Pharmaceuticals derived from Cordyceps species and their relatives are used widely in western medicine, for example cyclosporin which is used to prevent rejection after transplant surgery and to treat autoimmune disorders (Borel 2002), and ergotamine which can be used to treat migraine and also for induction of childbirth (Schardl et al. 2006). Ophiocordyceps sinensis is not currently used in mainstream Western healthcare, but is one of the most highly regarded remedies in traditional Oriental medicine and has been widely adopted by devotees elsewhere. O. sinensis has been shown to produce a wide range of bioactive molecules which have been claimed to produce therapeutic effects (reviewed by Paterson 2008), although in many cases the research is not peer-reviewed to international standards. It is also unclear whether bioactive compounds are produced in sufficient quantity in the natural product to have an adequate therapeutic effect in the amounts typically consumed.
Traditional Oriental medicine is practised in a substantially different manner to western healthcare, often adopting a holistic approach where medicines are used to support and stimulate overall health rather than curing specific conditions. It is also common for a range of medicines to be prescribed simultaneously. For these reasons it is unsurprising that little direct evidence of therapeutic effect of Ophiocordyceps sinensis exists within traditional Oriental health systems, and it would indeed be difficult to devise specific trials except in very large-scale research projects.
In China, Ophiocordyceps sinensis and its larval cadaver are collectively referred to as 冬 虫 夏 草 (‘Dong Chong Xia Cao’; Jiang and Yao 2002), a translation of the Tibetan term ‘yartsa gunbu’. It is known throughout the Himalayan region by various modifications of the Tibetan name, including ‘yartsa guenbub’Footnote 1 in Bhutan and ‘yarsagumba’ in Nepal (Devkota 2006). The name translates as ‘winter worm, summer grass’, in reference to its dual origins and transformation from larva to stroma. It is widely believed that the medicinal effect of the collective entity is in part due to its dual nature, and is therefore compatible with the Chinese philosophical concept of yin and yang. Its medicinal properties have been recorded for at least 500 years (Winkler 2005) and are reputed to have been discovered through observation of increased vigour of yaks grazing in the grasslands in which O. sinensis grows.
The primary use of yartsa guenbub in traditional Oriental medicine is as a tonic to aid in recovery from illness or disease, to build up strength and restore energy (Pegler et al. 1994; Jiang and Yao 2002). More recently it has been cited as possessing a range of more specific therapeutic properties, including action against asthma and bronchial inflammation (Kuo et al. 2001), cure of renal complaints (Guo et al. 1999) and stimulation of the immune system (Kuo et al. 2005). Perhaps inevitably, it has been ascribed aphrodisiac properties (it is referred to as ‘Himalayan Viagra’ in numerous websites devoted to alternative medicine) and it has even been claimed to be the secret of eternal youth (see Paterson 2008). Vinning and Tobgay (2004) provide what they refer to as a ‘near miraculous’ listing of what yartsa guenbub can address, including:
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Improvement of respiratory functions.
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Increase of cellular oxygen absorption.
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Improvement of the functioning of the heart.
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Improvement of cholesterol balance, increasing HDL cholesterol and lowering triglyceride cholesterol.
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Promotion of DNA repair.
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Improvement of liver function, helping to combat hepatis and cirrhosis.
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Reduction of tumour size.
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Assistance to the immune system by increasing NK cell activity.
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Anti-aging through stimulation of hormone production and inhibition of monoamine oxidase enzymes.
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Protection against free radical damage.
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Combat of sexual dysfunction.
Due to the cultural importance placed in the dual nature of yartsa guenbub, it is used in China and surrounding countries largely in its original form—i.e. as the dried stroma emerging from the caterpillar cadaver. The quality of the product is also of paramount importance, with the highest prices paid for immature specimens with the insect component still intact and much lower amounts paid for broken or otherwise damaged material. There is a market for pharmaceutical and neutraceutical products (pills, capsules, tonics etc. often combined with other therapeutic substances) derived from Ophiocordyceps sinensis in Western alternative medicine, but these are less popular in the Orient and we are not convinced that all of them contain the genuine product. Some are marketed as derived from cultures (with the benefits to conservation stressed), but in our experience O. sinensis grows very slowly in culture and is unlikely to prove commercially viable in this form. In China, research into artificial rearing of yartsa guenbub by inoculating farmed Thitarodes larvae with O. sinensis spores has been pursued for a number of years (Winkler 2005). However, the results have not been highly publicized and if successful there has not been an obvious effect on market prices.
Yartsa guenbub is traditionally used by boiling the whole (dual) organism in water or soup, and then drinking the resulting liquid (Pegler et al. 1994). It may also be prepared in a more elaborate (and expensive) manner by as a stuffing in roast or boiled duck. In Bhutan, it is sometimes taken in a hot soup derived from home-distilled spirits which must compromise any therapeutic benefit, although the effect is undeniably warming when taken at high altitude.
It is appropriate to question some of the more extreme claims of health benefits of yartsa guenbub, especially those promoted by less scrupulous suppliers on the Internet. At least until comprehensive medical trials can be completed, we would not wish to deny more general therapeutic effects within the traditional Oriental medical system. Whether or not the claimed therapeutic benefits of yartsa guenbub can be substantiated, demand is such that conservation and sustainability of supply is a legitimate concern for the Himalayan nations.