Astragalus

Astragalus

Common Names

  • Huang chi
  • Huang qi
  • Milk vetch
  • Radix astragali

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For Patients & Caregivers

Astragalus has immune-stimulating effects and may help to reduce side effects from chemotherapy, but it has not been shown to treat or prevent cancer.

Astragalus root belongs to a group of medicinal plants from the legume family. It has a long history of use in traditional Chinese medicine for a variety of conditions, and as a tonic to increase stamina.

Astragalus works by stimulating several factors of the immune system. However, this property may also reduce the intended effects of certain drugs used to suppress the immune function. In addition, a compound in astragalus may have hormonal effects, and it is unknown whether this characteristic may change the effectiveness of some cancer treatments. So even though lab and population studies suggest astragalus might reduce chemotherapy-associated side effects, this has not been studied well enough. Clinical trials are needed to determine the circumstances under which astragalus can safely be used along with standard cancer treatments.

  • To stimulate the immune system
    Laboratory studies suggest that astragalus stimulates the immune system.
  • To reduce severity of chemotherapy side effects, including immune suppression
    Studies in animals show that astragalus reverses immune suppression caused by cyclophosphamide and stimulates certain cells of the immune system. Astragalus may also reduce the side effects of other types of chemotherapy such as nausea, vomiting, and fatigue. In addition, it may enhance the effectiveness of some types of chemotherapies, but these observations need to be confirmed in well-designed human studies.
  • To fight bacterial infections
    There is currently no evidence to support this claim, but one study in humans did suggest that astragalus can induce a viral-type immune response.
  • To prevent and treat heart disease
    Lab and animal studies suggest astragalus and its compounds have heart-protective properties as well as blood-thinning effects.
  • To treat diabetes
    Although astragalus has not been specifically studied for this purpose, long-term population studies suggest that astragalus is among several herbs used in Chinese medicine that may improve diabetes-related complications. Clinical trials are needed to confirm such effects.
  • To increase strength and stamina
    An herbal formula containing astragalus reduced fatigue in athletes by increasing uptake and use of oxygen. Another small study showed that a purified astragalus extract infusion may also help manage cancer-related fatigue, but whether an oral formula would work the same way is unknown.
  • You are taking immunosuppressants such as tacrolimus and cyclosporine: Astragalus may lessen their effects.
  • You have a hormone-sensitive cancer: Because astragalus has demonstrated estrogenic effects, it is unknown how it may affect hormone-sensitive cancers or hormonal chemotherapy.
  • You are undergoing cancer treatment: Laboratory studies suggest that certain properties of astragalus might interfere with the effectiveness of some types of cancer treatment.
  • You are taking anticoagulants: Lab studies suggest that astragalus may increase bleeding risk.
  • You are undergoing surgery: Lab studies suggest that astragalus may increase bleeding risk.
  • You are taking diuretic medications: A small study suggests that astragalus may increase their effects.
  • You are taking blood pressure medications: Astragalus may increase the blood pressure-lowering effect.

Fatigue, unease, and headache were reported in a study.

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For Healthcare Professionals

Astragalus membranaceus

Astragalus belongs to a group of medicinal plants from the Leguminosae family. The root of A. membranaceus has a long history of use in traditional Chinese medicine (TCM), and is often used along with other herbs as a tonic to increase stamina, strength, and vitality. Extracts of astragalus are sold as dietary supplements to improve immune function and to decrease fatigue. Polysaccharides and triterpenoid saponin compounds isolated from astragalus have been used in scientific research.

Astragalus and its constituents have antioxidant (27), anti-inflammatory (28), and antiviral (29) activities. In vitro and animal studies suggest protective effects on the heart (30) (31) (32), kidney (33) (34) (35), bones (36) , and the nervous system (11) (17) (37).

Clinical studies of astragalus in humans showed promising results. A case report suggests it may reduce proteinuria associated with idiopathic membranous nephropathy (7). In small studies of healthy individuals, astragalus exhibited sodium-excreting properties (8) and produced a viral-type immune response (38). A formula containing astragalus as a major ingredient reduced fatigue in athletes (10). When used as an injection, astragalus appeared to benefit patients with IgA nephropathy (26). Astragalus used in Chinese medicine helped reduce diabetic ketoacidosis (39). In a small study of dialysis patients, an astragalus-based TCM formula significantly preserved residual renal function (40).

Anticancer properties have been observed in vitro with some compounds from astragalus against gastric (41), colon (42) (43) (44) (45), hepatic (46) and ovarian (59) cancers. Astragalus has also been associated with prolonged survival times in acute myeloid leukemia patients (47).

Data also suggest beneficial effects when used with chemotherapy (1) (2). In vitro, concomitant treatment with aldesleukin and astragalus potentiated tumoricidal activity while decreasing side effects (14). It also enhanced platinum-based chemotherapy (3) and protected against oxaliplatin neurotoxicity (48). Astragalus saponins reversed toxicities of fluorouracil (42) (28) and augmented the therapeutic benefit of vinblastine while reducing neutropenic and anemic effects in vivo (44). An injectable form of astragalus with vinorelbine and cisplatin improved quality of life in patients with advanced non-small cell lung cancer (20), but whether orally administered astragalus would exert the same effects is unknown. In another study, an astragalus extract helped to manage cancer-related fatigue (22). Meta-analyses identified astragalus as among the traditional medicines associated with reductions in chemotherapy-induced nausea and vomiting (49), and to have benefits in patients with hepatocellular cancers (16), but larger well-designed trials to confirm these findings are needed.

Although astragalus is generally safe, it may interact with certain drugs. Because this botanical and its constituents have demonstrated antioxidant (27) and estrogenic (23) (50) activities, it may interfere with some chemotherapy drugs and/or affect hormone-sensitive cancers. However, these findings are from in vitro and animal studies, and cannot be extrapolated to clinical recommendations. The physiological concentration used in these studies is unlikely to be achieved in humans, which makes it difficult to predict the downstream effects/interactions.

Clinical studies are needed to determine the circumstances under which astragalus could be useful as an adjuvant therapy to standard cancer treatments.

  • Cardiovascular disease
  • Chemotherapy side effects
  • Diabetes
  • Immunostimulation
  • Microbial infection
  • Strength and stamina

Polysaccharides, triterpenoid saponins, and flavonoids are the main constituents of astragalus with immunomodulating, antioxidant, anti-inflammatory, and anticancer effects (27) (51). In vitro studies suggest the saponin astragaloside I promotes osteoblastic differentiation by regulating the Wnt/beta-catenin signaling pathway (36). Cardioprotective effects from astragaloside IV may occur via the notch1/hes1 signaling pathway (30). In addition, it augments fibrinolytic potential via increases in tissue-type plasminogen activator (t-PA) synthesis and downregulation of PA inhibitor type 1 (PAI-1) (21). Other anticoagulant activities are attributed to upregulation of KLF2 mRNA expression and inhibition of NF-kB signaling pathway (52).

Polysaccharides isolated from astragalus produce immunomodulating effects via activation of toll-like receptor 4 (TLR4)-related mitogen-activated protein kinase (MAPK) activities (53). In murine models, they reduced colitis via inhibition of NOD-like receptor protein 3 inflammasome, which decreases inflammatory factors such as interleukin (IL)-18 and IL-1beta (54), and reduced multiorgan iron overload via upregulated hepcidin and IL-6 expression and enhanced p38 MAPK phosphorylation (55). Cardioprotective effects with this constituent were attributed to anti-inflammatory properties and improved balance between reactive oxygen species (ROS) and NO (32).

In a diabetic rat model, astragalus polysaccharides exerted effects on glucose and lipid metabolism and insulin resistance (37).

Benefits to counteract memory disorders were seen with astragalus due to its activity as a nerve-growth promoting factor (17) and by its ability to increase M-cholinergic receptor density in senile rats (11).

In dialysis patients, an astragalus-based TCM formula enhanced NO production and transforming growth factor beta suppression (40). In IgA nephropathy patients, an astragalus injection decreased Core I β3-Gal-T-specific molecular chaperone (Cosmc) gene expression and increased IgA1 O-glycosylation levels (26). In healthy individuals, a sublingual/ingested astragalus root extract produced increases in monocytes, neutrophils, lymphocytes, and platelets, as well as circulating cytokines levels, and self-reported symptoms similar to viral type immune responses such as fatigue, malaise, and headache (38). In another study, a formula containing astragalus reduced fatigue in athletes by increasing the uptake and utility of oxygen (10).

Mechanisms by which astragalus and its constituents may exert anticancer effects have also been examined. In human colorectal cancers cell lines, astragalus suppressed chromosome organization, histone modification, and regulation of macromolecule metabolism, as well as several cancer signaling pathways (56). Saponins induced S phase and G2/M arrest and suppressed p21 expression and cyclin-dependent kinase activity (42). Modulation of mTOR signaling and COX2 downregulation also occurred, which in turn can reduce VEGF levels to suppress angiogenesis (43). In gastric adenocarcinoma cells, caspase 3 activation, G2/M phase cell cycle arrest, cyclin B1, p21 and c-myc regulation, and downregulation of vascular endothelial growth factor (VEGF) and metalloproteinase (MMP)-2 and MMP-9 occurred (41). Combined with vinblastine, saponins boosted downregulation of proangiogenic and proliferative factors while attenuating neutropenia and anemia seen with this chemotherapy (44). In combination with calpain inhibitors, these saponins may also exert more pronounced apoptotic effects (45). Polysaccharides potentiate immune-mediated antitumor activity of interleukin-2 in vitro (13), improve lymphocyte responses, enhance natural killer cell activity, potentiate monocyte activity (14), and increase phagocytosis perhaps by regulating tumor necrosis factor production (5). Apoptotic effects by polysaccharides in hepatocellular carcimona cells were attributed to decreased Notch1 expression (46).

Formononetin derived from astragalus was shown to have estrogen-receptor-modulating effects (50). Angiogenic effects of astragaloside IV appear to be synergized when combined with ferulic acid from Angelica sinsensis (57).

Fatigue, malaise, headache, and lowering of blood pressure have been reported (38).

  • Immunosuppressants: Theoretically, astragalus may antagonize the effects of immunosuppressants such as tacrolimus and cyclosporine.
  • Hormonal therapies: Astragalus and its constituents have estrogenic (23) (50) properties and may interfere with their actions.
  • Anticoagulants: In vitro studies suggest that astragalus and its constituents have anticoagulant properties (52), which may increase bleeding risk when used with these drugs.
  • Diuretics: In a small study, astragalus was shown to have natriuretic effects (8) and may therefore have additive effects with these medications.
  • Antihypertensive drugs: Astragalus extract can lower both systolic and diastolic blood pressure and may have additive effects with other antihypertensive drugs (38).
  • P-glycoprotein substrates: Astragalus polysaccharides can inhibit P-glycoprotein efflux pump function. This may increase the cytotoxicity of chemotherapy drugs, including doxorubicin, etoposide, and vincristine (58).

  1. Chu DT, Wong WL, Mavligit GM. Immunotherapy with Chinese medicinal herbs. II. Reversal of cyclophosphamide-induced immune suppression by administration of fractionated Astragalus membranaceus in vivo. J Clin Lab Immunol 1988;25:125-9.

  2. Taixiang W, Munro AJ, Guanjian L. Chinese medical herbs for chemotherapy side effects in colorectal cancer patients. Cochrane Database Syst Rev. 2005 Jan 25;(1):CD004540.

  3. McCulloch M, See C, Shu XJ, et al. Astragalus-based Chinese herbs and platinum-based chemotherapy for advanced non-small-cell lung cancer: meta-analysis of randomized trials. J Clin Oncol. 2006 Jan 20;24(3):419-30.

  4. Cui R, He J, Wang B, et al. Suppressive effect of Astragalus membranaceus Bunge on chemical hepatocarcinogenesis in rats. Cancer Chemother Pharmacol. 2003 Jan;51(1):75-80.

  5. Cho WC, Leung KN. In vitro and in vivo anti-tumor effects of Astragalus membranaceus.Cancer Lett. Jul 8 2007;252(1):43-54.

  6. Yu L, Lu Y, Li J, Wang H. Identification of a gene associated with astragalus and angelica’s renal protective effects by silver staining mRNA differential display. Chin Med J (Engl) 2002;115:923-7.

  7. Ahmed MS, Hou SH, Battaglia MC, et al. Treatment of idiopathic membranous nephropathy with the herb Astragalus membranaceus. Am J Kidney Dis. Dec 2007;50(6):1028-1032.

  8. Ai P, Yong G, Dingkun G, et al. Aqueous extract of Astragali Radix induces human natriuresis through enhancement of renal response to atrial natriuretic peptide. J Ethnopharmacol. Mar 28 2008;116(3):413-421.

  9. Shen HH, Wang K, Li W, et al. Astragalus membranaceus prevents airway hyperreactivity in mice related to Th2 response inhibition.J Ethnopharmacol. Mar 5 2008;116(2):363-369.

  10. Chen KT, Su CH, Hsin LH, et al. Reducing fatigue of athletes following oral administration of huangqi jianzhong tang. Acta Pharmacol Sin. 2002 Aug;23(8):757-61.

  11. Shi R, He L, Hu Y, et al. The regulatory action of radix astragali on M-cholinergic receptor of the brain of senile rats. J Tradit Chin Med 2001;21:232-5.

  12. Tang W, et al. Chinese Drugs of Plant Origin. Berlin: Springer-Verlag; 1992.

  13. Qun L, Luo Q, Zhang ZY, et al. Effects of astragalus on IL-2/IL-2R system in patients with maintained hemodialysis. Clin Nephrol. 1999 Nov;52(5):333-4.

  14. Chu DT, Lepe-Zuniga J, Wong WL, et al. Fractionated extract of Astragalus, a Chinese medicinal herb, potentiates LAK cell cytotoxicity generated by a low dose of recombinant interleukin-2. J Clin Lab Immunol 1988;26:183-7.

  15. Upton R. Astragalus root: analytical, quality control and therapeutic monograph. American Herbal Pharmacopoeia. 1999;1:1-25.

  16. Wu P, Dugoua JJ, Eyawo O, Mills EJ. Traditional Chinese medicines in the treatment of hepatocellular cancers: a systematic review and meta-analysis. J Exp Clin Cancer Res. 2009 Aug 12;28(1):112.

  17. Lu MC, Yao CH, Wang SH, et al. Effect of Astragalus membranaceus in rats on peripheral nerve regeneration: in vitro and in vivo studies. J Trauma. 2010 Feb;68(2):434-40.

  18. Wojcikowski K, Wohlmuth H, Johnson DW, Gobe G. Effect of Astragalus membranaceus and Angelica sinensis combined with Enalapril in rats with obstructive uropathy. Phytother Res. 2010 Jun;24(6):875-84.

  19. Auyeung KK, Woo PK, Law PC, Ko JK. Astragalus saponins modulate cell invasiveness and angiogenesis in human gastric adenocarcinoma cells. J Ethnopharmacol. 2012;141(2):635-41.

  20. Guo L, Bai SP, Zhao L, Wang XH. Astragalus polysaccharide injection integrated with vinorelbine and cisplatin for patients with advanced non-small cell lung cancer: effects on quality of life and survival. Med Oncol. 2012;29(3):1656-62.

  21. Zhang WJ, Wojta J, Binder BR. Regulation of the fibrinolytic potential of cultured human umbilical vein endothelial cells: astragaloside IV downregulates plasminogen activator inhibitor-1 and upregulates tissue-type plasminogen activator expression. J Vasc Res. 1997 Jul-Aug;34(4):273-80.

  22. Chen HW, Lin IH, Chen YJ,  et al. A novel infusible botanically-derived drug, PG2, for cancer-related fatigue: a phase II double-blind, randomized placebo-controlled study. Clin Invest Med. 2012 Feb 1;35(1):E1-11.

  23. Zhang CZ, Wang SX, Zhang Y, Chen JP, Liang XM. In vitro estrogenic activities of Chinese medicinal plants traditionally used for the management of menopausal symptoms. J Ethnopharmacol. 2005 Apr 26;98(3):295-300.

  24. Fu J, Wang Z, Huang L, et al. Review of the Botanical Characteristics, Phytochemistry, and Pharmacology of Astragalus membranaceus (Huangqi). Phytother Res. 2014 Sep;28(9):1275-83.

  25. Xu X, Li F, Zhang X, et al. In vitro synergistic antioxidant activity and identification of antioxidant components from Astragalus membranaceus and Paeonia lactiflora. PLoS One. 2014 May 9;9(5):e96780. doi: 10.1371/journal.pone.0096780. eCollection 2014.

  26. Ji L, Chen X, Zhong X, et al. Astragalus membranaceus up-regulate Cosmc expression and reverse IgA dys-glycosylation in IgA nephropathy. BMC Complement Altern Med. 2014 Jun 18;14:195. doi: 10.1186/1472-6882-14-195.

  27. Shahzad M, Shabbir A, Wojcikowski K, et al. The Antioxidant Effects of Radix Astragali (Astragalus membranaceus and Related Species) in Protecting Tissues from Injury and Disease. Curr Drug Targets. 2016;17(12):1331-1340.

  28. Wang Y, Ren T, Zheng L, et al. Astragalus saponins Inhibits Lipopolysaccharide-Induced Inflammation in Mouse Macrophages. Am J Chin Med. 2016;44(3):579-593.

  29. Wang S, Li J, Huang H, et al. Anti-hepatitis B virus activities of astragaloside IV isolated from radix Astragali. Biol Pharm Bull. Jan 2009;32(1):132-135.

  30. Huang H, Lai S, Wan Q, et al. Astragaloside IV protects cardiomyocytes from anoxia/reoxygenation injury by upregulating the expression of Hes1 protein. Can J Physiol Pharmacol. May 2016;94(5):542-553.

  31. Hu JY, Han J, Chu ZG, et al. Astragaloside IV attenuates hypoxia-induced cardiomyocyte damage in rats by upregulating superoxide dismutase-1 levels. Clin Exp Pharmacol Physiol. Apr 2009;36(4):351-357.

  32. Han R, Tang F, Lu M, et al. Protective effects of Astragalus polysaccharides against endothelial dysfunction in hypertrophic rats induced by isoproterenol. Int Immunopharmacol. Sep 2016;38:306-312.

  33. Shan G, Zhou XJ, Xia Y, et al. Astragalus membranaceus ameliorates renal interstitial fibrosis by inhibiting tubular epithelial-mesenchymal transition in vivo and in vitro. Exp Ther Med. May 2016;11(5):1611-1616.

  34. Shahzad M, Small DM, Morais C, et al. Protection against oxidative stress-induced apoptosis in kidney epithelium by Angelica and Astragalus. J Ethnopharmacol. Feb 17 2016;179:412-419.

  35. Meng LQ, Tang JW, Wang Y, et al. Astragaloside IV synergizes with ferulic acid to inhibit renal tubulointerstitial fibrosis in rats with obstructive nephropathy. Br J Pharmacol. Apr 2011;162(8):1805-1818.

  36. Cheng X, Wei B, Sun L, et al. Astragaloside I Stimulates Osteoblast Differentiation Through the Wnt/beta-catenin Signaling Pathway. Phytother Res. Jul 10 2016.

  37. Dun C, Liu J, Qiu F, et al. Effects of Astragalus polysaccharides on memory impairment in a diabetic rat model. Neuropsychiatr Dis Treat. 2016;12:1617-1621.

  38. Denzler K, Moore J, Harrington H, et al. Characterization of the Physiological Response following In Vivo Administration of Astragalus membranaceus. Evid Based Complement Alternat Med. 2016;2016:6861078.

  39. Lien AS, Jiang YD, Chih-Hsin Mou MS, et al. Integrative Traditional Chinese Medicine Therapy Reduces the Risk of Diabetic Ketoacidosis in Patients with Type 1 Diabetes Mellitus. J Ethnopharmacol. Jun 20 2016.

  40. Lui SL, Zhu D, Cheng SW, et al. Effects of Astragalus membranaceus-based Chinese Medicine Formulae on Residual Renal Function in Patients on Peritoneal Dialysis. Perit Dial Int. Sep-Oct 2015;35(5):595-597.

  41. Auyeung KK, Woo PK, Law PC, et al. Astragalus saponins modulate cell invasiveness and angiogenesis in human gastric adenocarcinoma cells. J Ethnopharmacol. Jun 1 2012;141(2):635-641.

  42. Tin MM, Cho CH, Chan K, et al. Astragalus saponins induce growth inhibition and apoptosis in human colon cancer cells and tumor xenograft. Carcinogenesis. Jun 2007;28(6):1347-1355.

  43. Law PC, Auyeung KK, Chan LY, et al. Astragalus saponins downregulate vascular endothelial growth factor under cobalt chloride-stimulated hypoxia in colon cancer cells. BMC Complement Altern Med. 2012;12:160.

  44. Auyeung KK, Law PC, Ko JK. Combined therapeutic effects of vinblastine and Astragalus saponins in human colon cancer cells and tumor xenograft via inhibition of tumor growth and proangiogenic factors. Nutr Cancer. 2014;66(4):662-674.

  45. Wang Y, Auyeung KK, Zhang X, et al. Astragalus saponins modulates colon cancer development by regulating calpain-mediated glucose-regulated protein expression. BMC Complement Altern Med. 2014;14:401.

  46. Huang WH, Liao WR, Sun RX. Astragalus polysaccharide induces the apoptosis of human hepatocellular carcinoma cells by decreasing the expression of Notch1. Int J Mol Med. Aug 2016;38(2):551-557.

  47. Fleischer T, Chang TT, Chiang JH, et al. Improved Survival With Integration of Chinese Herbal Medicine Therapy in Patients With Acute Myeloid Leukemia: A Nationwide Population-Based Cohort Study. Integr Cancer Ther. Aug 16 2016.

  48. Di Cesare Mannelli L, Zanardelli M, Bartolucci G, et al. In Vitro Evidence for the Use of Astragali Radix Extracts as Adjuvant against Oxaliplatin-Induced Neurotoxicity. Planta Med. Aug 2015;81(12-13):1045-1055.

  49. Chen MH, May BH, Zhou IW, et al. Integrative Medicine for Relief of Nausea and Vomiting in the Treatment of Colorectal Cancer Using Oxaliplatin-Based Chemotherapy: A Systematic Review and Meta-Analysis. Phytother Res. May 2016;30(5):741-753.

  50. Chen J, Zhang X, Wang Y, et al. Differential ability of formononetin to stimulate proliferation of endothelial cells and breast cancer cells via a feedback loop involving MicroRNA-375, RASD1, and ERα. Mol Carcinog. 2018 Jul;57(7):817-830. doi: 10.1002/mc.22531. Epub 2018 May 2

  51. Auyeung KK, Han QB, Ko JK. Astragalus membranaceus: A Review of its Protection Against Inflammation and Gastrointestinal Cancers. Am J Chin Med. 2016;44(1):1-22.

  52. He CL, Yi PF, Fan QJ, et al. Xiang-Qi-Tang and its active components exhibit anti-inflammatory and anticoagulant properties by inhibiting MAPK and NF-kappaB signaling pathways in LPS-treated rat cardiac microvascular endothelial cells. Immunopharmacol Immunotoxicol. Apr 2013;35(2):215-224.

  53. Wei W, Xiao HT, Bao WR, et al. TLR-4 may mediate signaling pathways of Astragalus polysaccharide RAP induced cytokine expression of RAW264.7 cells. J Ethnopharmacol. Feb 17 2016;179:243-252.

  54. Tian Z, Liu Y, Yang B, et al. Astagalus Polysaccharide Attenuates Murine Colitis through Inhibiton of the NLRP3 Inflammasome. Planta Med. Jun 9 2016.

  55. Ren F, Qian XH, Qian XL. Astragalus polysaccharide upregulates hepcidin and reduces iron overload in mice via activation of p38 mitogen-activated protein kinase. Biochem Biophys Res Commun. Mar 25 2016;472(1):163-168.

  56. Tseng A, Yang CH, Chen CH, et al. An in vivo molecular response analysis of colorectal cancer treated with Astragalus membranaceus extract. Oncol Rep. Feb 2016;35(2):659-668.

  57. Wang H, Zhang Y, Xia T, et al. Synergistic promotion of blood vessel regeneration by astragaloside IV and ferulic acid from electrospun fibrous mats. Mol Pharm. Jun 3 2013;10(6):2394-2403.

  58. Tian QE, De Li H, Yan M, et al. Effects of Astragalus polysaccharides on P-glycoprotein efflux pump function and protein expression in H22 hepatoma cells in vitro. BMC Complement Altern Med. 2012 Jul 11;12:94. doi: 10.1186/1472-6882-12-94.

  59. Zhang J, Liu L, Wang J, Ren B, Zhang L, Li W. Formononetin, an isoflavone from Astragalus membranaceus inhibits proliferation and metastasis of ovarian cancer cells. J Ethnopharmacol. 2018 Jul 15;221:91-99.

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