS induced liver injury identified 446 references describing 936 cases due to 79 different herbal products, the most common being He Shou Wu [91], green tea [90] Herbalife products [64], kava kava [62] and greater celandine [48]; Lingzhi is not listed or discussed).
• Bessone F, García-Cortés M, Medina-Caliz I, Hernandez N, Parana R, Mendizabal M, Schinoni MI, et al. Herbal and dietary supplements-induced liver injury in Latin America: experience from the LATINDILI Network. Clin Gastroenterol Hepatol. 2022;20:e548-e563. [PubMed: 33434654]

  (Among 367 cases of hepatotoxicity enrolled in the Latin American Drug-Induced Liver Injury Network between 2011 and 2019, 29 [8%] were attributed to herbal products, the most frequent being green tea [n=7], Herbalife products [n=5] and garcinia [n=3]; Lingzhi is not mentioned).
• Liu C, Song X, Li Y, Ding C, Li X, Dan L, Xu H, Zhang D. A comprehensive review on the chemical composition, pharmacology and clinical applications of Ganoderma. Am J Chin Med. 2023;51:1983-2040. [PubMed: 37903715]

  (Review of the chemical analyses, pharmacology and clinical uses of Ganoderma species used in Chinese traditional medicine mentions that Lingzhi has more than 470 natural components including terpenoids, steroids, alkaloids, and phenols, and has antitumor, antiinflammatory, immunomodulatory, hypolipidemic, and hypoglycemic activity, and is used in China to treat malignant tumors and diabetic nephropathy).
• Chen SN, Nan FH, Liu MW, Yang MF, Chang YC, Chen S. Evaluation of immune modulation by β-1,3; 1,6 D-glucan derived from Ganoderma lucidum in healthy adult volunteers, a randomized controlled trial. Foods. 2023;12:659. [PMC free article: PMC9914031] [PubMed: 36766186]

  (Among 157 healthy adult volunteers treated with polysaccharides [β-glucan] derived from Ganoderma lucidum vs placebo for 12 weeks, treated patients had increases in CD3, CD4 and CD8 lymphocytes and NK cells, but caused no serious adverse events or changes in serum ALT or AST levels).
• Khan H, Reyes JVM, Seen T, Irefej B, Ahmad S. Herbal supplement-induced liver injury: a case report. Cureus. 2023;15:e33663. [PMC free article: PMC9928137] [PubMed: 36819353]

  (45 year old woman developed epigastric pain 3 days after starting an herbal tea [bilirubin 1.9 mg/dL, ALT 940 U/L, AST 1465 U/L, Alk P 145 U/L], imaging demonstrating gallstone and biliary sludge but no evidence of biliary obstruction, with rapid improvement after stopping the tea which analysis showed contained multiple herbs including Reishi, Siberian ginseng, and aloe vera).
• Guedikian R, Kim B, Singh G, Alexander R. Ganoderma lingzhi (Reishi Mushroom)-induced acute liver injury in the setting of alcohol use: a case report and review of the literature. Cureus. 2023;15:e45953. [PMC free article: PMC10599861] [PubMed: 37885515]

  (47 year old man developed nausea, headache, and abdominal and leg pain which he treated with alcohol [750 mL daily] and several teaspoons of Reishi mushrooms daily for three days and then presenting to an emergency room with bilirubin 1.5 mg/dL, ALT 990 U/L, Alk P 301 U/L, which resolved rapidly with infusions of N-acetylcysteine and hydration, ALT falling to normal within 2 weeks).