Also known as: lingzhi, spirit mushroom, mushroom of immortality
Revered East Asian mushroom with solid evidence for immune support and cancer adjunct therapy. Strong traditional-modern convergence, but wide preparation variability and unclear optimal standardization.
Used for:immune supportcancer adjunctfatigueliver healthcholesterol
Traditional Use
Traditions: Traditional Chinese Medicine, Traditional Japanese Medicine, Western herbalism (modern)
Multiple traditions agree on use.
Historical Attributions
Lingzhi (灵芝, 'spirit mushroom'). Chinese Pharmacopoeia since 2000. Traditional actions: Replenish Qi, ease the mind, relieve cough and asthma. Used for dizziness, insomnia, palpitations, shortness of breath.
Reishi (霊芝) or Mannentake (万年茸, 'mushroom of immortality'). Valued for health promotion, longevity, spiritual significance.
Incorporated into complementary medicine. Focus on immune modulation, cancer support, hepatoprotection, standardized extract development.
Evidence
Reishi has strong evidence for immune modulation and cancer adjunct therapy, with consistent findings across multiple trials. The Cochrane review found significant immune enhancement during chemo/radiotherapy. However, preparation matters enormously - a 6mg ethanol extract and a 5,400mg polysaccharide extract are completely different medicines. Individual response varies based on baseline health status.
Key Studies
Cochrane Review: Cancer Adjunct Therapy (Jin 2016) (2016)
5 RCTs analyzed. CD3 increased 3.91%, CD4 increased 3.05%, CD8 increased 2.02%. Patients 50% more likely to respond positively to treatment (p=0.02). 4 studies showed improved quality of life.
Cancer Fatigue RCT (Zhao 2012) (2012)
48 breast cancer patients, 3,000mg/day spore powder for 4 weeks. TNF-α reduced 44% (128.70→71.89 pg/mL, p<0.01), IL-6 reduced 40% (62.43→37.62 pg/mL, p<0.05). Improved fatigue and quality of life.
Dyslipidemia RCT (Geng 2025) (2025)
110 participants, spore oil for 12 weeks. Significantly lower total cholesterol, triglycerides, LDL-C; significantly higher HDL-C compared to placebo.
Immune Modulation (Lin 2023) (2023)
Healthy adults, 200mg β-glucan daily for 84 days. Significant enhancement in CD3+, CD4+, CD8+ T-lymphocytes, improved CD4/CD8 ratio, increased NK cell counts.
Most studied preparations. β-glucan for immune support. Combined extracts for liver health. High-dose polysaccharide for fatigue. Spore powder MUST be wall-broken.
decoction — 6-12g dried fruiting body daily
Traditional Chinese method. Simmer 30-120 minutes, strain. Extracts polysaccharides primarily. Higher doses needed than concentrated extracts. Can re-decoct 2-3 times.
tincture — 2-4mL (40-80 drops) 2-3 times daily
1:5 at 25-40% alcohol common. Dual extraction - gets both water-soluble polysaccharides and alcohol-soluble triterpenoids. No clinical trials on tinctures specifically.
tea — 2-5g per cup, 2-3 cups daily
Simple infusion less potent than decoction. Convenient for mild immune support. Traditional decoction (simmering 30-120 min) extracts more compounds.
What The Evidence Says
Reishi represents strong convergence between ancient East Asian medicine and modern research, particularly for immune support. This isn’t a case of weak traditional use getting hyped - the Chinese Pharmacopoeia has included it since 2000, and clinical trials consistently validate traditional applications.
Strong evidence (Cochrane review, multiple RCTs):
Immune modulation: CD3+ T-cells increased 3.91%, CD4+ increased 3.05%, CD8+ increased 2.02% across 5 RCTs in cancer patients receiving chemo/radiotherapy [1]. Healthy adults taking 200mg β-glucan daily for 84 days saw significant enhancement in all T-cell subsets and natural killer cells [4]
Cancer adjunct therapy: You’re 50% more likely to respond positively to treatment when combining reishi with chemo/radiotherapy (RR 1.50, p=0.02). Four studies showed improved quality of life. Breast cancer patients taking 3,000mg spore powder daily saw fatigue improve significantly in 4 weeks [2]
Anti-inflammatory effects: TNF-α dropped 44% (from 128.70 to 71.89 pg/mL) and IL-6 dropped 40% in cancer patients - these are measurable cytokine reductions, not vague claims [2]
Moderate evidence:
Dyslipidemia: 12-week trial with spore oil showed significantly lower total cholesterol, triglycerides, LDL-C, and higher HDL-C compared to placebo (110 participants) [3]
Hepatoprotection: 6-month crossover trial (23 participants) with 450mg combined extract daily showed substantial increases in antioxidant enzymes (SOD, CAT, GPx) and substantial decreases in liver enzymes (GOT, GPT) in people with mild liver dysfunction [5]
Fatigue reduction: High-dose polysaccharide extract (5,400mg/day) reduced fatigue by 28.3% in 132 neurasthenia patients over 8 weeks [6]
Important limitation - preparation matters enormously: A 6mg ethanol extract for urinary symptoms, a 200mg purified β-glucan for immune support, and a 5,400mg polysaccharide powder for fatigue are completely different medicines. There’s no universal “reishi dose” - it depends entirely on what compounds you’re targeting.
Negative evidence: One trial in diabetes/metabolic syndrome patients (3,000mg daily, 16 weeks) showed no benefit for cardiovascular risk factors - effectiveness may depend on baseline health status.
Traditional Use
Traditional Chinese Medicine (ancient to present):
Lingzhi (灵芝) - “Spirit mushroom” or “mushroom of spiritual potency”
Official in Chinese Pharmacopoeia since 2000 (updated 2015)
Traditional actions: Replenish Qi (tonify vital energy), Ease the Mind (calm spirit, mental tranquility), Relieve Cough and Asthma (respiratory support)
Traditional indications: Dizziness, insomnia, palpitations, shortness of breath
Traditional dose: 6-12g decoction daily
Traditional Japanese Medicine:
Reishi (霊芝) or Mannentake (万年茸) - “Mushroom of immortality” or “Ten-thousand-year mushroom”
Valued for health promotion, longevity, spiritual significance
Similar therapeutic applications to Chinese tradition
Historical context: Historically rare in the wild, reserved for nobility. Now cultivated commercially, making it accessible.
The convergence is notable: Traditional indications (fatigue, immune support, respiratory, mental clarity, heart palpitations) align well with modern evidence. When you see consistent use across Chinese and Japanese medicine for millennia, validated by Cochrane reviews and RCTs, that’s worth attention.
Western adoption: Incorporated into complementary medicine in late 20th century. Focus shifted to immune modulation, cancer support, hepatoprotection, and development of standardized extracts targeting specific compounds.
How To Try It
Choose Your Preparation Based on Your Goal
For immune support:
Purified β-glucan extract: 200mg daily (most studied for immune modulation in healthy people) [1]
Hot water extract or decoction: 5,000-6,000mg daily (traditional polysaccharide-rich preparation)
Dual extraction effect - gets both polysaccharides and triterpenoids
No specific clinical evidence, but plausible based on extraction method
Tea (simple, less potent):
2-5g dried reishi per cup, 2-3 cups daily
Steep 10-15 minutes (or simmer 30+ min for stronger extraction)
Convenient for mild immune support
Lower potency than decoction or standardized extracts
Dosing Strategy
Starting dose (general wellness):
500-1,000mg standardized extract daily, OR
3-6g traditional decoction, OR
2mL tincture twice daily
Take with food if GI sensitive
Start with 4-8 weeks
Therapeutic dose (specific conditions):
Follow preparation-specific dosing above based on your goal
Duration: 12-16 weeks minimum for most conditions
Some conditions (hepatoprotection) may need 6 months
Frequency:
Once daily works for highly concentrated extracts (6mg ethanol extract)
Twice daily better for most (225mg combined extract × 2)
Three times daily for high total doses (1,000mg spore powder × 3, or 1,800mg polysaccharide × 3)
Pharmacokinetics support multiple daily doses - triterpenoids have very short half-life (~0.66 hours)
Timeline Expectations
Week 1-2: Most don’t feel anything initially. Some mild GI adjustment.
Week 4-8: Initial immune support effects may emerge. You might notice recovering from illnesses faster. Fatigue reduction becomes apparent if you’re going to respond.
Week 12-16: Most benefits solidify. Lipid changes, liver enzyme improvements, sustained immune enhancement. This is the minimum trial period for most conditions.
6+ months: Long-term hepatoprotective effects, sustained immune modulation. Traditional use emphasizes long-term wellness support.
Don’t expect immediate results. This isn’t a stimulant. Effects build over time.
What To Track
Baseline (1 week before starting):
How often you get sick (colds, infections)
Fatigue levels (daily 1-10 scale)
Energy throughout day
If applicable: liver function tests, lipid panel (for objective tracking)
During trial (weeks 1-16):
Track the same markers. Compare:
Baseline vs. Week 4 vs. Week 8 vs. Week 12
Include 2-week washout after week 12 to assess if benefits persist or disappear
What to notice:
Recovery time: Do you bounce back from illnesses faster? Shorter duration of colds?
Fatigue: Less chronic exhaustion, especially if cancer-related or neurasthenia
Quality of life: If undergoing cancer treatment, general sense of well-being
Digestive comfort: Mild GI effects (dry mouth, stomach discomfort) possible in small percentage
Jaundice or signs of liver dysfunction (rare, but one case report exists)
Unusual bleeding or bruising (theoretical risk)
Severe allergic reaction
Significant worsening of pre-existing conditions
Who This Is/Isn’t For
Strong candidates (likely to benefit):
Cancer patients undergoing chemo/radiotherapy (as adjunct, with oncologist approval) - 50% more likely to respond positively to treatment, improved quality of life [2]
People seeking immune support (especially if prone to frequent infections) - significant enhancement in T-cells and NK cells in healthy adults [1]
Elevated liver enzymes or mild liver dysfunction - substantial reduction in GOT/GPT over 6 months [5]
High cholesterol or dyslipidemia - significant improvements in lipid panel after 12 weeks [3]
Chronic fatigue or neurasthenia - 28.3% fatigue reduction with high-dose polysaccharide [6]
What they report: Fewer/shorter illnesses, better recovery during cancer treatment, improved energy, better lab markers.
May or may not benefit:
Healthy individuals with optimal baseline (immune enhancement still occurs, but subjective benefit unclear)
Diabetes/metabolic syndrome patients - one trial showed no cardiovascular benefit
Preparation matters - you might respond to one type (polysaccharide-rich) but not another (triterpenoid-rich)
What they report: Variable. Some notice subtle improvements, others nothing.
Action: Systematic trial with appropriate preparation for your goal. Give it 12-16 weeks. Track objectively.
Not appropriate for (contraindications):
Pregnancy/breastfeeding: No safety data. Not historically emphasized for pregnancy.
Organ transplant recipients on immunosuppressants: Immune enhancement may antagonize immunosuppressive therapy
Active autoimmune disease on immunosuppression: Same concern as transplant recipients
Severe bleeding disorders: Theoretical bleeding risk (no events in trials, but biological plausibility)
Surgery planned within 2 weeks: Discontinue due to theoretical bleeding risk
Pre-existing liver disease: Caution - one hepatotoxicity case report exists, though most evidence shows hepatoprotection. Consider monitoring.
Quality Matters (Non-Negotiable)
The problem: Commercial products vary wildly. Both Ganoderma lucidum and G. sinense are recognized as “Lingzhi” in Chinese Pharmacopoeia, but pharmacological equivalence is unclear. Mushrooms can accumulate heavy metals from growing substrate.
Critical for spore products: MUST be “broken-wall” or “de-walled” - spore cell walls are extremely tough and resist digestion. Non-processed spore products are essentially inert.
“Dual extraction” or “contains polysaccharides and triterpenoids” (for broad-spectrum)
Processing method:
“Hot water extract” (polysaccharides)
“Ethanol extract” or “alcohol extract” (triterpenoids)
“Dual extraction” (both)
For spores: “Broken-wall” or “de-walled” (non-negotiable)
Species verification:
“Ganoderma lucidum” (specific)
Third-party testing for authenticity
Third-party testing:
USP Verified, NSF Certified, or ConsumerLab Approved
Heavy metal testing (lead, arsenic, mercury, cadmium)
Pesticide screening
Microbial contamination testing
Sourcing:
Cultivated (more consistent than wild)
Organic certification (reduces contamination)
Reputable manufacturers with GMP certification
Avoid: Unbranded products, non-standardized extracts without testing, spore products that don’t specify wall-breaking, products without species verification.
The Bottom Line
This is a powerful immune modulator with remarkably strong evidence for specific applications - particularly cancer adjunct therapy, immune support, and hepatoprotection. When you see a Cochrane review showing 50% better treatment response and a dedicated RCT showing 44% reduction in inflammatory markers, that’s real medicine, not vague wellness claims.
When it works: You recover from illnesses faster. If undergoing cancer treatment, you respond better and feel better. Fatigue decreases measurably. Liver enzymes improve. Lipid panels normalize.
When it doesn’t: You may be targeting the wrong indication (no benefit in diabetes/metabolic syndrome), using the wrong preparation (polysaccharide-rich for liver symptoms won’t work as well as triterpenoid-rich), or have optimal baseline health (hard to improve what’s already optimal).
When it causes problems: Generally excellent safety profile, but rare hepatotoxicity case exists. Theoretical bleeding risk. May antagonize immunosuppressive therapy (don’t use if transplant recipient).
Critical nuances:
Preparation matters enormously - a 6mg ethanol extract is not the same as a 5,400mg polysaccharide extract
Choose based on goal - immune support needs polysaccharides, liver support benefits from combined extracts, spore products excel for lipids
Spore products MUST be wall-broken - otherwise they’re inert
Individual variation exists - baseline health status affects response
Quality is non-negotiable - standardization and third-party testing essential
Start with appropriate preparation for your goal, give it 12-16 weeks, track honestly, respect contraindications (especially immunosuppressants), prioritize quality products with verified standardization.
Trying It
Duration: Minimum 4-8 weeks for initial effects, optimal 12-16 weeks. Immune modulation studies ran 84 days. Hepatoprotection trial was 6 months. Effects build over time.
What to notice:
Recovery time from illnesses (fewer/shorter colds)
Energy levels and fatigue (especially chronic fatigue)
Quality of life if undergoing cancer treatment
Digestive comfort (mild GI effects in small percentage)
Liver function markers if monitoring (GOT/GPT reduction)
Start low, especially with concentrated extracts. Choose preparation based on goal: polysaccharide-rich (β-glucan, hot water extract) for immune support; triterpenoid-rich (ethanol extract) for liver/urinary symptoms; combined extracts for broad effects; spore preparations for lipid management. Take with food if GI sensitive. Multiple daily doses may be better than once daily (triterpenoids have short half-life ~0.66 hours). Individual variation exists - you may be a strong responder, non-responder, or someone who needs specific preparation types.
Combinations
astragalus — Traditional Chinese pairing for immune support and Qi tonification. Both immune-enhancing adaptogens.
cordyceps — Studied in combination (Gao 2016), though no added benefit in that trial. Traditional pairing for vitality and endurance.
turmeric — Complementary anti-inflammatory effects. Reishi reduces TNF-α and IL-6; turmeric targets different inflammatory pathways.
Safety
Generally considered: safe
Contraindications:
Bleeding disorders - theoretical concern from antiplatelet effects (no bleeding events in trials)
Surgery - discontinue 2 weeks before (theoretical bleeding risk)
Pregnancy and breastfeeding - no safety data available
Immunosuppressant medications - may antagonize immunosuppressive therapy (organ transplant recipients)
Pre-existing liver disease - one hepatotoxicity case report, though most evidence shows hepatoprotective effects
Pregnancy/Nursing: Avoid - no safety data in pregnant or lactating women. Not historically emphasized for pregnancy/postpartum.
Generally excellent safety profile. Meta-analysis of 5 trials (398 participants) found no abnormalities in blood, liver, or kidney markers [1]. Dedicated safety study: 16 volunteers, 4g/day for 10 days, no adverse effects [9]. Common mild effects: dry mouth, GI discomfort, sore throat (small percentage) [1]. One isolated hepatotoxicity case after 1 month (contradicts general hepatoprotective findings) [8]. High-dose spore extracts increased CA 72-4 tumor marker (no harmful effects on organs, mechanism unclear) [10]. May interact with anticoagulants (theoretical bleeding risk) [7], antihypertensives (heart rate reduction shown), immunosuppressants (immune enhancement may antagonize). Positive interaction with chemotherapy - enhanced tumor response and quality of life in Cochrane review [1]. Safe up to 1 year based on trial data. Spore products MUST be wall-broken for safety and bioavailability.