Can Chinese Herbs Protect the Kidneys? Evidence-Based Herbs for Chronic Kidney Disease
Many patients with chronic kidney disease ask the same question: “Can I still take Chinese herbs if my kidneys are not healthy?”
The answer is not a simple yes or no. Some Chinese herbs have shown potential kidney-protective effects in experimental studies and clinical research, while some herbs may be harmful to the kidneys. The key is to use the right herbs, avoid nephrotoxic substances, and monitor kidney function regularly.
Herbs with relatively more kidney-related evidence include Astragalus membranaceus, Salvia miltiorrhiza, Rheum palmatum, Angelica sinensis, and Abelmoschus manihot. These herbs have been studied for their potential effects on proteinuria, inflammation, oxidative stress, renal fibrosis, and CKD progression. [1][2][3]
1. Astragalus membranaceus: One of the Most Studied Kidney-Protective Herbs
Astragalus membranaceus, known as Huangqi in Chinese medicine, is commonly used to tonify Qi and support overall resilience.
A Cochrane review found that Astragalus may improve certain kidney-related markers in patients with chronic kidney disease, including proteinuria and renal function indicators. However, the quality of evidence was limited, so Astragalus should not be viewed as a replacement for standard medical care. [3]
Possible mechanisms include anti-inflammatory, antioxidant, immunomodulatory, and anti-fibrotic effects. [1][2]
2. Salvia miltiorrhiza: Blood Circulation and Anti-Fibrotic Potential
Salvia miltiorrhiza, known as Danshen, is traditionally used to promote blood circulation and remove blood stasis.
Its active compounds, including tanshinone IIA and salvianolic acids, may help reduce oxidative stress, inflammation, microcirculatory dysfunction, and renal fibrosis. [1][2]
Patients taking antiplatelet or anticoagulant medications, such as aspirin, clopidogrel, or warfarin, should consult a physician before using Danshen because of possible herb-drug interactions.
3. Rheum palmatum: More Than a Laxative
Rheum palmatum, known as Dahuang, is often associated with its purgative effect. However, CKD research has also focused on its possible role in the gut-kidney axis.
As kidney function declines, gut microbiota imbalance, uremic toxin accumulation, and intestinal barrier dysfunction may accelerate CKD progression. Rheum palmatum may help regulate gut microbiota, reduce inflammation, and suppress renal fibrosis. [4]
However, it is not suitable for everyone. Patients with diarrhea, frailty, gastrointestinal sensitivity, or electrolyte imbalance should be cautious.
4. Angelica sinensis: More Evidence in Formulas Than as a Single Herb
Angelica sinensis, known as Danggui, is traditionally used to nourish and move blood.
For CKD, the clinical evidence for Danggui as a single herb is limited. Most evidence comes from its use in herbal combinations, especially with Astragalus, Salvia miltiorrhiza, and Rheum palmatum.
A nationwide cohort study in Taiwan evaluated the use of Astragalus, Angelica sinensis, Rheum palmatum, and Salvia miltiorrhiza in patients with stage 4 to 5 CKD. The study found that users had lower risks of end-stage renal disease and mortality, without an increased risk of hyperkalemia. [5]
5. Abelmoschus manihot: A Promising Herb for Proteinuria
Abelmoschus manihot, commonly used in the form of Huangkui capsule in China, has been studied in CKD and proteinuria-related conditions.
Research has focused on IgA nephropathy, diabetic kidney disease, and proteinuria reduction. Possible mechanisms include anti-inflammatory, antioxidant, podocyte-protective, and anti-proteinuric effects. [1]
Patients should still pay attention to product quality, standardization, legality, and individual kidney function before using related products.
A Taiwan Nationwide Cohort Study on Four Chinese Herbs
A Taiwanese nationwide cohort study evaluated the use of four prescribed Chinese herbal medicines in patients with advanced CKD: Astragalus membranaceus, Angelica sinensis, Rheum palmatum, and Salvia miltiorrhiza. [5]
Compared with non-users, users had:
- Lower risk of end-stage renal disease
- Lower risk of mortality
- No increased risk of hyperkalemia
- Greater observed benefit when all four herbs were used
However, this was an observational study. It can show an association, but it cannot prove direct causality.
How Might Chinese Herbs Protect the Kidneys?
Research suggests that Chinese herbs may affect CKD through multiple mechanisms:
- Antioxidant effects: reducing oxidative damage to renal cells
- Anti-inflammatory effects: regulating chronic inflammation
- Anti-fibrotic effects: slowing renal interstitial fibrosis
- Gut microbiota regulation: improving the gut-kidney axis
- Microcirculation support: improving the local renal environment
This is why Chinese medicine treatment for CKD should not focus only on a single lab number. Proteinuria, blood pressure, blood sugar, edema, fatigue, digestion, and long-term eGFR trends all matter. [2][4][6]
Important Safety Warning: Avoid Aristolochic Acid
Not all herbs are safe for kidney patients. Aristolochic acid can cause acute kidney injury, chronic kidney disease, renal interstitial fibrosis, and may increase the risk of urothelial cancer. [7][8]
Herbs historically associated with aristolochic acid include Aristolochia species and related products. Patients should avoid unknown herbal products, internet remedies, and poorly labeled supplements.
5 Safety Rules for CKD Patients Considering Chinese Herbs
- Inform your medical team: both your nephrologist and Chinese medicine physician should know your medications.
- Monitor regularly: eGFR, creatinine, potassium, and urine protein should be followed.
- Avoid unknown products: contamination, adulteration, and nephrotoxins are real risks.
- Do not increase dosage by yourself: kidney patients require individualized dosing.
- Watch for interactions: especially with anticoagulants, antiplatelet drugs, antihypertensives, antidiabetic drugs, and diuretics.
Clinical View from Wellcome TCM
In CKD care, the goal is not just to make eGFR temporarily rise by a few points.
The more meaningful goals are reducing proteinuria, slowing kidney function decline, stabilizing blood pressure and blood sugar, and delaying dialysis when possible.
Chinese medicine should not be used as a dialysis substitute. It should be part of a carefully monitored, individualized plan based on constitution, lab results, lifestyle, diet, and current medications.
FAQ
Q1: Can CKD patients take Astragalus?
Astragalus has shown potential kidney-protective effects in some studies, but it should not be taken without medical evaluation. CKD stage, proteinuria, blood pressure, potassium level, and current medications all matter.
Q2: Can Chinese herbs improve eGFR?
Some patients may experience improvement in eGFR, but long-term trends are more important. Slowing decline and reducing proteinuria are meaningful treatment goals.
Q3: Which herbs should kidney patients avoid?
Patients should avoid herbs containing aristolochic acid and any unknown, poorly labeled, contaminated, or adulterated herbal products.
Q4: Can Chinese herbs be used with Western medications?
Sometimes yes, but only with proper medical guidance. Patients taking antiplatelet drugs, anticoagulants, blood pressure medications, diabetes medications, or diuretics should be especially careful.
Medical Disclaimer
This article is for health education only and does not replace diagnosis, laboratory monitoring, or treatment by a nephrologist. Patients with chronic kidney disease should consult a qualified physician before using Chinese herbs.
Book a CKD Chinese Medicine Consultation
If you have proteinuria, declining kidney function, diabetic kidney disease, hypertensive kidney disease, or questions about whether Chinese medicine may be suitable for you, you may schedule a clinical evaluation.
Chronic Kidney Disease Chinese Medicine Consultation｜Wellcome TCM｜Dr. Hao-Yu Kao
References
[1] Medicinal Plant-Derived Phytochemicals in the Prevention and Management of Chronic Kidney Disease.
https://doi.org/10.2174/0113892010422876251203114604
[2] New Insights Into the Effects of Individual Chinese Herbal Medicines on Chronic Kidney Disease.
https://doi.org/10.3389/fphar.2021.774414
[3] Astragalus for Treating Chronic Kidney Disease. Cochrane Database of Systematic Reviews.
https://doi.org/10.1002/14651858.CD008369.pub2
[4] Unraveling the Mysteries of the Gut-Kidney Axis: The Protective Role of Traditional Chinese Medicine in Chronic Kidney Disease.
https://doi.org/10.3389/fmicb.2025.1642377
[5] Four Prescribed Chinese Herbal Medicines Provide Renoprotection and Survival Benefit Without Hyperkalemia Risk in Patients With Advanced Chronic Kidney Disease.
https://doi.org/10.1016/j.phymed.2021.153873
[6] Mechanisms and Efficacy of Chinese Herbal Medicines in Chronic Kidney Disease.
https://doi.org/10.3389/fphar.2020.619201
[7] Chronic Kidney Disease Diagnosis and Management: A Review.
https://doi.org/10.1001/jama.2019.14745
[8] Nephrotoxicity and Chinese Herbal Medicine.
https://doi.org/10.2215/CJN.11571017