Author: Min Geraets | BNatMed
Originally published in the Avena journal of the New Zealand Association of Medical Herbalists (NZAMH).
The fungi renaissance
In recent years, medicinal mushrooms have experienced a resurgence. From ancestral traditions to trendy mushroom coffees and nootropic supplements, fungi are often at the centre of health and wellbeing. Beyond the hype lies a compelling intersection of traditional knowledge and emerging science; a place where medical herbalists are uniquely positioned to lead.
As medical herbalists, we are asked to evaluate mushroom-based extracts with the same critical eye and holistic perspective we apply to botanicals. This article explores the evolving role of medicinal mushrooms in modern herbal practice, from extraction methods to clinical applications and new research trends.
Fungi in traditional medicine
Medicinal use of mushrooms spans centuries and continents, dating back to the Tao Dynasty.1 In Traditional Chinese Medicine (TCM), Ganoderma lucidum (lingzhi or reishi) is revered as ‘The Mushroom of Immortality’, associated with longevity, vitality and strength of spirit.2 In Rongoā Māori, an array of fungi was consumed as food and used medicinally. Agrocybe parasitica (tawaka) was used by Māori to treat fever and as an antidote to poisoning by karaka or tutu. The spores of Calvatia spp. (pukurau) were used to heal burns, to staunch bleeding and were administered as anaesthetic.3
Like medicinal plants, fungi evolved to produce protective compounds as a defence against predators. These bioactive substances are the same components sought by herbalists in medicinal mushrooms, highlighting the evolutionary relationship between humans and the natural world.
Mycological modernisation
Considering the extensive use of medicinal mushrooms throughout history, it is no surprise that modern science has taken an interest. Scientific research provides the opportunity to delve deeper into the ‘how’ that drives the observed physiological effects medicinal mushrooms exert on the human body. In vitro assays and in vivo studies in animal models have revealed the bioactive properties of medicinal mushrooms. These include beta-glucans, terpenoids, functional proteins and phenolic compounds. While clinical trials carried out on humans are assessing their efficacy and safety.4
Mushroom extraction methods
Chitin, a structural component of mushroom cell walls, is indigestible to humans. This makes the choice of extraction method crucial for accessing the bioactive compounds within. Liquid mushroom extracts commonly used in clinical practice are typically produced via hydroethanolic extraction. Water-based extraction is particularly effective for isolating beta-glucans, the water-soluble polysaccharides responsible for mushrooms key immunomodulatory effects.5 However, since beta-glucans precipitate in alcohol and are therefore removed during filtration, alcohol-based extracts lack these constituents. Conversely, alcohol extraction is useful for isolating lipid-soluble compounds such as terpenoids.6
The choice of extraction method is guided by the primary constituents of each mushroom. For species rich in polysaccharides, hot water extraction is typically sufficient.5 When a broader bioactive profile is desired, a dual-extraction process is employed. This begins with an organic solvent to extract lipophilic compounds such as terpenoids. Once these constituents have been collected and the solvent removed, a hot water decoction is performed to obtain hydrophilic constituents. The resulting precipitates are then collected and dried into a powder, which may be used directly or reconstituted in water with glycerine or ethanol to produce a comprehensive and potent mushroom extract.
Ten mushrooms shaping the future
Hericium erinaceus (Lion’s mane)
Hericium erinaceus has a long-standing history of medicinal use, particularly within TCM and Japanese Kampo, where it was traditionally employed to support digestive health and enhance cognitive function.7 Today, it has garnered interest for its ability to stimulate nerve growth factor (NGF) synthesis and cross the blood-brain barrier, exerting notable neuroprotective effects. These actions are largely attributed to its terpenoid constituents, particularly hericenones and erinacines. NGF plays a critical role in the growth, maintenance and repair of neurons, especially during aging and in neurodegenerative conditions such as Alzheimer’s disease. Preclinical studies and early clinical trials suggest Hericium erinaceus may benefit individuals with mild cognitive impairment, anxiety, and depression.8
Hericium erinaceus contains a range of phenolic compounds that demonstrate strong antioxidant activity. These compounds help mitigate oxidative stress by scavenging free radicals and enhancing glutathione activity. By protecting against oxidative damage, Hericium erinaceus’ phenolics contribute to the prevention of age-related conditions such as Alzheimer’s disease and chronic inflammatory disorders. Furthermore, its terpenoids exert anti-inflammatory effects by modulating key inflammatory pathways, including NF-κB and COX-2, which are both implicated in systemic and neuroinflammation.9
Among Hericium erinaceus’ polysaccharide constituents, beta-glucans are the most well-studied. Boasting significant immunomodulatory activity by stimulating natural killer cells, macrophages, and T lymphocytes. Additionally, Hericium erinaceus polysaccharides help regulate inflammatory responses by downregulating pro-inflammatory cytokines (IL-6, TNF-α, IL-1β) and upregulating anti-inflammatory cytokines such as IL-10. They also act as prebiotics, supporting gut health by reducing lipopolysaccharide (LPS)-induced inflammation and improving intestinal barrier integrity.9
Hericium novae-zealandiae (New Zealand Lion’s mane)
Hericium novae-zealandiae, often referred to as the kiwi cousin of famed Hericium erinaceus, is known as pekepeke-kiore in Te Reo Māori. Traditionally consumed as food throughout Aotearoa, this native fungus is gaining attention for its potential therapeutic value.10
While H. novae-zealandiae and H. erinaceus share similarities, it’s important to recognise their differences. In New Zealand, all H. erinaceus is imported. Under the Hazardous Substances and New Organisms (HSNO) Act 1996, it is classified as a ‘new organism’ because it was introduced after the Act came into effect. Therefore, it cannot be legally cultivated within the country. The HSNO Act was established to protect Aotearoa’s unique ecosystems from potentially invasive species, making the legal cultivation of H. erinaceus off-limits.11
Previously, the actives in H. novae-zealandiae were considered inferior to those present in H. erinaceus. However, emerging research is beginning to challenge this perception. Recent studies have identified a range of active compounds in H. novae-zealandiae, including polysaccharides, hericenone C, lipophilic compounds (hericene B, ergosterol and ergosterol peroxide) and nucleosides (cytidine, uridine, adenosine and guanosine).12-16 These compounds are associated with therapeutic actions such as neuroprotection and anti-carcinogenic activity, positioning H. novae-zealandiae as a native New Zealand mushroom with promising and distinctive therapeutic potential.17
Ganoderma lucidum (reishi)
Ganoderma lucidum is one of the most abundantly used medicinal mushrooms. Its historical use in TCM was to support longevity and promote wellbeing. In recent times, numerous pharmacological actions have been discovered, displaying benefits for the immune, nervous, metabolic and cardiovascular systems. 4
Polysaccharides from Ganoderma lucidum, particularly β-glucans, are the underlying constituents behind its immunomodulatory activity. They enhance the activity of immune cells, stimulate macrophage phagocytosis and anti-inflammatory cytokine production, promote dendritic cell maturation, and support T and B cell proliferation. This is largely mediated through interaction with pattern recognition receptors like TLR4, triggering pathways such as NF-κB and MAPK. These actions strengthen immune surveillance and responsiveness, making Ganoderma lucidum a valuable addition in immune tonics and a potential adjunct in infection management and immunotherapy.18
Ganoderma lucidum also shows promising neuroprotective, cardiovascular and lipid metabolism modulating actions. Some of its polysaccharide content appear to support neuronal health by reducing oxidative stress and modulating protein aggregation.19 In vitro and animal studies have revealed Ganoderma lucidum’s lipid-lowering, hypotensive and anti-inflammatory effects. In human clinical trials, there is compelling evidence to suggest Ganoderma lucidum’s benefit in conditions of hyperglycaemia due to the hypoglycaemic activity of its polysaccharides and terpenoids.20 These findings suggest Ganoderma lucidum may have utility in managing neurodegenerative disease risk and metabolic disorders, beyond its traditional immunomodulatory roles.
Cordyceps militaris (cordyceps)
Coined ‘zombie-ant fungus’ for its ability to inject spores into an ant’s brain and drain vital nutrients, effectively controlling its mind. However, humans have no need to fear this fungi, as it cannot withstand our body temperature. Rather, it is highly valued for its medicinal benefits and has been used to benefit human health for centuries. Scientific research has shown Cordyceps militaris offers considerable advantages for health conditions including fatigue, immune insufficiency, respiratory and renal diseases, and cardiovascular dysfunction.21
Cordyceps militaris has garnered interest from elite athletes and those wanting to improve their athletic performance. This is due to its ergogenic, adaptogenic and anti-fatigue activity. A randomised double-blind placebo-controlled trial conducted with 28 young adults explored its effect on endurance and exercise performance. A daily dose of 4g of Cordyceps militaris for 3 weeks revealed improved maximal oxygen consumption, larger ventilation threshold and greater time to exhaustion. Minimal benefits were observed with acute supplementation, suggesting greater benefit with long-term dosing for exercise endurance and anti-fatigue activity.21
Recent research highlights the therapeutic potential of Cordyceps militaris cultivated on Ginkgo biloba seeds in mitigating metabolic and renal complications associated with type 2 diabetes. In a mouse model of diet-induced diabetes, supplementation with this formulation significantly reduced hyperglycaemia and improved overall glycaemic control. Notably, it also alleviated diabetic nephropathy, as evidenced by reductions in serum creatinine and blood urea nitrogen levels. Tissue analysis of the kidneys revealed healthier structure and less scarring, along with lower expression of fibrosis-associated proteins and higher levels of protective proteins that maintain normal kidney function. These findings suggest Cordyceps militaris may exert multi-targeted effects on both metabolic regulation and renal protection, offering promise as a complementary approach in managing diabetes-related complications. 22
Coriolus versicolour (turkey tail)
Coriolus versicolour has been long recognised for its uses in immune enhancement, adjunct cancer therapy and infections. Its predominant constituents, polysaccharides, terpenoids and phenolic compounds, have demonstrated potent anti-inflammatory, anti-bacterial, antioxidant and immunomodulatory effects. These effects are exerted through multiple mechanisms including inhibition of pro-inflammatory cytokines and enzymes, scavenging free radicals while amplifying antioxidant enzymes, enhancing antimicrobial cytokine release and upregulating immune cell activity. 23
Grifola frondosa (maitake)
Grifola frondosa, a revered mushroom in traditional Asian medicine systems, presents multiple benefits for immune enhancement, modulating the inflammatory process and as an adjunct cancer support.24 A 2022 randomised clinical trial investigated the effects of Grifola frondosa’s polysaccharide content on 141 head and neck cancer patients undergoing chemotherapy. Three grams of Maitake D-Fraction extracted from Grifola frondosa was administered daily, revealing a reduction in the severity and incidence of treatment-related adverse events. The mushroom was well-tolerated, and patients reported enhanced quality of life during and after therapy.25
Lentinula edodes (shiitake)
Lentinula edodes, like its fellow fungi, is highly valued for its immunomodulatory properties and inhibitory effects on tumour growth. Lentinan, a β-glucan derived from Lentinula edodes, exerts anti-cancer effects by activating the immune system, enhancing the efficacy of chemotherapy and radiation therapy, and inhibiting the growth of colon and skin carcinomas.26 Additionally, Lentinula edodes exhibits antidiabetic properties through its β-glucan content, which enhances glucose uptake by intestinal cells, inhibits carbohydrate-digesting enzymes, and activates the Nrf2/HO-1 pathway to reduce oxidative stress and improve insulin sensitivity.27
Inonotus obliquus (chaga)
Inonotus obliquus is renowned for its potent antioxidant properties and benefits to cellular health. A range of its phenolic compounds have demonstrated powerful antioxidant effects through multiple mechanisms, including free radical scavenging and upregulating antioxidant enzyme activity. Inonotus obliquus polysaccharides may also increase resilience and reduce physical and mental fatigue by lowering lactate, boosting glycogen, increasing GRAF1, and decreasing brain 5-HT in animal models.28
Agaricus blazei (agaricus)
Brazilian native, Agaricus, is highly valued in Japan for its anti-tumour activity and immunomodulatory effects. Its proposed anti-carcinogenic mechanism is inducing apoptosis in tumour cells and downregulating VEGF. These effects are largely attributed to active constituents such as β-glucans, polysaccharides and ergosterol, which also play a key role in immune modulation. These constituents activate immune cells by binding to specific receptors to increase cytokine production (IL-12, TNF-α, IFN-γ), enhancing anti-tumour activity and improving immune balance. Additionally, researchers have identified Agaricus to enhance the therapeutic effects of chemotherapy, while reducing its adverse effects.29
Auricularia polytricha (black fungus)
Auricularia polytricha, is traditionally used in TCM. It exhibits notable antimicrobial activity, particularly against Candida albicans, Pseudomonas aeruginosa and Staphylococcus aureus. This activity is likely due to its phenolic compounds, that rupture microbial cell membranes, leading to inhibited pathogenic growth.30 Additionally, Auricularia polytricha mitigates the harmful effects of lead toxicity through antioxidant, immunomodulatory and metal-chelating mechanisms. A 2023 study revealed graded doses (40, 80, 160 mg/kg) of Auricularia polytricha via a purified glycoprotein, successfully reduced blood and organ (liver & kidney) lead accumulation in rats and reinstated ALT and AST levels to near normality.31
Clinical Applications
Traditional use and modern research affirm the important role medicinal mushrooms can play in clinical practice. These mushrooms may be used as single extracts or incorporated into herbal formulas to support a range of health conditions. These include chronic immune dysregulation, fatigue, autoimmunity, neurodegeneration, adjunctive cancer treatment, detoxification, metabolic health, and blood lipid balance.
As medical herbalists, understanding the nuances of mushroom extraction is essential. The bioavailability of key constituents depends on dual extraction methods, which yield both water-soluble polysaccharides and lipid-soluble terpenoids. When incorporating medicinal mushrooms into practice, it is important to prioritise high-quality liquid extracts from GMP-certified manufacturers.
Additionally, selecting extracts derived from the bioactive-rich fruiting body, rather than from mycelium is recommended. While mycelium does contain bioactive compounds, the fruiting body has significantly higher concentrations of polysaccharides, terpenoids, and phenolic compounds, which are largely responsible for the therapeutic effects of medicinal mushrooms.32,33
Conclusion
The future of herbalism will be shaped by plants and complimented by fungi. Their long-standing use in traditional medicine systems, now increasingly validated by clinical and pharmacological research, positions fungi as a vital component in the evolving herbal toolkit. With actions spanning immune modulation, neuroprotection, metabolic regulation, and adjunctive oncology support, medicinal mushrooms offer solutions to many of the complex, chronic conditions faced in modern practice.
Yet, with their growing popularity comes the responsibility to navigate quality extraction methods, and therapeutic appropriateness with discernment. Understanding the pharmacological actions of their active constituents, as well as the critical role of dual extraction and fruiting body sourcing, ensures we uphold the integrity of our herbal prescribing.
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