Natural Standard Monograph (www.naturalstandard.com) Copyright © 2010. Synonyms/Common Names/Related Substances: Acid protease, Chi zhi, coumarin, Enhanvol®, ergosterol, fungal lysozyme, fungus, fu zhen herb, ganoderic acids, Ganoderma lucidum, Ganoderma tsugae extract, Ganopoly®, he ling zhi, holy mushroom, hong ling zhi, ling chi, ling chih, ling zhi (Chinese), ling zhi-8, linzhi extract, mannentake, mannitol, mushroom, mushroom of immortality, mushroom of spiritual potency, polysaccharides peptide, rei-shi, shiitake, spirit plant, sterols, Sunrecome®, triterpenoids, triterpene, varnished polypore, young ji, zi zhi. Combination product examples: PC-SPES (baikal skullcap, chrysanthemum, ganoderma, isatis, licorice, Panax ginseng, Isodon rubescens and saw palmetto); Echinacea/Astragalus/Reishi formula.

	Reishi mushroom (Ganoderma lucidum), also known as ling zhi in China, grows wild on decaying logs and tree stumps. Reishi occurs in six different colors, but the red variety is most commonly used and commercially cultivated in East Asia and North America.
	Ganoderma lucidum has been used in traditional Chinese medicine for more than 4,000 years to treat liver disorders, hypertension, arthritis and other ailments. In modern times, the available data from human trials together with evidence from animal studies suggest that Ganoderma lucidum may have some positive benefits for cancer patients, as well as patients with liver disease. However, available information on the number of trials and patients enrolled is very limited. Other promising uses for which there is still inconclusive evidence include diabetes, heart disease, pain, Russula subnigricans poisoning, hypertension, mushroom poisoning, proteinuria, postherpetic neuralgia, and arthritis.
	Reishi is currently regulated in the United States as a dietary supplement. It is also included in the 2000 Pharmacopoeia of the People's Republic of China as an agent approved for treatment of dizziness, insomnia, palpitations, shortness of breath, and cough and asthma. At this time, high-quality clinical trials supporting the efficacy of reishi mushroom for any indication are lacking in the available literature.

Indication Evidence Grade Arthritis C Cancer C Chronic hepatitis B C Coronary heart disease C Diabetes mellitus type 2 C Hypertension C Poisoning (Russula subnigricans) C Postherpetic neuralgia C Proteinuria C

Adaptogen, altitude sickness (treatment or prevention), angina pectoris, anti-aging, anticonvulsive, anti-inflammatory, antioxidant, anti-platelet effects, antiviral, asthma, blood cleanser, bronchitis, cardiovascular disease, cough, Epstein-Barr virus, fatigue, herpes simplex virus infection (1), high cholesterol, HIV (2), immune system enhancement, insomnia, leukemia (3; 4; 5), leukopenia, lipid lowering (high triglycerides), liver disorders (hepatopathy), lymphoma (6), muscular dystrophy, myasthenia gravis, nephritis, neurasthenia (nerve weakness, nervous exhaustion), neuromuscular disorders (atrophic myotonia) (7), poisoning (general), tension, ulcers.

	The reishi mushroom is a derivative of the Far East with its usage dating back to Ancient China. Ancient Chinese and Japanese shamans have held reishi in high regard. They believed reishi has the power to prolong healthy existence and maintain calmness during meditation. Royalty considered it a precious mushroom and used it in the hopes of obtaining immortality and promoting calmness and thought. Chinese medicine now includes therapy with reishi for fatigue, asthma, insomnia, and cough.
	Some experts believe that Ganoderma lucidum promotes longevity and maintains vitality of the human body. Reishi's primary benefit appears to be its immunomodulating action, improvement of liver function, and improvement and restoration of normal respiratory system functioning. In the 16th Century Pharmacopoeia Ben Cao Gang Mu, reishi was described as being able to affect the life energy (qi) of the heart, repair the chest area, increase intellectual capacity, and improve memory.
	Reishi is believed to reduce high blood pressure and cholesterol levels, and has anti-platelet aggregation effects, which may make it useful in coronary heart disease treatment and prevention. It is also believed that Ganoderma lucidum has antioxidant effects, which may contribute to the overall well being of patients.
	Reishi is not currently listed as GRAS (generally regarded as safe).

	Likely safe: When used orally in recommended doses for 12 weeks in both healthy volunteers (8; 9) and patients with cancer (10; 11).
	Possibly safe: When used by patients with proteinuria for up to 26 months (12; 13; 14).
	Possibly unsafe: When used in patients with bleeding disorders/coagulopathies or in those taking anticoagulants, as reishi mushroom may alter platelet aggregation and thus, prolong bleeding time (15). When used in patients with gastrointestinal bleeding, ulcers, low blood pressure, diabetes, or in those taking antidiabetic agents or antihypertensives.
	Likely unsafe: When used in patients with allergy/hypersensitivity to reishi mushroom, as it has been known to trigger a hypersensitivity reaction and should be avoided in susceptible patients. When used during pregnancy and lactation, due to unknown pharmacological effects.

Recommended doses are based on those most commonly used in available trials, or on historical practice. However, with natural products it is often not clear what the optimal doses are to balance efficacy and safety. Preparations of products may vary from manufacturer to manufacturer, and from batch to batch within one manufacturer. Because it is often not clear what the active components of a product are, standardization may not be possible, and the clinical effects of different brands may not be comparable.

	Standardization of extracts may not be clinically relevant in predicting effectiveness, as the active ingredient in Ganoderma lucidum has not been fully determined. However, the dose of Ganoderma lucidum is often based on its content of polysaccharide peptides and triterpenes. These doses can be extracted from spores or the whole fruiting body preparation.
	The New Zealand product Ganopoly®, used in some clinical trials, contains 600mg extract of Ganoderma lucidum per capsule, with 25% (w/w) crude polysaccharides, which is equivalent to 30g fruiting body of Ganoderma lucidum (11).
	Oral doses of 150-300mg three to four times daily have been standardized to contain 10-12.5% polysaccharides and 4% triterpenes per dose.

	General: Doses of 2-6g raw reishi or an equivalent dosage of concentrated extract has been taken daily with meals.
	Cancer: Doses of 600-1,800mg reishi mushroom as Ganopoly® has been taken three times daily for up to 12 weeks (10; 11; 16).
	Chronic hepatitis B: Ganopoly® has been taken three times daily (dose unavailable) for 12 weeks (17).
	Coronary heart disease: Ganopoly® has been taken three times daily (dose unavailable) for 12 weeks (18).
	Diabetes: A dose of 1,800mg Ganopoly® has been taken three times daily for 12 weeks (19).
	Hypertension: A clinical trial reported using linzhi extract (reishi) in daily doses of 55mg for four weeks (20).
	Poisoning (Russula subnigricans): A dose of 100g reishi mushroom has been boiled in 600mL water per dose (21).
	Postherpetic neuralgia: In clinical reports of reishi used in pain management for herpes zoster (shingles), reishi has been administered in doses from 36-72g dry weight in three divided doses daily for up to 10 days (22).
	Proteinuria: Doses of 500-1,125mg reishi mushroom has been taken daily for up to 26 months (12; 13; 14).

Injectable reishi has been used in China with no clear indication of dosing.

Insufficient available evidence.

	In 2004, Ganoderma lucidum (ling zhi) mushroom powder was first described to have hepatotoxic effects in a patient from Hong Kong (23). In 2005, a fatal case of fulminant hepatitis was linked to reishi mushroom powder. Both patients had taken other therapeutic agents and traditionally boiled ling zhi without any toxic effects. After switching to ling zhi in powder form for 1-2 months, the hepatotoxic episode occurred in both patients.
	An in vitro study conducted on oral cancer and normal cells, determined the ID50 of Ganoderma lucidum to be about 3mg/mL and the total lethal dosage was beyond 4mg/mL (24).
	An in vitro study conducted in mice to evaluate the genotoxicity of the extract of 220g of fresh Ganoderma fruit body/kg body weight produced no evidence for genotoxic chromosomal breakage nor cytotoxic effects by Ganoderma extract (25).
	Secondary sources have reported that the LD50 of an intraperitoneal injection of an undefined reishi preparation in mice is 38.3 ± 1.048g/kg.

	Known allergy/hypersensitivity to reishi mushroom (Ganoderma lucidum), any of its constituents, or other members of its family.
	Skin reactivity to spore and whole body extracts of reishi mushroom have been reported (26).

	General: Acute and long-term studies have found Ganoderma lucidum to be generally well tolerated in recommended doses for up to 16 months (8; 9; 10; 11; 12; 13; 14; 16; 17; 18; 19; 27). The small number of human trials compiled has not yielded significant adverse effects, as good tolerance was reported. The most common adverse events reported are skin rash, dizziness, and headaches.
	Cardiovascular: Hypotension may occur upon utilization of reishi and its derivatives (28).
	Dermatologic: There have been reports that patients ingesting reishi mushroom have developed dermatitis, pruritus, and skin rash. Skin reactivity to spore and whole body extracts of reishi mushroom has also been reported (26).
	Endocrine: PC-SPES, a combination of eight herbs, including reishi, caused breast tenderness in all eight patients being treated for prostate cancer (29). Theoretically, reishi alone may have similar adverse effects, but there is currently a lack of evidence supporting this.
	Gastrointestinal: Due to blood-thinning capabilities, gastric bleeding may be precipitated by the use of reishi (15). Mild gastrointestinal discomfort including nausea and diarrhea was found in a small percentage of cancer patients taking Ganoderma lucidum as Ganopoly® (11; 16). Reishi may also cause diarrhea and bloody stools. Hepatic: In 2004, Ganoderma lucidum (ling zhi) mushroom powder was first described to have hepatotoxic effects in a patient from Hong Kong (23). In 2005, a fatal case of fulminant hepatitis was linked to reishi mushroom powder. Both patients had taken other therapeutic agents and traditionally boiled ling zhi without any toxic effects. After switching to ling zhi in powder form for 1-2 months, the hepatotoxic episode occurred in both patients.
	Hematologic: Theoretically, reishi may have an effect on bleeding time due to the inhibition of platelet aggregation (15). Combination product PC-SPES caused venous thrombosis in one out of eight patients being treated for prostate cancer (29).
	Musculoskeletal: Bone pain has been anecdotally reported with use of reishi supplement.
	Neurologic/CNS: Dizziness and light-headedness have been reported likely due to the hypotensive properties of reishi (30). PC-SPES, an herbal combination of eight herbs, caused loss of libido in all eight patients being treated for prostate cancer (29). Insomnia was reported in one lung cancer patient taking Ganoderma lucidum in a 12-week trial (11).
	Pulmonary/Respiratory: Secondary sources have reported hypersensitivity reactions to reishi and its derivatives, including dry mouth, nosebleed, and nasal and throat dryness.

	Avoid in patients with known allergies to reishi mushroom (Ganoderma lucidum), any of its constituents, or other members of its family.
	Use cautiously in patients with diabetes or in those taking hypoglycemic agents because reishi may lower blood sugar levels (31; 32).
	Use cautiously in patients with blood disorders, such as thrombocytopenia or in patients who are taking anticoagulants or antiplatelets, such as warfarin (Coumadin®), due to the apparent anticoagulative effects of reishi (15). Reishi may precipitate an additive effect on clotting factors and prolongation of prothrombin time. Theoretically, patients with tendency for bleeding should be cautious when taking reishi, although human data are currently lacking.
	Use cautiously in patients taking amphetamines, as this combination may theoretically result in an antagonistic effect.
	Use cautiously in patients with a history of hypotension or patients receiving therapy for hypertension due to the theoretical hypotensive properties exhibited by reishi (30).
	Use cautiously in patients with liver disorders or in those taking hepatotoxic agents, as this may theoretically increase the risk of liver damage (23). However, another hepatoprotectant study performed in rats showed that extracts from reishi reduced free radicals that harm the liver (33).
	Use cautiously in patients with gastric ulcers and active gastrointestinal bleeding due to the apparent anticoagulant effects of reishi (15).

Not recommended due to lack of sufficient data. Information of reishi's effects on lactation is currently lacking in the National Institute of Health's Lactation and Toxicology Database.

	Adenosine: Reishi mushroom contains high levels of adenosine (34).
	Analgesics: Theoretically, reishi mushroom may increase the effects of analgesics. Reishi mushroom plus the traditional Chinese medicine (TCM) herbal combination formula, San Miao San (SMS), was reported to reduce pain in patients with active rheumatoid arthritis when taken in combination with standard arthritis medications (35). However, these effects cannot be definitively attributed to reishi mushroom because other herbs were also taken.
	Anesthetics: Based on secondary sources, reishi mushroom may interact with anesthetics.
	Antibiotics: Based on in vitro evidence, reishi mushroom and cefazolin may have synergistic effects against Bacillus subtilis and Klebsiella oxytoca (36); the combination of Ganoderma lucidum with ampicillin, cefazolin, oxytetracycline and chloramphenical may also have additive, antasgonistic or synergistic interactions (36).
	Anticoagulants and antiplatelets: Based on laboratory evidence, reishi may affect platelet aggregation (15). Reishi mushroom contains high levels of adenosine, which may be responsible for inhibition of platelet aggregation (34; 37), but there is controversy in this area. Concomitant therapy with reishi and anticoagulants or NSAIDs may theoretically lead to additive effects or increased risk of bleeding due to potential prolongation of prothrombin time.
	Antidiabetic agents: Based on animal evidence, reishi may reduce blood sugar levels and increase insulin levels (31; 32).
	Antihypertensive drugs: Based on animal study, mycelium isolated from reishi mushroom (28) and a peptidoglycan of reishi (38) may have hypotensive effects. In laboratory study, the 70% MeOH extract of Ganoderma lucidum demonstrated an inhibitory activity on angiotensin converting enzyme (39).
	Antilipemic agents: In laboratory study, reishi can inhibit the rate-limiting enzyme HMG-CoA in cholesterol biosynthesis (40).
	Antineoplastic agents: Based on in vitro and animal studies, reishi mushroom may theoretically increase the effects of antineoplastic agents (3; 4; 5; 8; 9; 10; 11; 24; 30; 41; 42; 43; 44; 45; 46; 46; 47; 48; 49; 50; 51; 52; 53; 54; 55; 56).
	Antiretroviral agents, protease inhibitors: Based on laboratory evidence, triterpenes isolated from Ganoderma lucidum may inhibit HIV or HIV protease (2; 57).
	Antiviral agents: Based on laboratory evidence, the acidic protein bound polysaccharide (APBP) isolated from capophores of Ganoderma lucidum may have synergistic effects when administered with acyclovir (58).
	Aspirin/aspirin-containing drugs: Based on laboratory evidence, reishi may affect platelet aggregation (15); adjustments may be necessary if the patient is receiving therapy aspirin.
	Cardiovascular agents: Based on animal study, mycelium isolated from reishi mushroom (28) and a peptidoglycan of reishi (38) may have hypotensive effects. In laboratory study, the 70% MeOH extract of Ganoderma lucidum demonstrated an inhibitory activity on angiotensin converting enzyme (39).
	CNS stimulants: Theoretically, use of reishi and amphetamines may result in an antagonistic effect.
	Hepatotoxic agents: Theoretically, the risk of liver damage may increase when reishi mushroom powder is taken with drugs that are known to damage the liver (23). However, another hepatoprotectant study performed in rats showed that extracts from reishi-reduced free radicals that harm the liver (33)
	Immunomodulators: Based on in vitro animal evidence, Ling zhi-8 may be a potent immunosuppressive drug in vitro able to delay rejection in allogeneic pancreatic islet transplantation (59).
	Neurologic agents: Ganoderma lucidum spore preparations have been used in patients with atrophic myotonia (7). Based on secondary sources, use of reishi and amphetamines may result in an antagonistic effect.
	Thyroid hormones: Based on secondary sources, reishi mushroom may interact with thyroid agents.

	Analgesics: Theoretically, reishi mushroom may increase the effects of analgesics. Reishi mushroom plus the traditional Chinese medicine (TCM) herbal combination formula, San Miao San (SMS), was reported to reduce pain in patients with active rheumatoid arthritis when taken in combination with standard arthritis medications (35). However, these effects cannot be definitively attributed to reishi mushroom because other herbs were also taken.
	Anesthetics: Based on secondary sources, reishi mushroom may interact with anesthetics.
	Antibacterials: Based on in vitro evidence, reishi mushroom and antibiotics, such as cefazolin, may have synergistic effects against Bacillus subtilis and Klebsiella oxytoca (36); interactions with herbs and supplements with antibacterial effects may be additive, synergistic or antagonistic.
	Anticoagulants and antiplatelets: Based on laboratory evidence, reishi may affect platelet aggregation (15). Reishi mushroom contains high levels of adenosine, which may be responsible for inhibition of platelet aggregation (34; 37), but there is controversy in this area. Concomitant therapy with reishi and anticoagulants or NSAIDs may theoretically lead to additive effects or increased risk of bleeding due to potential prolongation of prothrombin time.
	Antilipemics: In laboratory study, reishi can inhibit the rate-limiting enzyme HMG-CoA in cholesterol biosynthesis (40).
	Antineoplastics: Based on in vitro and animal studies, reishi mushroom may theoretically increase the effects of antineoplastic agents (3; 4; 5; 8; 9; 10; 11; 24; 30; 41; 42; 43; 44; 45; 46; 46; 47; 48; 49; 50; 51; 52; 53; 54; 55; 56).
	Antivirals: Based on laboratory evidence, the acidic protein bound polysaccharide (APBP) isolated from capophores of Ganoderma lucidum may have synergistic effects when administered with acyclovir (58).
	Cardiovascular herbs and supplements: Based on animal study, mycelium isolated from reishi mushroom (28) and a peptidoglycan of reishi (38) may have hypotensive effects. In laboratory study, the 70% MeOH extract of Ganoderma lucidum demonstrated an inhibitory activity on angiotensin converting enzyme (39).
	CNS stimulants: Theoretically, use of reishi and amphetamine-like herbs or supplements may result in an antagonistic effect.
	Hepatotoxic agents: Theoretically, the risk of liver damage may increase when reishi mushroom powder is taken with drugs that are known to damage the liver (23). However, another hepatoprotectant study performed in rats showed that extracts from reishi reduced free radicals that harm the liver (33).
	Hypoglycemics: Based on animal evidence, reishi may reduce blood sugar levels and increase insulin levels (31; 32).
	Hypotensives: Based on animal study, mycelium isolated from reishi mushroom (28) and a peptidoglycan of reishi (38) may have hypotensive effects. In laboratory study, the 70% MeOH extract of Ganoderma lucidum demonstrated an inhibitory activity on angiotensin converting enzyme (39).
	Immunosuppressants: Based on in vitro animal evidence, Ling zhi-8 may be a potent immunosuppressive drug in vitro able to delay rejection in allogeneic pancreatic islet transplantation (59).
	Neurologic herbs and supplements: Ganoderma lucidum spore preparations have been used in patients with atrophic myotonia (7). Based on secondary sources, use of reishi and amphetamines may result in an antagonistic effect.
	Selenium: Reishi may contain up to 72mcg selenium per gram (dry weight) (60).
	Stimulants: Based on secondary sources, use of reishi and amphetamine-like herbs or supplements may result in an antagonistic effect.
	Thyroid agents: Based on secondary sources, reishi mushroom may interact with thyroid agents.

Insufficient available evidence.

	Blood glucose: Reishi reduced blood sugar levels and increased insulin levels in mice (31; 32).
	Blood pressure: Based on an animal study, mycelium isolated from reishi mushroom (28) and a peptidoglycan of reishi (38) may have hypotensive effects. A 70% MeOH extract of Ganoderma lucidum demonstrated an inhibitory activity on angiotensin converting enzyme (39).
	Prothrombin time/INR (International Normalized Ratio): Theoretically, the effect of reishi on platelet aggregation (15) could increase bleeding time.

Glucose: Reishi reduced blood sugar levels and increased insulin levels in mice (31; 32).

	Constituents: Constituents of Ganoderma lucidum with proposed or demonstrated pharmacological activity include lanostanoids (61), lectins (62), steryl esters and steroids (44), polysaccharides, and triterpenes (57; 63; 64). The fruit body of Ganoderma lucidum contains ergosterol, fungal lysozyme, and acid protease (65). The major active constituents found in reishi are polysaccharides and triterpenoids, which contain ganoderic acids. Other constituents include sterols, coumarin, and mannitol.
	Analgesic effects: Reishi mushroom plus the traditional Chinese medicine (TCM) herbal combination formula, San Miao San (SMS), was reported to reduce pain in patients with active rheumatoid arthritis when taken in combination with standard arthritis medications (35). Fifteen percent of patients who received this herbal combination achieved the American College of Rheumatology (ACR) 20% response compared to 9.1% in the placebo group (p>0.5). Pain score and patient's global score improved significantly only in the TCM group. However, these effects cannot be attributed to reishi mushroom because it was used in combination with other herbs.
	Antiviral/antiretroviral effects: Substances from Ganoderma lucidum have been shown to inhibit herpes simplex virus type 1 & 2 (1) and Epstein-Barr Virus (66). In laboratory study, isolated ganoderic acid alpha from Ganoderma lucidum was a moderately active inhibitor against HIV-1, with a 50% inhibitory concentration of 0.17-0.23mM (2). In another study, ganolucidic acid A showed significant anti-human immunodeficiency virus-1 protease activity with IC50 values of 20-90mcM (57).
	Cardiovascular effects: In a study conducted on rabbits and rats, mycelium was isolated from reishi mushroom (28). The extract decreased diastolic and systolic blood pressure, which was accompanied by an inhibition of renal efferent sympathetic nerve activity. The extract did not result in a decreased heart rate although there was clear hypotension in a dose dependent manner. This led to the theory that the decrease in blood pressure from reishi may be attributed to the sympatholytic activity of mycelium on the central nervous system. Ganoderma lucidum extract was also found to have an inhibitory effect on angiotensin converting enzyme, theoretically yielding a decrease in blood pressure due to vasodilation (39). ACE inhibitory activity is thought to be due to terpenes, such as ganoderic acid B, D, F, H, K, S, and Y, and the triterpenes ganoderal A, and ganoderols A and B (38; 39).
	Chemoprotective/anti-tumor effects: Numerous in vitro studies have found that Ganoderma lucidum inhibited tumor cell growth (3; 3; 24; 41; 42; 43; 44; 45; 46; 47; 53; 67). In vivo animal studies also demonstrated potential anticancer effects of Ganoderma lucidum. It possibly works through multiple mechanisms including:
	Antioxidation: Ganoderma lucidum has been shown to induce glutathione-s-transferase activity (48). It was also found to inhibit iron-induced lipid peroxidation in rat brain homogenates and showed a dose-dependent inactivation of hydroxyl radicals and superoxide anions (8; 9; 30).
	Apoptosis induction: Extracts from Ganoderma lucidum have been shown to induce apoptosis (4) by increasing the activity of caspase-3 (49), or by up-regulating pro-apoptotic Bax protein (50; 51).
	Cytokine induction: Polysaccharides isolated from Ganoderma lucidum were shown to induce cytokines (tumor necrosis factor-alpha) in vitro, comparable to other cancer treatment drugs (4; 68). It also up-regulated interleukin 1 (4; 55) and interleukin 6 (4) secretion in macrophage cells. A clinical study has demonstrated that 12 weeks of reishi mushroom administration increased plasma levels of IL-2, IL-6, interferon-gamma and natural killer activity and decreased levels of IL-1 and TNF-alpha in 34 patients with advanced cancers (10; 11).
	Inhibition of cancer cell proliferation or growth: Ganoderma lucidum has been shown to directly inhibit migration and motility of invasive breast and prostate cancer cells (5; 46; 47; 50; 51; 52; 53; 54).
	Other mechanisms: Apoptosis inhibition (55), anti-angiogenesis (41), anti-inflammation (49), enhanced neutrophil phagocytosis, and chemotaxis (56).
	Endocrine effects: Results from a study on glycan ganoderan B of Ganoderma lucidum fruit bodies indicate that ganoderan B increased the plasma insulin level in normal and glucose-loaded mice but elicited no effect on insulin binding to isolated adipocytes (31).
	Hematological effects: Laboratory, animal, in vivo and in vitro studies suggest an effect on platelets, although there is a lack of consensus in this area. A study using gel chromatography showed that a water-soluble fraction of Ganoderma lucidum suppressed platelet aggregation (69). A study conducted on HIV-positive hemophiliacs showed that crude extracts of Ganoderma lucidum did not have any untoward antiplatelet effect in vivo despite the high contents of adenosine (34). Ganodermic acid S isolated from Ganoderma lucidum exhibited inhibitory effects on platelet responses to various aggregating agonists (70), suggesting that ganodermic acid played a role in potentiating the prostaglandin E induced cyclic AMP synthesis and together additively inhibited the platelet response to collagen. In animal study, aqueous extracts of Ganoderma lucidum collected in Kyoto prevented the decreases of blood platelet and fibrinogen, the prolongation of prothrombin time and the increase of fibrin degradation products at a dose of 500mg/kg in normal rats on disseminated intravascular coagulation induced by endotoxin; Ganoderma lucidum collected in Odawara prevented the decrease of blood platelet at a dose of 500mg/kg and both prevented the formation of hepatic vein thrombosis induced by endotoxin in hyperlipidemic rats (71). Ling Zhi-8 (LZ-8), a protein purified from Ganoderma lucidum, also has exhibited potent mitogenic effects on human peripheral blood lymphocytes (72).
	Hepatic effects: Polysaccharides isolated from reishi yielded a decrease in serum aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase, total bilirubin, and also reduced the collagen content in the liver. The inhibition of collagen is not fully understood, but the results provide supportive evidence for reishi's hepatoprotectant ability (73). Another hepatoprotectant study performed in rats showed that extracts from reishi reduced free radicals that harm the liver (33). Chloroform toxicity in the rats was dramatically decreased upon induction of a water extract of reishi, which was evident by the effect of reishi extracts on the levels of glutamic oxaloacetic transaminase and lactic dehyrodenase in the serum. Ganoderan B, a glycan of Ganoderma lucidum fruit bodies, reduced glycogen content in the liver but had no influence on total cholesterol and triglyceride levels in the plasma and liver (31).
	Immunologic effects: The immunological effects of reishi have been documented in animal, in vivo and in vitro studies. Ling Zhi improved the survival rate of lupus mice, decreased the amount of proteinuria, decreased serum levels of anti-ds DNA autoantibody, and showed evidence of decreased parenchyma mononuclear cell and perivascular cell infiltration in vital organs (74). Ling zhi was a potent immunosuppressive drug in vitro and was able to delay rejection in allogeneic pancreatic islet transplants in rats (59; 75). Reishi mushroom, plus the traditional Chinese medicine (TCM) herbal combination formula, San Miao San (SMS), did not affect the percentage, absolute counts, and CD4+/CD8+/natural killer/B lymphocytes ratio in patients with rheumatoid arthritis when compared to placebo (35). CD3, CD4, and CD8 lymphocyte counts and markers of inflammation, including plasma interleukin-18 (IL-18), interferon-gamma (IFNgamma)-inducible protein 10, monocyte chemoattractant protein 1, monokine induced by IFNgamma, and RANTES were unchanged. However, in an ex vivo experiment, the percentage change of IL-18 was significantly lower in the TCM group.
	Lipid-lowering effects: Triterpenes are thought to be responsible for the inhibition of cholesterol absorption and inhibition of cholesterol synthesis. Cholesterol biosynthesis is inhibited by the rate-limiting enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA). Oxygenated triterpenes are inhibitors of HMG-CoA in vitro. Ganodermic acid, a terpene, and its derivatives, especially sterol VI, potently inhibited cholesterol synthesis at the step containing (24,25-(3)H)-24,25-dihydrolanosterol (40).
	Platelet effects: Based on laboratory evidence, reishi affects platelet aggregation (15). Reishi mushroom contains high levels of adenosine, which may be responsible for inhibition of platelet aggregation (34; 37), but there is controversy in this area. The triterpene, ganodermic acid S, may play a role as it is able to stimulate platelet aggregation at concentrations greater than 20mM (76; 77; 78).

Insufficient available evidence.

	Reishi mushroom was only introduced to the Western world within the past 30 years. Of the many known species, only six (red, black, blue, white, yellow, and purple reishi) have been investigated for their potential health benefits. The black and especially the red reishi mushroom (Ganoderma lucidum) have demonstrated the most significant health-enhancing effects.
	Reishi mushroom has traditionally been used as an anti-aging herb to treat many diseases and disorders. In traditional Chinese medicine, this mushroom is valued as the "elixir of immortality" and is claimed to promote calmness, centeredness, balance, and inner awareness and strength. In the Orient, reishi is considered a Fu Zhen herb, meaning that it is believed to have immune modulating properties. Presently, reishi is being used to treat numerous conditions with varying degrees of effectiveness.
	In 2004, the Food and Drug Administration (FDA) reviewed the website for Far East Ginseng Herbs and Tea and found the product "Wild Ling Zhi - Reishi Mushroom" (among others) were promoted for conditions that cause the products to be drugs under section 201(g)(1) of the Federal Food, Drug, and Cosmetic Act (the Act) [21 USC 321(g)(1)], and the marketing of these products with these claims violated the Act.

Condition Study Design Author, Year N Statistically Significant? Quality of Study 0-2=poor 3-4=good 5=excellent Magnitude of Benefit ARR NNT Comments Cancer Randomized, controlled trial Gao, 2003b 68 Yes 2 Medium 35.7% (Karnofsky score) 3 600mg Ganopoly® 3 times daily for 12 weeks vs. placebo. Cancer Clinical trial Gao, 2002b 143 NA 1 Small NA NA 1,800mg Ganopoly® 3 times daily for 12 weeks. Cancer Case series Gao, 2003a 34 Yes 1 Medium NA NA 1,800mg Ganopoly® 3 times daily for 12 weeks. Chronic hepatitis B Randomized, controlled trial Gao, 2002a 90 Yes 2 Medium 21% (reduce HBV DNA) 5 Ganopoly® for 12 weeks vs. placebo. Coronary heart disease Randomized, controlled trial Gao, 2004a 170 Yes 2 Medium 17% (decrease abnormal ECG) 6 Ganopoly® for 12 weeks vs. placebo. Diabetes mellitus type 2 Randomized, controlled trial Gao, 2004b 71 Yes 1 Small NA NA 1,800mg Ganopoly® 3 times daily for 12 weeks vs. placebo. Hypertension Randomized, controlled, double-blind trial Jin, 1996 54 Yes 4 Large NA NA Relatively short-term study, 4 weeks. Significant decrease in blood pressure was seen after 2 weeks of administration. Hypertension Clinical trial Kanmatsuse, 1985 53 Yes 2 Moderate NA NA Study consisted of moderate and high hypertensive subjects. Poisoning (Russula subnigricans) Case series Xiao, 2003 25 NA NA NA NA NA Ganoderma lucidum 100g decocted with water to 600mL was used. Postherpetic neuralgia Case series Hijikata, 1998 4 NA NA NA NA NA Ganoderma lucidum 36 to 72g dry weight daily. Proteinuria Case series Futrakul, 2002 10 NA NA NA NA NA Ganoderma lucidum 750-1,100mg daily plus vasodilators vs. vasodilators alone.

Summary: A combination of reishi mushroom and San Miao San (SMS, a mixture of several Chinese herbs) may help reduce the pain of rheumatoid arthritis. However, these herbs did not reduce swelling. More research with reishi mushroom as a monotherapy is needed.

Evidence: Li et al. conducted a randomized, controlled trial to determine if reishi mushroom, plus the traditional Chinese medicine (TCM) herbal combination formula, San Miao San (SMS), has various health benefits, including antioxidant properties, in rheumatoid arthritis (RA) patients (35). Sixty-five patients with active RA, despite treatment with disease-modifying antirheumatic drugs, were included in the study. Thirty-two patients were randomly assigned to receive 4g of reishi mushroom and 2.4g of SMS daily in addition to their current medications for 24 weeks. Thirty-three subjects were assigned to placebo in addition to their current medications for 24 weeks. A total of 13 patients (14 in the placebo group and eight in the TCM group) reported 22 episodes of mild adverse effects during the study. The primary outcome measure was the number of patients who achieved the American College of Rheumatology (ACR) 20% response. Secondary outcomes included changes in the ACR components, plasma levels, and ex vivo-induced cytokines and chemokines and oxidative stress markers. Eighty-nine percent of the subjects completed the entire study. In the TCM group, 15% achieved ACR20, compared to 9.1% in the placebo group (p>0.5). Pain score and patient's global score improved significantly only in the TCM group. The percentage, absolute counts, and CD4+/CD8+/natural killer/B lymphocytes ratio were unchanged between groups. CD3, CD4, and CD8 lymphocyte counts and markers of inflammation, including plasma interleukin-18 (IL-18), interferon-gamma (IFNgamma)-inducible protein 10, monocyte chemoattractant protein 1, monokine induced by IFNgamma, and RANTES were unchanged. However, in an ex vivo experiment, the percentage change of IL-18 was significantly lower in the TCM group. The authors concluded that reishi mushroom plus SMS may help reduce pain in patients with active RA. The treatment was generally considered safe and well tolerated. However, no significant antioxidant, anti-inflammatory, or immunomodulating effects were observed. Because reishi mushroom was combined with other herbs, these effects cannot be conclusively attributed to reishi mushroom.

	Summary: Reishi has been shown to have antineoplastic and immunomodulatory effects in animal studies. Three human trials have been done in advanced cancer patients using Ganopoly®, a Ganoderma lucidum polysaccharide extract. One was a randomized controlled trial, while the other two were case series. All the patients treated with Ganopoly® showed improved quality of life and enhanced immune responses, which are typically reduced or damaged in cancer patients receiving chemotherapy and/or radiation therapy. In two studies, the patients' quality-of-life was also improved. All three studies were done by the same group of authors who are affiliated or closely related with the manufacturer of Ganopoly®. All three studies were conducted for only 12 weeks, so long-term studies are needed to evaluate the effectiveness of Ganopoly®, as well as the side effects. More randomized, controlled trials using a larger patient size are also needed to obtain a comparison between Ganopoly® and placebo.
	Evidence: A randomized, double-blind, placebo controlled trial using Ganopoly® was conducted in 68 patients with advanced lung cancer (11). One capsule of Ganopoly® (Ganoderma lucidum polysaccharide extract) contains 600mg, which equals 30g fruiting body of Ganoderma lucidum. The study found that after Ganopoly® 600mg three times daily oral administration, 35.1% lung cancer patients had stable disease at the 12-week evaluation point, which was significantly greater than that of the control group (22.6%). Treatment with Ganopoly® resulted in a significant increase (>10 scores) in the Karnofsky performance scores (a method measuring patients performance of activity of daily living) in 50.0% of patients compared with 14.3% in the control group. Immune responses (e.g., lymphocyte mitogenic reactivity to concanavalin A, CD3 percentage, and natural killer cell activity) were significantly increased in Ganopoly®, but not placebo, treated cancer patients. Only mild side effects of nausea and insomnia were recorded in patients receiving Ganopoly®. The study results suggested that Ganopoly® may have an adjunct role in the treatment of patients with advanced lung cancer. However, further long-term studies with larger patient size are needed to find the optimal dosing, efficacy, and safety of Ganopoly®. Moreover, it is better ethically, as well as methodologically, to compare the effect of Ganopoly® with or without chemotherapy/radiotherapy or other immunotherapies in late-stage cancer patients.
	Gao et al. conducted a clinical trial to evaluate the efficacy and safety of Ganopoly® in patients with advanced cancer (16). One hundred forty-three patients with advanced, previously treated cancer were enrolled. Eligibility criteria included confirmation of diagnosis, objectively measurable disease, Eastern Cooperative Oncology Group performance status of 0-2, life expectancy of 12 weeks or greater, no recent or concomitant anticancer therapy, and informed consent. Patients underwent evaluation of the extent of disease, quality of life, hematologic, biochemical, and selected immune function studies at baseline and after six and 12 weeks of Ganopoly® therapy. Standard criteria were used to evaluate adverse events and response. Ganopoly® was given orally at 1,800mg three times daily. Twenty-seven patients were not assessable for response and toxicity because they were lost to follow-up or refused further therapy before 12 weeks of treatment. Of the 100 fully assessable patients, 46 patients (32.2%) had progressive disease (PD) before or at the six-week evaluation point (range, five days-six weeks). Sixteen patients (11.2%) developed PD between six and 12 weeks of therapy. No objective (partial or complete) responses were observed, but 38 of 143 patients (26.6%) had stable disease (SD) for 12 weeks or more (range, 12-50 weeks). There was no significant change in the FACT-G scores in 85 assessable patients. However, palliative effects on cancer-related symptoms, such as sweating and insomnia, have been observed in many patients. In the group of patients with SD, FACT-G scores improved in 23 patients, were unchanged in five patients, and declined in one patient. Within this group, the median change from the baseline score to the 6- and 12-week score was +7.6 and +10.3 score, both statistically significant (p<0.05). No significant changes of the selected immune function parameters were observed in 75 assessable patients. However, in the group of 32 patients with SD for 12 weeks or more, Ganopoly® significantly increased lymphocyte mitogenic reactivity to concanavalin A and phytohemagglutinin by 28 ± 7.3% (p<0.05) and significantly enhanced natural killer cell activity by 25 ± 5.9% (p<0.05). Five adverse events (grade 1) were recorded, three of which were gastrointestinal (nausea, 2; diarrhea, 1). The results indicate that Ganopoly® may have an adjunct role in the treatment of patients with advanced cancer, although objective responses were not observed in this study. It is unclear whether the stable disease states were the result of less advanced stages of cancer or the result of treatment benefits.
	In a case series, thirty-four patients with advanced-stage cancers from lung, breast, liver, colon, prostate, bladder, or brain were treated with 1,800mg of oral Ganopoly® three times daily before meals for 12 weeks (10). Cytokines, T-cell subsets, and natural killer cell activity were measured to assess the effects of Ganopoly®. Researchers found a significant increase in T-cell populations and NK cell activity at the 12-week period compared to baseline although the mechanism is unclear. Ganopoly® also increased natural killer cell activity to 34.5% compared with 26.6% at baseline. Baseline characteristics of patients were well presented in a table. It is noteworthy that three patients had cancer of unknown origin, raising the question of proper diagnosis. Unfortunately, the change of immune parameters was not categorized according to either tumor origins or sites affected or prior treatments. The study could be improved if placebo or standardized treatments were included as controls. Evaluation of clinical response and toxic effects were still ongoing. It is also noteworthy that patients included in this study would not have other anticancer treatment for a total 20-24 weeks, which raises an ethical issue.

Summary: Based on in vitro evidence, a clinical trial using Ganopoly® or placebo was conducted in chronic hepatitis B patients. Ganopoly® treatment decreased the level of hepatitis B virus (HBV) DNA. Levels of HbeAg were also reported to have decreased, and since HbeAg is usually reported as either positive or negative, a decrease may suggest HBeAg changes from positive to negative. This study was well designed. However, the small patient size and short duration of treatment and follow-up grant this study less value; chronic hepatitis B is a chronic viral infection that may need to be studied for a longer period. The virus is also notoriously hard to clear from the body and recurrence after treatment is common. Additionally, the affiliation of authors to the manufacturer of the drug is noteworthy.

Evidence: A randomized, placebo controlled, multicenter study (16) was conducted in 90 chronic hepatitis B patients (17). Ganopoly® (dose unknown) or placebo was used for 12 weeks, and then followed-up for 13 weeks. Ganopoly® treatment reduced the HBV DNA level in 25% patients compared with 4% in the placebo group. Within the six-month study period, 33% of Ganopoly®-treated patients had normal aminotransferase values, and 13% had cleared hepatitis B surface antigen (HBsAg) from serum, whereas none of the controls had normal aminotransferase values or had lost HBsAg. However, the number of patients (13%) who dropped out was not included in the calculation of the above results. Further research is needed before recommending for or against the use of reishi in the treatment of hepatitis B, for which other treatments are available.

Summary: Based on in vitro evidence, a clinical trial was conducted to evaluate the effect of Ganopoly® on coronary heart disease. Ganopoly® treatment improved primary symptoms (e.g., chest pain, palpitation, angina pectoris, shortness of breath), decreased abnormal ECG appearance, and decreased blood pressure and cholesterol levels in these patients. However, long-term study is needed to evaluate the efficacy and safety of Ganopoly®. The authors are closely related to the manufacturer of Ganopoly®.

Evidence: A randomized, double-blind, placebo controlled trial was conducted in 170 patients with confirmed coronary heart disease (19). Ganopoly® treatment (dose unknown) improved primary symptoms (e.g., chest pain, palpitation, angina pectoris, shortness of breath) in a significantly higher percentage of patients compared with that of placebo patients, although the degree of improvement is unknown and difficult to measure. Ganopoly® treatment also significantly decreased diastolic pressure (( 10mmHg) in 22.5% of patients, whereas the control group did not. Serum cholesterol levels were also decreased in Ganopoly® treated patients. However, details of methodology and statistical analysis are limited.

Summary: Based on animal studies which demonstrated the hypoglycemic and lipid-lowering activities of Ganoderma lucidum (Ling Zhi, reishi mushroom), a clinical study was conducted to evaluate the effect of Ganopoly® vs. placebo in diabetic patients. Treatment with Ganopoly® slightly decreased the levels of plasma glucose and glycosylated hemoglobin and improved other markers for diabetes. Long-term studies with larger sample size are needed to evaluate the efficacy and safety of Ganopoly® in treating diabetic patients. The authors are closely related to the manufacturer of Ganopoly®.

Evidence: A randomized, non-blinded, placebo controlled trial was conducted in 71 patients with confirmed type 2 diabetes mellitus (19). 1,800mg Ganopoly® was used three times daily for 12 weeks. Ganopoly® significantly decreased the mean glycosylated hemoglobin 10% at 12 weeks compared with baseline values. However, the decrease of fasting plasma glucose was only 2% in Ganopoly® treated patients, although these parameters either did not change or slightly increased in patients receiving placebo. The comparison of fasting plasma glucose levels between groups was not clear. Giving diabetic patients no treatment (for washout) or placebo treatment (for 12 weeks) raises an ethical issue and could be dangerous to these patients. Long-term studies with proper control groups are needed to evaluate the efficacy of Ganopoly®.

	Summary: Ancient Chinese monks utilized reishi mushroom to calm their mind for meditation. Theory would lead one to believe that the physiological effects of decreasing blood pressure may have lead to the calming effect precipitated by the ingested reishi. Preliminary data suggest that reishi may exert a blood pressure-lowering effect (28; 38; 79); however, the currently available evidence in this area is weak. Future studies are warranted to validate the results of these small studies and to provide evidence for clinical usefulness of reishi as a possible treatment for hypertension.
	Evidence: Jin et al. conducted a double-blind trial to evaluate the effects of lin zhi (reishi) in patients with stage II hypertension (20). Fifty-four subjects had their recent therapy discontinued for a week prior to administration of lin zhi (reishi) tablets containing 55mg of lin zhi extract (N=40). A placebo was manufactured to look and feel identical to the experimental drug (N=14). Results were measured by the cuff method for arterial blood pressure and nailfold microcirculation was measured using vital biomicroscopic observation. The results yielded a dynamic change over a four-week period with the greatest drop in systolic and diastolic blood pressure becoming apparent after the first week. Also, after a two-week administration of lin zhi, there was a significant change in nailfold microcirculation. Improvements were seen in capillary loop density, diameter, and red blood cell (RBC) velocity. These results continued for the four-week period. The results of this study may suggest potential therapeutic benefits of reishi (lin zhi) in patients with stage II hypertension. This study was based on acceptable criteria with beneficial results. However, randomization procedures were not well described and the sample size was small making the results less reliable.
	A study by Kanmatsuse et al. involved a group of 53 patients with essential hypertension, mild hypertension or normotensive patients to evaluate the effects of Ganoderma lucidum extract (80). Subjects were divided into two groups, essential hypertensive patients and mild hypertensive or normotensive patients. This study revealed a significant drop in blood pressure in the essential hypertensive patient group and a smaller drop in the mild hypertensive group (percentages and p value not given). The hematological effects of reishi after oral administration did not result in any change in the values of the 21 test items beyond the normal range, except that total cholesterol decreased slightly and fibrinogen increased slightly. This study did not utilize blinding and did not clearly identify inclusion and exclusion criteria. There was no indication of other herbal supplements or medications being taken by any of the patients. Therefore, the results of this trial are not dependable, but certainly not avoidable.

Summary: Ganoderma lucidum has shown a beneficial effect in treating Russula subnigricans poisoning (RSP) in one small trial. However, this trial suffers from small sample size and lacks a proper control group. The suggested beneficial effect must be substantiated in larger randomized properly controlled trials.

Evidence: A clinical trial was conducted in 14 RSP patients using Ganoderma lucidum decoction (one dose was prepared by 100g of Ganoderma lucidum decocted with water to 600mL) together with conventional treatment (21). The duration and dose of treatment were not clear from the abstract. The results were compared with those of 11 patients who received conventional therapy in the previous year. Authors reported that the Ganoderma lucidum decoction significantly decreased urinary protein and blood cell count, and improved other markers of kidney injury. The between-group comparison was also significant. However, this trial may have bias from both control and treatment patient selection. Moreover, the traditional method of preparing Ganoderma lucidum decoction is difficult to standardize, which may lead to variations in results. A large randomized, double-blinded, properly controlled trial using a standardized formula is needed to evaluate the effect of Ganoderma lucidum in treating RSP.

Summary: Reishi extract was shown to be effective in decreasing postherpetic pain in a case series. However, there is currently insufficient available evidence to make any conclusion. Additional high quality clinical research is needed in this area.

Evidence: Hijikata et al. reported the administration of hot water soluble extracts of Ganoderma lucidum decreased pain in two female patients with postherpetic neuralgia and two male patients with severe pain due to herpes zoster infection (22). Two women (Case 1 and 2) with herpes zoster were treated with 6.4g dry reishi extracts (equivalent to 36g dry weight) in three divided doses daily. No other treatment was used. In Case 1, pain dramatically decreased four days after the onset of therapy. She stopped taking reishi after about 45 days of treatment. Months later a mild form of the pain recurred, so she initiated therapy with the extract. Within two days, the pain decreased and was almost gone within ten days. In Case 2 the initial dose did not decrease the woman's severe pain. She doubled her reishi intake to 12.8g dry powder extract (equivalent to 72g of dry reishi) daily and after ten days her pain was reduced on a three-point pain scale from 3 to 2. When the extract was stopped, the pain recurred. The extract was resumed and within 60 days, her pain scores were one and within nine months, she was pain-free. Two male patients who received the 6.4g dose of reishi for the treatment of herpes zoster experienced pain relief and complete remission without the need for additional treatments. Limitations of this study include lack of a control group and small sample size.

Summary: Clinical study was conducted to evaluate the effect of Ganoderma lucidum in treating nephritic patients with persistent proteinuria resistant to steroids with or without immunosuppressants. Ganoderma lucidum treatment decreased proteinuria; however, the sample size was small. This trial provides good preliminary data, but long-term studies with a larger sample size and a proper control group are needed to evaluate the effect of Ganoderma lucidum on proteinuria.

Evidence: A clinical trial was conducted in ten necrotic patients associated with persistent proteinuria following treatment with steroids with or without immunosuppressants (12). Five patients received crude extract of Ganoderma lucidum 750-1,100mg daily plus vasodilators (specifics unknown) for one year. Urinary protein levels dropped 85% in these patients to close to normal range. The other five patients received vasodilators only, and their urinary protein levels dropped only 11% after one-year treatment. However, the small sample size of the trial, lack of placebo control group, lack of detailed and standardized method for extraction of Ganoderma lucidum, and wide dose range all made this study less significant.

Ganopoly® (Encore International Ltd., Auckland, New Zealand) (10; 11; 16; 17; 18; 19).

	Consumer Lab: NA. Last Accessed 2/16/09.
	Consumer Reports: NA. Last Accessed 2/16/09.
	Natural Products Association: NA. Last Accessed 2/16/09.
	NSF International: NA. Last Accessed 2/16/09.
	U.S. Pharmacopeia: NA. Last Accessed 2/16/09.

Not applicable.

	JP61225649 (A) 10/7/1986: QUALITY TEST OF REISHI (GANODERMA)
	JP60056924 (A) 4/2/1985: PREPARATION OF REISHI TEA
	JP59113827 (A) 6/30/1984: CULTURING OF REISHI BASE MEDIUM FOR COMPONENTIAL EXTRACTION
	JP58109424 (A) 6/29/1983: METHOD FOR IMPROVING TASTE OF REISHI EXTRACT
	JP57026522 (A) 2/12/1982: ARTIFICIAL CULTURING METHOD OF REISHI OF FOMES
	JP55124718 (A) 9/26/1980: PREPARATION OF DRINK FROM *REISHI* *FOMES JAPONICUS*
	US2008267991 (A1) 10/30/2008: IMMUNO-MODULATING ANTITUMOR ACTIVITIES OF GANODERMA LUCIDUM (REISHI) POLYSACCHARIDES
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	CN1572307 (A) 2/2/2005: Cola containing cactus and reishi mushroom
	JP2003040783 (A) 2/13/2003: TUNGSTIC ACID SALT OR MOLYBDIC ACID SALT AND ADDITION PRODUCT OF REISHI SPORE USEFUL AS PHARMACEUTICAL PRODUCT AND HEALTH FOOD
	DE10050669 (A1) 4/25/2002: Hair restorer obtained by diluting with water and ethanol the extract produced by boiling with added water mixture of reishi, angelica root, astragalus, red ginseng and sea algae
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	JP3083521 (A) 4/9/1991: CULTIVATION OF 'REISHI'
	JP2104258 (A) 4/17/1990: PRODUCTION OF PROCESSED FOOD USING 'REISHI' FUNGUS (FOMES JAPONICUS)
	JP62239953 (A) 10/20/1987: PREPARATION OF REISHI TEA
	JP62019529 (A) 1/28/1987: PRODUCTION OF YMV REISHI
	JP62012720 (A) 1/21/1987: PRODUCTION OF ALOE REISHI
	JP62012719 (A) 1/21/1987: PRODUCTION OF YM REISHI
	JP62012721 (A) 1/21/1987: PRODUCTION OF SHIITAKE REISHI

Authors/Editors: Tracee Rae Abrams, PharmD (University of Rhode Island); Stephen Bent, MD (University of California, San Francisco); Heather Boon, BScPhm, PhD (University of Toronto); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Cynthia Dacey, PharmD (Natural Standard Research Collaboration); Jacquelyn Guilford, PhD, MBA (Natural Standard Research Collaboration); Nicole Giese, MS (Natural Standard Research Collaboration); Dana A. Hackman, BS (Northeastern University); Lisa Scully, PharmD (Massachusetts College of Pharmacy); Erica Seamon, PharmD (Nova Southeastern University); Michael Shaffer, MA (University of Florida); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Nazhiyath Vijarian, MD (Natural Standard Research Collaboration); Wendy Weissner, BA (Natural Standard Research Collaboration); Shannon Welch, PharmD (Northeastern University); Denise Wong, PharmD (Northeastern University); Jen Woods, BS (Natural Standard Research Collaboration).

Blinded Peer-Review: Natural Standard Editorial Board.

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