In the Ayurvedic system of medicine, both fresh and dry ginger are used. Ginger has been widely used as a common household remedy for various illnesses from ancient times. The properties and uses of ginger in Ayurvedic medicine are available from authentic ancient treatises like Charaka Samhitha and Susrutha Samhitha, which are the basics for this system. Descriptions of ginger are available from similar documents of Chinese and Sanskrit literature written in the subsequent centuries. Dry ginger seems to be an essential ingredient in several Ayurvedic recipes, and hence ginger is called Mahaoushadha, the great cure. This emphasizes the extensive usage of ginger in Ayurveda.
Fresh ginger and dry ginger are used in Ayurveda in different ways:
1. As a single medicine for internal use
2. As an ingredient in compound medicines
3. For external use
4. As an adjuvant
5. As an antidote
In Sanskrit literature, ginger has several synonymous words, which are indicative of its properties, and in Ayurveda different terms are used to denote the usage of ginger in different contexts. Aiyer and Kolammal (1966) quotes the following synonyms:
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Ardrika, Ardraka—that which waters the tongue and also shows the relation to the star Ardra
Sringivera, Sringa, Sringika—that which resembles the shape of the horns of animals Chatra, Rahuchatra—that which dispels diseases
Sunti, Kaphahari, Soshana—that which overcomes diseases due to kapha (phlegm)
Mahaushadha—the great cure
Viswa, Viswabeshaja—universal remedy
Nagara—that which is commonly found in towns
Katubhadra—drug that has a pungent taste, which is capable of bringing goodness Katootkata, Katuka, Katu, Ushna, Katigranthi—drug having a very pungent taste Gulma moola—rhizome (root), which is generally spongy in nature Saikatesta—that which grows generally in sandy places Anoopaja—plant that requires plenty of water for its growth
Fresh and dry ginger are similar in their properties. The only difference is that fresh ginger is not so easily digested as the dried type (Aiyer and Kolammal, 1966). All the Ayurvedic classics like Charaka samhitha, Susrutha samhitha, Ashtanga hridaya, and Nighantus give the same properties for ginger
Guna (property)—Laghu, Snigdha (light and unctuous)
Veerya (potency)—Ushna (hot)
Vipaka (metabolic property)—Madhura (sweet)
Ginger rhizome has pungent taste and is considered to be converted to sweet products after metabolic changes. Being hot and light, ginger is easily digestible. It has an unctuous quality. In Bhavaprakasa (a famous ancient text in Ayurveda, by Bhavamisra) fresh ginger is called rooksha, meaning dry. It acts as an appetizer, carminative, and stomachic. Ginger is acrid, anodyne, antirheumatic, antiphlegmatic, diuretic, aphrodisiac, and cordial. It has anti-inflammatory or anti-edematous action according to Dhan-wantary nighantu (another ancient gospel of Ayurveda attributed to the legendary Rishi Dhanwanthari). It cleanses the throat, is good for the voice (corrective of larynx affections), subsides vomiting, relieves flatulence and constipation, and relieves neck pain (Saligrama nighantu; yet another ancient text). Due to its hot property, ginger is capable of causing dryness and thus is antidiarrheal in effect. Bhavaprakasa specifically emphasizes the antiarthritic and antifilarial effects of dry ginger. It is also good in asthma, bronchitis, piles, eructation, and ascitis.
Kirtikar and Basu (1935) mentioned a remedy for cough in which fresh ginger is made into pills along with honey and ghee, and taken in a dose of four pills a day. It is applied externally to boils and enlarged glands, and internally as a tonic in Cambodia (Kirtikar and Basu, 1935). The outer skin of ginger is used as a carminative and is said to be a remedy for opacity of cornea. In acute Ascitis with dropsy arising from liver cirrhosis, complete subsidence by the use of fresh ginger juice is reported. The juice also acts as a strong diuretic (Kirtikar and Basu, 1935).
Ginger strengthens memory according to Nadkarni (1954) and removes obstruction in the vessels, incontinence of urine, and nervous diseases. Dry ginger paste with water is effective in recovering from fainting as an external application to the eyelids, or the ginger powder can be used as a snuff.
Bhaishajya ratnavali (another ancient Ayurvedic text) gives an important combination of dry ginger, rock salt, long pepper and black pepper, powdered and mixed with fresh ginger juice, to be gargled after warming, as a specific drug for phlegmatic affections of the heart, head, neck, and thoracic region. It is very good for all types of severe fevers and their associated symptoms. Ginger is made use of in veterinary science as a stimulant and carminative, in indigestion in horses and cattle, in spasmodic colic of horses, and to prevent gripping by purgatives (Pruthi, 1979). The ginger sprouts and shoots do not have any conspicuous taste and are said to aggravate Vata and Kapha (Saligrama nighantu) (Aiyer and Kolammal, 1966).
Note: According to the Ayurveda system of medicine, all the physiological functions of the human body are governed by three basic biological parameters—the thridoshas, or the three basic qualities: vata, pitta, and kapha (kafa). Vata is responsible for all voluntary and involuntary movements in the human body, pitta is responsible for all digestive and metabolic activities, and kapha provides the static energy (strength) for holding tissues together, and also provides lubrications at various joints of friction. When these three qualities (doshas) are in a normal state of equilibrium, the human body is healthy and sound, but when they lose equilibrium and become vitiated by varying internal and external factors, they produce varied diseases. Ayurveda treatment of any disease is aimed at restoring the equilibrium of the three doshas, or qualities.
Apart from its extensive use as a spice, ginger plays an important and unavoidable role in traditional medicine with a wide range of indications. Because of its carminative, stimulant, and digestive properties, ginger, wet or dry, is commonly used in fever, anorexia, cough, dyspnea, vomiting, cardiac complaints, constipation, flatulence, colic, swelling, elephantiasis, disuria, diarrhea, cholera, dyspepsia, diabetes, tympanitis, neurological disorders, rheumatism, arthritis, and inflammation of liver. It is also indicated in all phlegmatic conditions and respiratory problems such as asthma and cough.
In diseases like leprosy, anemia, leukoderma, painful micturition, hematemesis, ulcers, and fevers of Pitha predominance and in hot seasons, wet or dry ginger is not indicated (Bhavaprakasa and Saligrama nighantu).
Experimental and Clinical Investigations Effect on Digestive System
Goso et al. (1996) investigated the effect of ginger on gastric mucin against ethanol-induced gastric injury in rats and found that the oral administration of ginger significantly prevented gastric mucosal damage. Patel et al. (1996) and Patel and Srinivasan (2000) investigated the influence of dietary spice on digestive enzymes experimentally.
Dietary ginger prominently enhanced the secretion of saliva and intestinal lipase activity by chymotripsin and pancraetic amylase as well as the disaccharides sucrose and maltose. The positive influence on this terminal enzyme of the digestive process could be an additional feature of this spice to stimulate digestion. Ginger contains proteolytic enzymes that promote the digestive process and also enhance the action of the gall bladder and protects the liver against toxins (Yamahara et al., 1990).
Yoshikawa et al. (1994) analyzed ginger for its stomachic principles. An antiulcer constituent (6-gingesulfonic acid), three monoacyl digalactosyl glycerols (gingerogly-colipids A, B, C), and ( + )-angelicoidenol (2-0-beta-D-glucopyranoside) were isolated.
Suekawa et al. (1984) reported that gingerol and shogaol present in ginger juice cause vagal stimulation leading to a decrease in both the blood pressure and heart rate. Ahmed and Sharma (1997) found that male rats fed with 0.5 percent ginger for 4 weeks had a significant decrease in blood glucose, in total serum cholesterol with an increase in high-density lipoprotein (HDL) cholesterol. Additionally, these workers also found that compared to other treatment groups (control, 5 percent garlic, and ginger plus garlic), the animals consuming ginger failed to show an increase in body weight during the study. The hypoglycemic activity of ginger was also reported by Mascolo et al. (1989). They found that ethanolic ginger extract (100 to 300 mg/kg) contains compounds that inhibit prostaglandin release by leukcocytes. The inhibition of prostaglandin release is related to the antipyretic and anti-inflammatory properties of ginger.
Stimulation of the sarcoplasmic reticulam Ca2+ ATPase by gingerol and its analogues was investigated by Ohizumi et al. (1996). They studied the effects of 6-gingerol, (8)-gingerol, and (10)-gingerol isolated from rhizomes of ginger and the synthetic analogues (AP-004, AP-005, and AP-015). Ca2+ ATPase activity and Ca2+ pumping activity were increased by these compounds in a concentration-dependent manner. It was suggested that both the O-methoxyphenol and hydrocarbon chain of compounds were necessary for the activation of Ca2+ pumping ATPase activity of SR.
Jih Hwa et al. (1995) showed that gingerol at a 0.5 to 20 (xM concentration depen-dently inhibited the aggregation and release reaction of arachidonic acid and collagen-induced rabbit platelets—activating factor (PAF) u-4661 and thrombin. Gingerol (0.5 _ 10 fxM) also concentration dependently inhibited thromboxane B2 and prostaglandin D2 formation caused by arachidonic acid and completely inhibited phosphoinositide breakdown induced by arachidonic acid, but had no effect on that of collagen, PAF or thrombin even at concentrations as high as 300 fxM. In human platelet-rich plasma, gingerol and indomethacin (indometacin) prevented the secondary aggregation and blocked ATP release from platelets induced by ADP (5 fxM) and adrenaline (epinephrine) (5 fxM), but had no effect on primary aggregation. The highest antiplatelet effect was obtained when platelets were incubated with gingerol for 30 minutes and this inhibition was reversible. It has been concluded that the antiplatelet action of gingerol is mainly due to the inhibition of thromboxane formation.
Janssen et al. (1996) studied the effect of the dietary consumption of ginger on platelet thromboxane production in humans. The result of the clinical assay of the raw and cooked ginger does not support the hypothesis on the antithrombolic activity of ginger in humans.
Lumb et al. (1994) investigated the effect of dried ginger on human platelet function, thrombogin, and hemostasis. The use of ginger as an antiemetic in the preoperative period has been criticized because of its effect on thrombaxane synthetase activity and platelet aggregation. When administrated to the healthy volunteer, ginger had no dose-dependent effect on thromboxane synthetase activity or such an effect only occurs in fresh state.
However, in a previous investigation by Verma et al. (1993) on 10 male healthy volunteers, it was shown that 5 g of ginger taken with a high-fat meal for 7 days was able to inhibit significantly the enhanced tendency to platelet aggregation normally seen after a high-fat intake. Earlier studies (Srivastava 1986, 1989) indicated that ginger, in addition to inhibiting platelet aggregation, also reduces platelet thromboxane synthesis both in vivo and in vitro. However, this effect in vivo was seen after consumption of 5 g/day for 7 days. It is unknown whether the effect would also be seen under normal patterns of consumption. It is unlikely that 5 g of ginger per day would be part of a normal consumption pattern, and this amount is far in excess of what is currently available in ginger-containing preparations.
Bordia et al. (1997) showed that the dose of 10 g of powdered ginger administered to patients suffering from coronary artery disease produced a significant reduction in ADP- and epinephrine-induced platelet aggregation. An aqueous extract of ginger has strong anticlotting activity. Some components present in ginger have been shown to prevent blood clotting through physiological changes exerted on the arachidonic acid metabolism and cicosanoid metabolism (Srivastava, 1984; 1986).
One of the best-known and best-studied areas is the use of ginger for the treatment of various forms of nausea. Many animal and clinical trials have been conducted to investigate the use of ginger in preventing nausea of various types. Arfeen et al. (1995) carried out a double-blind randomized clinical trial to investigate the effect of ginger on the nausea and vomiting following gynecological laparoscopic surgery. Both 0.5 and 1.0 g of ginger were effective in reducing nausea, with only the higher dose being effective at reducing vomiting. Phillips et al. (1993) and Bone et al. (1990) reported that ginger was as effective as metoclopromide in reducing postoperative nausea and vomiting. In both of the above studies treatment with ginger reduced the need for other antiemetics during the postoperative period. In a later study Visalyputra et al. (1996) found that 2 g of ginger was ineffective in preventing the postoperative nausea and vomiting associated with diagnostic gynecological laparoscopy.
Suekawa et al. (1984) reported that 6-gingerol and 6-shogaol suppressed gastric contraction but increased gastrointestinal motility and spontaneous peristaltic activity in laboratory animals. However, these effects were observed only when ginger was administered orally and not when given intravenously. This suggests that direct contact with the intestinal mucosa and not delivery by the blood is required for the action of ginger; possibly the hepatic metabolism is involved in the action.
Treatment of morning sickness using ginger is an area in which many studies have been carried out. Fischer—Rasmussan et al. (1991), in a double-blind randomized crossover trial, found that 1 g/day of ginger was effective in reducing the symptoms of morning sickness and did not appear to have any side effect or adverse effect on pregnancy.
Murphy (1998), in her analysis of the published data on randomized clinical trials, concluded that although there was some evidence for the beneficial effects of ginger in alleviating the symptoms of morning sickness, there was so little information that definite conclusions were impossible. Nevertheless, of the various alternative therapies suggested, ginger holds the most promise as a safe, effective treatment. Similar opinions were also expressed by Jewell and Young (1998) in their Cochrane-Cochrane report on treatments of nausea and vomiting in early pregnancy.
Backon (1991) reported that ginger may affect binding of testosterone to its receptor, and when this occurs in the uterus, may alter steroid dependent differentiation. No supporting evidence is available for this conclusion. However, several sources (McGuffin et al., 1997) advise against the use of therapeutic doses of ginger during pregnancy. A survey has found that whereas 55 percent of sources recommended ginger as being safe and effective in pregnancy, 16 percent stated that ginger should not be used in pregnancy due to its potential to cause miscarriage (Wilkinson, 2003).
Recently, Keating and Chez (2003) administered ginger syrup in water to study the ameliorating effect of ginger on nausea in early pregnancy. This double-blind study showed a positive improvement in 77 percent of the cases tested. They concluded that 1 g of ginger in syrup form in a divided dose daily is useful in some patients experiencing nausea and vomiting during the first trimester of pregnancy. On the other hand, Vutya-vanich et al. (2001) concluded, from another double-blind study, that ginger effectively treats the symptoms of pregnancy-associated nausea and vomiting and that there is no evidence of any adverse effect. Fulder and Tenne (1996) reported that ginger is an over-the-counter medicine recommended for managing pregnancy-related nausea in many western countries.
Sontakke et al. (2003) studied the antiemetic effect of ginger in preventing nausea and vomoting induced by cyclophosphamide. The results indicated that in 62 percent of patients complete control of nausea was achieved; metoclopromide controlled nausea in 58 percent of patients, whereas with odansetron 86 percent control resulted. The authors recommended that the use of powdered ginger is useful in preventing nausea and vomiting induced by cyclophosphamide. The antiemetic efficacy of ginger was equal to that of metaclopromide.
Ernst and Pittler (2000) carried out a systematic review of the evidence that have accumulated from randomized clinical trials on the effect of ginger in checking nausea and vomiting. They found only six studies that satisfied all the experimental conditions. Three studies on postoperative nausea and vomiting indicated that in two cases ginger was superior to placebo and equally effective as metoclopromide. The pooled information indicated only a nonsignificant difference between the ginger and placebo groups for ginger 1 g taken before operation. One study was found for each of the following conditions: seasickness, morning sickness, and chemotherapy-induced nausea. These studies collectively favored ginger over placebo.
Ginger is also reported to be an effective remedy for travel and motion sickness. Mowrey and Clayson (1981) has done one of the best-known experiments in this area. In this clinical trial 39 men and women who reported a very high susceptibility to motion sickness were tested. Motion sickness was induced by being subjected to a rotating chair while blindfolded under controlled conditions. It was found that ginger was significantly more effective in reducing motion sickness than the antihistaminic dimenhydrinate and a placebo.
A Danish controlled trial on seasickness involved 80 naval cadets who were unaccustomed to sailing in rough seas. The subjects reported that ginger consumption reduced the tendency to vomiting and cold sweating significantly better than the placebo did.
Han Chung et al. (2003) analyzed the effect of ginger on motion sickness and gastric slow-wave dysrhythmias induced by circular vection. Volunteers subjected to circular vection were studied for nausea induction, electrogastrographic recordings, plasma vaso-pressin levels, both with and without ginger pretreatment, in a crossover design, doubleblind, randomized placebo-controlled study. Pretreatment with ginger reduced the nausea, tachygastria, and plasma vasopressin. Ginger also prolonged the latency before nausea onset and shortened the recovery time after vection cessation. Intravenous vasopressin infusion at 0.1 and 0.2 U/min induced nausea and increased bradygastric activity; ginger pretreatment (2000 mg) affected neither. Ginger effectively reduced nausea, trachygastric activity, and vasopressin release induced by circular vection. The authors suggest that ginger may act as a novel agent in the prevention and treatment of motion sickness.
The general hypothesis of the mode of action is that ginger ameliorates the nausea associated with motion sickness by preventing the development of gastric dysrhythmias and the elevation of plasma vasopressin. Ginger also prolonged the latency before nausea onset and shortened the recovery time. So ginger is recommended as a novel agent in the prevention and treatment of motion sickness (Holtmann et al., 1989).
Anti-Inflammatory Properties; Effect on Rheumatoid Arthritis and Musculoskeletal Disorders
In the Indian system of medicine (Ayurveda) ginger is used as an anti-inflammatory drug. It has been suggested that ginger may be useful as a treatment for arthritis, and a number of commercial preparations are available for this use. For example, Bio-organics Arthri-Eze Forte (Bullivants, Australia) and Extralife Artri-care (Felton grimwade & Brickford, Ltd., Australia) are marketed as arthritis treatments and contain 500 mg dried, powdered ginger rhizome. Srivastava and Mustafa (1989, 1992) reported more than 75 percent of patients receiving 3 to 7 g of powdered ginger daily for 56 days had a significant reduction in pain and swelling associated with either rheumatoid or osteo-arthritis. Adverse effects have not been so far reported. The results indicate that ginger has anti-inflammatory properties. Follow-up studies carried out (from 3 months to 2.5 years) in patients using 0.5 to 1 g powder/day exhibited a significant reduction in pain and swelling in 75 and 100 percent, respectively, of arthritis (rheumatoid and osteoar-thritis) and muscular discomfort. The World Health Organization (WHO) document (2000) reports that 5 to 10 percent ginger extract administration brought about full or partial pain relief, or recovery of joint function and a decrease of swelling in patients with chronic rheumatic pain and lower back pain.
Kishore et al. (1980) clinically evaluated the effects of a ginger and Tinospora cordifolia combination in rheumatoid arthritis. The combination showed better results compared to other traditional medicines. The antiarthritic effect of ginger and eugenol was studied by Sharma et al. (1997a), who reported that ginger significantly suppressed the development of adjuvant arthritis.
Rebild et al. (2002) evaluated a biocomplex, Zinaxin, derived from a highly concentrated extract of ginger for its efficacy and safety in relieving knee osteoarthritis in 247 patients. The extract significantly reduced the knee pain after standing and walking. However, the extract increased the incidence of gastrointestinal pain in treated patients.
Jana et al. (1999) demonstrated that ginger at a dose of 100 mg/kg body weight was as effective as acetylsalicylic acid (100 mg/kg) in reducing carrageenin-induced edema in rats. Although this dose also reduced inflammation, it was not as effective as phenylbutazone. Similar results for the anti-inflammatory and analgesic activities of ginger were reported by Mascolo et al. (1989). It is thought that these anti-inflammatory actions are a result of inhibition of prostaglandin release, and hence ginger may act in a similar fashion to other nonsteroidal anti-inflammatory drugs that interfere with prostaglandin release or biosynthesis. Bliddal et al. (2000) carried out a randomized, placebo-controlled, crossover study on the effects of ginger extract and ibuprofen in patients suffering from osteoarthritis. The workers obtained a significant effect from ginger administration. More intensive and wider study on the beneficial effect of ginger in reducing pain due to osteoarthritis and rheumatoid arthritis have been advocated (Reginster et al., 2000).
A common side effect of treating inflammation with modern drugs is that they can lead to ulcer formation in the digestive system. Ginger not only prevents the symptoms of inflammation, but it also prevents ulcers in the digestive tract (Anonymous, 2003b).
Ginger is also shown to be effective in preventing gastric mucosal damage induced by ethanol (administered 30 minutes later). In ethanol-treated rats the mucin content of the deep mucosa was reduced. This reduction of the deep corpus mucin content was significantly inhibited by treatment with ginger rhizome (Goso et al., 1996).
There is considerable emphasis on identifying potential chemoprotective agents present in foods consumed by the human population. In prior in vitro studies, the water or organic solvent extract of ginger was shown to possess antioxidative and anti-inflammatory properties. Ethanolic extract of ginger (GE) rhizome was investigated for anti-tumor—promoting effects in a mouse skin tumerogenesis model (Katyar et al., 1996). Skin tumor promotes induced epidermal ornithine decarboxylase (ODC), cyclooxygenase, and lipoxygenase activities, and hence edema and hyperplasia are conventionally used markers of skin tumor promotion. So the effect of GE on these parameters was assessed initially. Preappli-cation of GE onto the skin of SENCAR mice resulted in significant inhibition of 12-0-tet-radecanoylphorbol-13-acetate (TPA) induction of epidermal ODC-cyclooxygenase and lipoxygenase activities and ODC m-RNA expression in a dose-dependent manner. Preap-plication of GE to mouse skin also afforded significant inhibition of TPA-induced epidermal edema (56 percent) and hyperplasia (44 percent). In long-term tumor studies, topical application of GE, 30 minutes prior to each TPA application of 7,12-dimethyl-benz(a)-anthracene—initiated SENCAR mice, resulted in a highly significant protection against skin tumor incidence and its subsequent multiplicity. The animals pretreated with GE showed substantially lower tumor body burdens compared with non-GE-treated controls. The results provide clear evidence that GE possesses anti-skin-tumor—promoting effects, and that the mechanism of such effects may involve inhibition of tumor promoter-caused cellular, biochemical, and molecular changes in mouse skin.
Sharma and Gupta (1998) investigated the effect of ginger in reversing the delay in gastric emptying caused by the anticancer drug cisplatin. Cisplatin causes nausea, vomiting, and inhibition of gastro-emptying. Acetone and 50 percent ethanolic extracts of ginger (100, 200, and 500 mg/kg, p.o) and ginger juice (2 and 4 ml/kg) were investigated against cisplatin effects on gastric emptying in rats. Ginger administration significantly reversed cisplatin-induced delay in gastric emptying. The ginger juice and acetone extracts were more effective than the 50 percent ethanolic extract. The reversal produced by the ginger acetone extract was similar to that caused by the 5-HT3 receptor antagonist ondansteron; however, ginger produced better reversal than ondansteron. These authors suggested that ginger, used as an antiemetic in cancer therapy, may also be useful in improving the gastrointestinal side effects of cancer chemotherapy.
Chih Peng et al. (1995) showed that the extract of dried ginger rhizome exhibited biphasic effects on the secretion of cytokines by human peripheral blood mononuclear cells in vitro. The stimulatory effect of the extract on cytokine secretion was shown to be time dependent; a significant increase in the secretion of cytokines was noted in the presence of low doses of ginger extract (10 to 30 mg/ml) 18 to 24 hours after administration. At a higher concentration of the extract, cytokine production was suppressed.
Kim et al. (2002) found that the four types of shogaols from ginger protect IMR32 neuroblastoma and normal human umbilical vein endothelial cells from beta-amyloid at EC50 = 4.5 to 8.0 (xM l _1. The efficacy of cell protection from beta-amyloid insult by the shogaols was shown to improve as the length of the side chain increases.
Sharma et al. (1997) investigated the effect of ginger extract (50 percent ethanolic and aqueous) for activity against emesis induced by 3 mg/kg cisplatin (iv) in healthy mongrel dogs. The acetone and 50 percent ethanolic extract at doses of 25, 50, 100, and 200 mg/kg, p.o. exhibited significant protection, whereas the aqueous extract was ineffective at these doses. The acetone extract was more effective than the ethanolic extract. However, both were less effective when compared with the 5-HT receptor antogonist granisetron. Ginger extract was not effective against apomorphine-induced emesis, ruling out mediation at the level of dopaminergic transmission. The findings suggest that ginger could be an effective and cheap antiemetic adjunct to cancer therapy.
Sharma et al. (1996) studied hypolipidemic and antiatherosclerotic effects of Z. officinale in cholesterol-fed rabbits. The administration of GE increased the fecal excretion of cholesterol, thus suggesting a modulation of absorption; the treatment reduced total serum cholesterol and low density cholesterol (LDC) levels. The atherogenic induct was reduced from 4.7 to 1.12.
An herbal medicine containing ginger was investigated for vaso-relaxant action on isolated vessels from rat, guinea pigs and rabbits by Calixto and Cabrini (1997) and the extract produced partial relaxation. Inoue et al. (1996) subjected for study a kampo medicine containing ginger for its restorating effect, and the drug prevented the modification of the macrophage function induced by atherogenic factors.
Wijaya et al. (1995) Investigated a Chinese medicine, Slimax, containing ginger for its effect on lipid metabolism in obese experimental animals. The major pharmacological action of Slimax appeared to be on the regulation of glucose utilization and mobilization.
Lumb (1994) investigated the effect of dried ginger on human platelet function, thrombogin, and hemostasis. The use of ginger as an antiemetic in the preoperative period has been criticized because of its effect on thromboxane synthetase activity and platelet aggregation. Bordia et al. (1997) studied the effect of ginger and fenugreek on blood lipids, blood sugar, and platelet aggregation in patients with coronary artery disease (CAD). A single dose of ginger powder (10 g) administered to CAD patients significantly reduced platelet aggregation induced by ADP or epinephrine and found no effect on blood lipid or blood sugar.
Bhandari et al. (1998) studied the protective action of ginger on cholesterol-fed rabbits. The animals receiving GE showed a lower degree of atherosclerosis.
Hiserodd et al. (1998) successfully isolated 6-, 8-, and 10-gingerol and evaluated their activity to inhibit Mycobacterium avium and M. tuberculoses. 10-Gingerol was identified as an active inhibitor of these two microbes in vitro.
The protective effect of a traditional Chinese medicine, Shigyakuto (containing 50 percent ginger), against infection of herpes T virus infection was investigated by Ikemoto et al. (1994) and the drug was found to be protective through the activation of CD8 + T cells. No virucidal or virostatic activity was observed.
Sandeson et al. (2002) studied the bioactivity of ginger extract on adult Schistosoma mansoni worms and their egg production under in vitro and in vivo conditions in laboratory mice. Ethyl acetate extract of ginger at a concentration of 200 mgL"1 of extract killed almost all worms within 24 hours. Male worms are more susceptible than females. The cumulative egg output of surviving worm pairs in vitro was considerably reduced when exposed to the extract. After 4 days of exposure to 50 mgL"1, the cumulative egg output was only 0.38 eggs per worm pair compared with 36.35 for untreated worms. However, in vivo GE did not show any significant effect on worms or on their egg-laying capacity. Extract of the rhizome of Zingiber corallium was shown to be effective in killing the larvae of S. japonicum cercaria (Shuxuan et al., 2001)
A combination of ginger and Ginkgo biloba was studied experimentally in elevated plus maze by Hasenohrl et al. (1996). The investigation evidently proved the anxiolytic effect of ginger is comparable to diazepam. But the action is biphasic; in high dosage it may also have an anxiogenic effect. The known antiserotonergic action of ginger and G. biloba is considered to be the responsible factor for the anxiolytic-like action.
Yamaoka et al. (1996) investigated a kampo medicine for its action in augmenting natural killer (NK) cell activity. This medicine isused in Japan to treat chronic hepatitis, distress, and fullness in the chest and ribs. Ginger is one of its seven ingredients, and studies showed that extracts of ginger and Zizyphus jujube and the other three components augmented NK cell activity.
Sohni and Bhatt (1996) studied the activity of a formulation in hepatic amebiasis and in immunomodulation studies. The ingredients in the formulation were Boerhaavia diffusa, Tinospora cordifolia, Berberis aristata, Terminalia chebula, and Z. officinale. The formulation showed a maximum cure rate of 73 percent. Humoral immunity was enhanced. The cell-mediated immune response was stimulated as observed in the leukocyte migration inhibition test. Bhandari et al. (2003) studied the effect of an ethanolic extract of ginger on country-made liquor (CML)-induced liver injury in rats. Hepato-toxicity was induced by administering CML (3 ml/100 g/day in two divided doses) and corn oil (1 mL/100g/day in a single dose) orally for 21 days. The administration of ginger ethanolic extract (200 mg/kg) orally from day 15 to 21 along with CML produced significant lowering of serum AST, ALT, ALP, gamma-GTP, and tissue lipid peroxide levels. The results were comparable to silymarin (25 mg/kg orally). The study thus showed that several mechanisms are involved in the reduction of liver damage by ethanolic GE.
Dedov et al. (2002) showed that gingerol functions as an agonist of the capsaicin-activated vanilloid receptor (VR1). (6)-Gingerol and (8)-gingerol evoked capsaicin-like intracellular Ca2+ transients and ion currents in cultured dorsal root ganglion neurons. These effects of gingerols were blocked by capsazepine, the VR1 receptor antagonist. The potency of gingerols increased with the increasing size of the side chain. The authors concluded that gingerol represents a novel class of naturally occurring VR1 receptor agonists that may contribute to the medicinal properties of ginger.
Kamtchouing et al. (2002) evaluated the androgenic activity of ginger in male rats. The aqueous extract significantly increased the relative weight of the testis, serum testosterone level, testicular cholesterol level, and epididymal alpha-alpha-glucosidase activity. The effects indicate the androgenic activity of ginger.
Ginger has also been shown to have an antivertigo activity similar to dramamine (Tyler, 1996). A significant decrease in induced vertigo indicated a possible inhibitory action of ginger on the vestibular impulses to the brain (Grotved and Hentzer, 1986),
Ginger has a strong antitussive effect, and helps to dispel bronchial congestion. A cup of hot ginger tea containing one-quarter tablespoon of ginger mixed with honey relieves congestion and has been reported to be more effective, when a cough mixture proved to be ineffective (McCaleb, 1996). Both gingerol and shogaol possess an antitussive property; shogaol is more potent (Miller and Murray, 1998).
Normally, ginger is a safe drug without any adverse reactions and has a wide range of utility. Paradoxically, it is included in the list of plants containing poisonous principles (Chopra et al., 1958) because of its oxalic acid content.
Ahmad et al. (2002) tested ginger oleoresin on adult Swiss mice. The oleoresin exhibited a marked action on the central nervous system. A single dose up to 0.5 g/kg resulted in vasodilatation, activeness, and alertness in animals. A dose up to 3 g/Kg was nonlethal, whereas doses above that resulted in mortalities, an abnormal gait associated with abdominal cramps, and gastric irritation. The LD50 is 6.284 g/kg. Death may be due to the direct action on the CNS resulting in respiratory failure as well as circulatory arrest.
Fresh and dry ginger are used as such and are generally not subjected to any purification methods. Yet there are some references to purification in Ayurvedic descriptions. Methods of purification for dry ginger and fresh juice are available from Arogyakalpadruma (an Ayurvedic text that concentrates on pediatrics). Purification of ginger may therefore be intended only for pediatric use, that is, to reduce the potency and pungency for infant use.
The method of purification of ginger involves immersing it in limewater for 1-1/2 hour, washing with sour gruel (or sour rice washings), and drying in bright sunlight.
The expressed fresh juice is to be kept undisturbed until the particles settle down. The supernatant alone is then poured into a red-hot iron vessel and thus becomes purified.
Ginger in Home Remedies (Primary Health Care)
1. Decoction of dry ginger together with jaggery (a form of crude sugar) relieves dropsy (an excessive accumulation of watery fluid in any of the tissues or cavities of the body.
2. Hot decoction of dry ginger is stomachic and digestive and relieves cough, asthma, colic, and angina pectoris.
3. Ginger juice with an equal quantity of milk is indicated in ascitis (abnormal accumulation of fluid in the peritoneal cavity). The ghee prepared with 10 times the ginger juice also has the similar effect.
4. Warm juice of ginger mixed with gingelly oil, honey, and rock salt is a good eardrop in otalgia (pain in the ear).
5. Paste of ginger made with Ricinus root decoctions is cooked over red-hot coals after covering with mud, and the juice is collected with this special method (Pudapaka swarasa). This juice, if taken along with honey, cures the symptoms of rheumatic fever.
7. Ghee prepared with ginger juice, ginger paste, and milk relieves edema, sneezing, ascitis, and indigestion.
8. Ginger juice along with lemon juice and mixed with little rock salt powder is effective in flatulence (presence of excessive gas in the stomach and intestine), indigestion, and anorexia (having no appetite for food).
9. Dry ginger is effective in all symptoms due to the ingestion of jackfruit.
10. Ginger immersed in lime water (calcium hydroxide) and applied to the skin can remove warts.
11. Ginger juice and clear lime water mixed and applied cures corn (a small painful horny growth on the sole of the foot or the toes).
12. Ginger juice and honey (from Apis indica) in equal quantities is hypotensive in action, and of course is excellent for relieving cough.
13. Application of ginger juice around the umbilical region is good for curing diarrhea.
14. Purified ginger juice, onion juice, and honey in equal parts if taken at bedtime is anthelmintic in action.
15. Dry ginger pounded in milk and then the expressed juice used as a nasal drop relieves headache and associated symptoms.
16. Dry ginger powder, tied in a small piece of cloth, if massaged after heating will cure alopecia (loss of hair, a condition in which the hair falls from one or more round or oval areas leaving the skin smooth and white) and promote hair growth.
17. Dry ginger paste, taken along with milk is indicated in jaundice, and when applied to the forehead relieves headache.
18. Dry ginger boiled in buttermilk is antipoisonous and is given for internal use.
19. Dry ginger paste taken internally with hot water and applied over the whole body is the antidote for the toxic effects of Gloriosa (spider lily).
20. In snake poisoning, the external application with ginger over the bite wound and cold body parts and the drinking of ginger decoction is said to be effective.
21. Ginger juice is an excellent adjuvant for the medicinal preparation Vettumaran (an ayurvedie preparation), which is indicated in such conditions as fever, chickenpox, and mumps.
22. Ginger juice is used in the purification of cinnabar (HgS) before incinerating it to lessen its toxicity and to make it biologically acceptable.
Ginger forms a component of a large variety of Ayurvedic preparations. However, the following cautions are indicated. Ginger has ushna (hot) and tikshna (intense-pungent) attributes, and hence is contraindicated in anemia, burning sensation, calculus (a concretion formed in any part of the body, usually by compounds of salts of organic or inorganic acids), hemorrhage of liver, leprosy, and blood diseases. Its consumption should be reduced or avoided in the hot summer season. Green ginger should not be used for medicinal purposes according to Nadkarni (1976). Ginger is also used in homeopathy and the Unani systems of medicine. In the former it is used to treat albuminemia (the presence of serum albumin and serum globulin in the urine), bad breath, dropsy, and retension of urine. In the Unani system, ginger is used for its anthelmintic, aphrodisiac, carminative, digestive, and sedative properties; in headache, lumbago, nervous diseases, pains, and rheumatism; and for strengthening of memory (Nadkarni, 1976).
Ginger is also used in veterinary medicine in horses and cattle for rheumatic complaints, and as an antispasmodic, and a carminative in atonic indigestion (Blumenthal, 1998; Pakrashi and Pakrashi, 2003).
Ginger rhizome is an important drug in the Chinese and Japanese systems medicine (known as sheng jiang in Chinese [Mandarin] and shokyoin in Japanese). In fact, in Chinese medicine fresh and dry ginger are used for different clinical purposes. Generally, fresh ginger (Zingiberis Recens rhizoma-Sheng Jiang) is used as an antiematic, antitussive, or expectorant, and is used to induce perspiration and dispel cold. Dried ginger (Zingiber Rhizoma, gan Jiang in China) is used for stomachache, vomiting, and diarrhea accompanied by cold extremities and faint pulse (Benskey and Gamble, 1986). In China ginger dried in the sun as well as heated and dried in pans with or without hot sand is used. In Japanese medicine ginger dried in the sun (shokyo in Japanese) as well as steamed dried (kankyo in Japanese) are used differently.
In Chinese Materia Medica (Benskey and Gamble, 1986) ginger is indicated to have the following functions and clinical uses:
• Releases the exterior and disperses cold; used for exterior cold patterns.
• Warms the middle burner and alleviates vomiting—used for cold in the stomach, especially when there is vomiting.
• Disperses cold and alleviates coughing, used for coughing from acute wind, cold cough patterns, and chronic lung disorders with phlegms.
• Reduces the poisonous effects of other herbs—used to detoxify or treat overdoses of other herbs such as radix, aconity carmichaeli praeparata (Fuzi) or Rhizoma Pinelliae Ternate (Banxia).
• Adjusts the nutritive and protective Qi—used for exterior deficient patients who sweat without an improvement in their condition.
In the Divine Husbandman's classic of the Materia Medica of China, ginger rhizome is indicated to have the following functions and chemical uses: "Vomiting, diarrhea, lightheadedness, blurred vision, and numbness in the mouth and extremities. In advanced cases, there can be premature atrial contractions, dyspnea, tremors, incontinence, stupor, and a decrease in temperature and blood pressure."
• Warms the middle body (stomach region) and expels cold: used to warm the spleen and stomach, especially in deficiency cold patterns with such manifestations as pallor, poor appetite, cold limbs, vomiting, diarrhea, cold painful abdomen and chest, a deep, slow pulse, and a pale tongue with a moist, white coating.
• Rescues devastated Yang and expels interior cold: used in patterns of devastated or deficient Yang with such signs as a very weak pulse and cold limbs.
• Warms the lungs and transforms phlegm: used in cold lung patterns with expectoration of thin, watery, or white sputum.
• Warms the channels and stops bleeding: used for deficiency cold patterns that may present with hemorrhages of various types, especially uterine bleeding. Ginger is used in hemorrhage only if the bleeding is chronic and pale in color and is accompanied by cold limbs, ashen white face, and a soggy, thin pulse.
— With Radix Glycyrrhizae Uralensis (Gan Cao) for epigastric pain and vomiting due to cold deficient stomach and spleen.
— With Rhizoma Alpiniae Officinari (Gao Liang Jiang) for abdominal pain and vomiting due to cold stomach.
— With Rhizoma Pinelliae Ternate (Ban Xia) for vomiting due to cold-induced congested fluids. Add radix ginseng (Ren Shen) for vomiting due to deficiency cold.
— With Rhizoma Coptidis (Huang Lian) for epigastric pain and distension, dysentery-like disorders, and indeterminate gnawing hunger. The latter is a syndrome characterized by a feeling of hunger, vague abdominal pain, or discomfort sometimes accompanied by belching, distension, and nausea, which gradually culminates in pain.
— With Cortex Magnoliae Officinalis (Hou Po) for epigastric distension and pain due to cold-induced congealed fluids.
— With Rhizoma Atractyloids Macrocephalae (Bai Zhu) for deficient spleen and diarrhea. If both herbs are charred, they can be used for bloody stool and excessive uterine hemorrhage.
— With Fructus Schisandrae Chinensis (Wu Wei Zi) for coughing and wheezing from cold congested fluids preventing the normal descent of lung Qi.
— Compared to Rhizoma Zingiberis Officinalis Recens (Sheng Jiang), Rhizoma Zingiberis officinalis (Gan Jiang) is more effective in warming the middle burner and expelling interior cold, whereas Rhizoma Zingiberis Officinalis Recens (Sheng Jiang) promotes sweating and disperses exterior cold.
Cautions and Contraindications
— Contraindicated in deficient Yin patterns with heat signs.
— Contraindicated in reckless marauding of hot blood.
— Use cautiously during pregnancy.
Chinese Healing with Muxibustion: The Ginger Moxa
Moxibustion is a Chinese treatment practice used along with acupuncture for conditions ranging form bronchial asthma to arthritis with amazing success. In moxibustion the leaves of the herb (Artemesiae vulgaris, Chinese mugwort) are dried, rolled into pencillike sticks and burned, and this burning stick is used for the treatment. The ginger moxa is one type of treatment that combines the therapeutic properties of muxibustion with those of ginger. A slice of ginger, 1 to 2 cm thick, is cut and pierced with tiny holes. Dried mugwort leaves are then rolled into a short cone. The ginger disk is placed on the umbilicus of a patient suffering from diarrhea or abdominal pains. The moxa cone is placed on the ginger disk and then carefully lit with a small flame. The burning nugget of moxa and ginger remain on the umbilicus until the patient perspires and the area turns red. New cones are added as the original cones burn down and this continues until 4 to 5 cones are consumed. Ginger moxa also has been proven to be beneficial in the treatment of painful joints (Balfour, 2003).
Ginger in Traditional Medical Care in Other Countries
Ginger is used in primary health care in almost all ginger-producing countries. The most important use to which it is put is to cure indigestion and stomachache. The expressed juice of fresh ginger mixed with sugar or honey is used widely for these purposes.
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