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An ancient Chinese remedy with huge prospects for modern health challenges

Baical Skullcap

Scutellaria baicalensis Lamiaceae

Baical skullcap (or simply baical) is one of the most widely used Chinese remedies in western herbal practice, applied to some of the most challenging modern health problems, including complex immunological, inflammatory, neurological and metabolic disease.

  • How does it feel?

    Baical skullcap has the complex taste profile one expects from a remedy with so much depth to its reputation. There is heat, aromatic and resinous qualities as well as the bitterness that gives baical its traditional cooling properties. The aftertaste is predominantly sweet.

    These traditional qualities add to the intriguing complexity of this remedy and to its prospects for helping a wide range of problems. Although not prominent in the traditional reputation of the herb its sweetness helps us to understand its overall supportive role.

  • What can I use it for?

    Baical skullcap is generally used in formulations rather than on its own. The modern practitioner focuses on its role in managing immunological problems, especially involving allergies and hypersensitivity reactions. Conditions in which it might be used include asthma, hayfever, allergic eczema and rhinitis.

    Baical is also used in complex protocols in the management of autoimmune and other longterm immunological problems and infections. These include particularly chronic hepatitis and lung diseases. It has a modern reputation in China for the treatment of quite severe bacterial and viral infections.

    Baicalin-rich extracts are used topically for skin conditions.

  • Into the heart of Baical Skullcap

    The indications outlined above are consistent with baical’s traditional reputation in Chinese medicine as cooling excessive ‘heat: modern equivalents of ‘heat’ include inflammation, agitation and wider hyperactivity. However the traditional quality also points towards relieving heat combined with ‘dampness’: ‘damp-heat’ is a traditional descriptor of hepatitis and also mucosal conditions associated with infections and acute inflammations.

    Some of the modern applications are to conditions that would have been described as ‘dry heat’, notably the classic hypersensitivity conditions like hayfever and uncomplicated asthma. These are marked by dry mucosa and non-productive cough. In such indications, the cooling and drying properties of baical shold be complemented with agents that are moistening and cooling, licorice being the most obvious and common example.

    There is nothing new in the apparent contradiction between characteristics and application. Baical was a component of a warming prescription (along with bupleurum, licorice, ginseng, ginger and others) recorded in the great Chinese classic Shanghan Lun (On Cold Damage), written around 200 AD. As is often the case in traditional medicine it is the combination that counts rather than the action of the remedy alone.

  • Traditional uses

    The first description of Baical skullcap was recorded as early as the Zhou Dynasty over 3000 years ago. The Han Dynasty Classic of Internal Medicine ‘Shennong Ben Cao Jing’ (the earliest existing traditional Chinese medicine book), recorded its medicinal application as a cure for lung and liver diseases almost 2000 years ago.

    Although the root of the plant is most often used there is also a tradition for using the aerial parts in teas for clearing heat and removing dampness, and promoting digestion, typical indications for bitters.

  • Traditional actions

    • Antimicrobial
    • Anti-inflammatory
    • Antispasmodic
    • Astringent
    • Nervine
  • What practitioners say

    Baical skullcap is widely used in traditional Chinese medicine for its cardiovascular, hepatic, and renal protective effects. It is commonly used by physicians there to treat potentially serious diseases such as hepatitis, hypertension, acute respiratory infection, acute gastroenteritis, infantile diarrhoea, vomiting during pregnancy and other diseases. It was also used for threatened miscarriage and other problems of pregnancy, and is also used in some cancer therapies.

    In modern western herbal practice, baical has been most widely used in immunological and hypersensitivity disorders.

    Respiratory: The most common application is for lung and airway symptoms of these disorders, notably asthmatic conditions (especially when associated with secondary bronchitis), hypersensitivity conditions like hayfever and allergic rhinitis, and especially fungal and bacterial infections. It has a reputation in China of being effective also in acute viral infections of the airways. Where there is no infective complication in an allergic or asthmatic condition, baical needs to be combined with licorice or other moistening herbs.

    Nervous system: There is growing interest in the potential role of baical in helping reducing neuroinflammation, the common factor now implicated in dementia, long-term psychiatric and neurological disease, and conditions such as chronic fatigue syndrome and fibromyalgia.

    Metabolism: Positive research findings on the role of baical in managing metabolic syndrome, insulin resistance and late-onset diabetes have encouraged practitioners to consider this remedy as these are often co-factors in immunological conditions.

    Liver: Baical is traditionally used for hepatitis and its role in supporting liver function is likely to be very important in some of the conditions above.

    Circulation: Baical is applied clinically in China for hypertension and other cardiovascular problems, including those of late onset diabetes.

  • Research

    Emerging evidence has established that baicalin improves chronic inflammation, immune imbalance, disturbances in lipid metabolism, apoptosis and oxidative stress. Thereby it offers beneficial roles against the initiation and progression of cardiovascular disorders such as atherosclerosis, hypertension, myocardial infarction and reperfusion, and heart failure (3).

    The protective effects of baicalin (a molecule from baical skullcap) on liver disease have received research attention. Studies have shown that baicalin protects against several types of liver diseases including viral hepatitis, fatty liver disease, xenobiotic induced liver injury, cholestatic liver injury, and hepatocellular carcinoma, with a variety of pharmacological mechanisms (4). 

    Baicalin also regulates intestinal flora by promoting the production of short chain fatty acids (SCFAs). Furthermore, Baicalin is involved in the interactions of the liver-gut axis by regulating TGR5, FXR, bile acids and the microbiota (5).

    Baical has been used in TCM as a frequent component in prescriptions for depression, anxiety and epilepsy. Modern reviews are supporting the neuroprotective properties of baicalin, with evidence for effects on the production of a variety of relevant anti-inflammatory cytokines (6).

    There are also studies showing the ameliorating effects of baical and its two major bioactive constituents, baicalin and baicalein, on parameters of metabolic syndrome, including antidiabetic, anti-hyperlipidemic, anti- obesity, and antihypertensive activity. Activation and upregulation of AMPK and PPAR-γ as the main signals in the haemostasis of glucose and lipid metabolisms appear to be important mechanisms (7). Wogonin has also shown laboratory effects in markers of diabetic circulatory complications (8), and has been used as an anti-cancer drug in Chinese medicine practice. It has been found in vitro to effectively tackle cancers cells via several mechanisms, however more studies are needed to see if this will translate into humans (9).

  • Did you know?

    The mandarin name huang qin means ‘golden herb’. It is one of the most prominent of traditional Chinese remedies, having a new lease of life in the modern treatments in China of cancer, complex infections and immune diseases and even in psychiatric and neurological medicine.

Additional information

  • Safety

    Baical skullcap is used in TCM for a number of pregnancy related conditions, including sickness and nausea. However, it is recommended to consult a Medical Herbalist before use during pregnancy and lactation.

  • Interactions

    None known

  • Contraindications

    Not to be used with cold syndromes of deficiency type according to TCM.

    There are few reports of adverse effects reliably linked to baical skullcap. However, one case report of an elderly lady taking a combination supplement for arthritis which included Baical Skullcap reports that acute liver injury was experienced as a result of the supplement. Cessation of the supplement resulted in led to a significant improvement in liver symptoms. On resumption of the supplement the patient again suffered from considerable hepatotoxicity (10). 

    However contamination or misidentification of the herbal components is always a possibility in explaining the appearance of such an adverse reaction. The specific ingredient responsible is somewhat unclear and the injury may have been due to a contaminant or misidentified constituent in the proprietary mixture (13, 14). Skullcap is indeed well known for being adulterated in over the counter supplements (see Quality Control below for more details).

    Baicalin has been shown to decrease the level of statins in healthy volunteers (11). It may be necessary to consider the use of baical skullcap in cases where cholesterol management is critical.

  • Preparation

    • Dried root
    • Powdered
    • Capsule
    • Tincture
    • Decocted root extraction
  • Dosage

    Infusion / Decoction: 2-6 g per day of the dried root, although lower doses are often used in combination with other herbs.

    Tincture (1:5 in 45%): Take 1-2 ml there times a day.

  • Plant parts used

    Root

  • Constituents

    The most prominent constituents are:

    • Flavones and flavone glycosides incl baicalin (quickly converted in the gut to its aglycone baicalein), and wogonoside (converted to wogonin). Over 40 other flavonoids and their flavonols, dihydroflavones and their dihydroflavonols, chalcones and bioflavonoids have also been identified (1)
    • Carotenoids
    • Diterpenes
    • Volatile oils (2)
  • Habitat

    Native to China, Korea and Mongolia, Baikal Skullcap grows happily on grassy mountain slopes.

  • Sustainability

    Over the past several decades, the wild resource of baical skullcap has suffered rapid declines. As a result, it was listed as a class III conserved medicinal plant in China. Large-scale cultivation programs have been initiated in China since 1958 to help meet the increasing demand for its root and as an effort to preserve wild resources. It is however still a highly popular medicinal plant whose wild resources are exploited (12). The IUCN Red List of Threatened Plants Status has not yet assessed baical skullcap on its database.

  • Quality control

    Adulteration of skullcap with American Germander

    In the early 1980s, baical skullcap was implicated as being a possible source of liver toxicity, mostly in combination herbal products. By the early 1990s, the suspected adulteration or substitution of baical skullcap was identified as plant matter from members of the genus Teucrium. This was identified as being the source of the alleged toxicity that falsely implicated skullcap. A paper published in 2011 suggests that the adulteration problem still exists (13).

    Herbal Medicines are often extremely safe to take, however it is important to supply herbal medicines from a reputed supplier. Sometimes herbs bought from unreputable sources are contaminated, adulterated or substituted with incorrect plant matter.

    Some important markers for quality to look for would be to look for certified organic labelling, ensuring that the correct scientific / botanical name. A supplier should also be able to tell you where the herbs have come from. There is more space for contamination and adulteration where supply chain is unknown.

  • How to grow

    • Baikal Skullcap prefers a sunny to part shade position, with a light soil if possible. The soil should be well drained, but should not dry out completely. The potency of the active chemicals in the roots is said to be greater if the plant is grown in sandy soils.
    • Baical skullcap is very easy to grow from seed and needs little extra care. It can be sown in early-mid spring directly outdoors, however it is recommend to start off indoors for better control. Keep seeds moist at all times but not wet. Seeds should germinate in 10 – 20 days. 
    • When large enough to handle seedlings can be transplanted to individual pots to be grown on until they reach a sufficient size to be transplanted to its final location. Ensure that plants are hardened off for full sun exposure before transplanting.
    • Established plants are thought to be drought tolerant. An average watering routine is sufficient. It is quite hardy and will also tolerate low temperatures and frost. The temperatures in the native habitat are generally quite low.

    Please note: Although baical skullcap is perennial, the life cycle may be as short as three years. Plants may need to be divided, before new spring growth appears. While larger, more viable divisions may be planted directly out, smaller sections are best to grow on in pots until ready for the garden. Woody or soft stem cuttings may also be taken from plants and many people have success with tip layering. This plant is also suitable for container growing.

  • References

    1. Li C, Lin G, Zuo Z. (2011) Pharmacological effects and pharmacokinetics properties of Radix Scutellariae and its bioactive flavones. Biopharm Drug Dispos. 32(8): 427-45. doi: 10.1002/bdd.771.
    2. Zhao T, Tang H, Xie L, et al. (2019)  Scutellaria baicalensis Georgi. (Lamiaceae): a review of its traditional uses, botany, phytochemistry, pharmacology and toxicology. J Pharm Pharmacol. 71(9):1353-1369. doi: 10.1111/jphp.13129
    3. Xin L, Gao J, Lin H, et al. (2020)  Regulatory Mechanisms of Baicalin in Cardiovascular Diseases: A Review. Front Pharmacol. 11:583200. doi: 10.3389/fphar.2020.583200.
    4. Yang JY, Li M, Zhang CL, Liu D. (2021) Pharmacological properties of baicalin on liver diseases: a narrative review. Pharmacol Rep. doi: 10.1007/s43440-021-00227-1
    5. Hu Q, Zhang W, Wu Z, et al. (2021) Baicalin and the liver-gut system: Pharmacological bases explaining its therapeutic effects. Pharmacol Res. 165:105444. doi: 10.1016/j.phrs.2021.105444
    6. Li Y, Song K, Zhang H, et al. (2020)  Anti-inflammatory and immunomodulatory effects of baicalin in cerebrovascular and neurological disorders. Brain Res Bull. 164:314-324. doi: 10.1016/j.brainresbull.2020.08.016
    7. Baradaran Rahimi V, Askari VR, Hosseinzadeh H. (2021) Promising influences of Scutellaria baicalensis and its two active constituents, baicalin, and baicalein, against metabolic syndrome: A review. Phytother Res. doi: 10.1002/ptr.7046.
    8. Khan S, Kamal MA. (2019) Can Wogonin be Used in Controlling Diabetic Cardiomyopathy? Curr Pharm Des. 25(19): 2171-2177. doi: 10.2174/1381612825666190708173108
    9. Kumar R, Harilal S, Parambi DGT, et al. (2021) Fascinating Chemopreventive Story of Wogonin: A Chance to Hit on the Head in Cancer Treatment. Curr Pharm Des. 27(4): 467-478. doi: 10.2174/1385272824999200427083040.
    10. Yang L, Aronsohn A, Hart J, et al. (2012) Herbal hepatoxicity from Chinese skullcap: A case report. World J Hepatol.  4(7): 231-233. doi: 10.4254/wjh.v4.i7.231.
    11. Fan L, Zhang W, Guo D, et al. (2008) The effect of herbal medicine baicalin on pharmacokinetics of rosuvastatin, substrate of organic anion-transporting polypeptide 1B1. Clin Pharmacol Ther.  83(3): 471-6 doi: 10.1038/sj.clpt.6100318
    12. Yuan, Q. (2010, April 29). Impacts of recent cultivation on genetic diversity pattern of a medicinal plant, Scutellaria baicalensis (Lamiaceae) – BMC Genomic Data. BioMed Central. Retrieved 18 October 2022, from https://bmcgenomdata.biomedcentral.com/articles/10.1186/1471-2156-11-29.
    13. www.herbalgram.org. (n.d.). Adulteration of Skullcap with American Germander – American Botanical Council. [online] Available at: https://www.herbalgram.org/resources/herbalgram/issues/93/table-of-contents/feat_skullgerm/ [Accessed 18 Oct. 2022].
    14. PubMed. (2012). Move Free. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK547841/ [Accessed 18 Oct. 2022].
Aromatic
An ‘aromatic’ remedy, high in volatile essential oils, was most often associated with calming and sometimes ‘warming’ the digestion. Most kitchen spices and herbs have this quality: they were used both as flavouring and to ease the digestion of sometimes challenging pre-industrial foods. Many aromatics are classed as ‘carminatives’ and are used to reduce colic, bloating and agitated digestion. They also often feature in respiratory remedies for colds, chest and other airway infections. They are also classic calming inhalants and massage oils, and are the basis of aromatherapy for their mental benefits.
Astringent taste
The puckering taste you get with many plants (the most familiar is black tea after being stewed too long, or some red wines) is produced by complex polyphenols such as tannins. Tannins are used in concentrated form (eg from oak bark) to make leather from animal skins. The process of ‘tanning’ involves the coagulation of relatively fluid proteins in living tissues into tight clotted fibres (similar to the process of boiling an egg). Tannins in effect turn exposed surfaces on the body into leather. In the case of the lining of mouth and upper digestive tract this is only temporary as new mucosa are replenished, but in the meantime can calm inflamed or irritated surfaces. In the case of open wounds tannins can be a life-saver – when strong (as in the bark of broadleaved trees) they can seal a damaged surface. One group of tannins, the reddish-brown ‘condensed tannins’ are procyanidins, which can reduce inflammation and oxidative damage.
Bitter
Bitters are a very complex group of phytochemicals that stimulate the bitter receptors in the mouth. They were some of the most valuable remedies in ancient medicine. They were experienced as stimulating appetite and switching on a wide range of key digestive functions, including increasing bile clearance from the liver (as bile is a key factor in bowel health this can be translated into improving bowel functions and the microbiome). Many of these reputations are being supported by new research on the role of bitter receptors in the mouth and elsewhere round the body. Bitters were also seen as ‘cooling’ reducing the intensity of some fevers and inflammatory diseases.
Blue-purple colouring
Any fruits with a blue-purple colouring contain high levels of the polyphenols known as anthocyanins. These work 1) on the walls of small blood vessels, helping to maintain capillary structure to reduce a key stage in inflammation, and improving the microcirculation to the tissues; 2) to improve retinal function and vision; 3) to support connective tissue repair around the body.
Cooling
Traditional ‘cold’ or cooling’ remedies often contain bitter phytonutrients such a iridoids (gentian), sesiquterpenes (chamomile), anthraquinones (rhubarb root), mucilages (marshmallow), some alkaloids and flavonoids. They tend to influence the digestive system, liver and kidneys. Cooling herbs do just that; they diffuse, drain and clear heat from areas of inflammation, redness and irritation. Sweet, bitter and astringent herbs tend to be cooling.
Hot
Traditional ‘hot’ or ‘heating’ remedies, often containing spice ingredients like capsaicin, the gingerols (ginger), piperine (black or long pepper), curcumin (turmeric) or the sulfurous isothiocyanates from mustard, horseradich or wasabi, generate warmth when taken. In modern times this might translate as thermogenic and circulatory stimulant effects. There is evidence of improved tissue blood flow with such remedies: this would lead to a reduction in build-up of metabolites and tissue damage. Heating remedies were used to counter the impact of cold, reducing any symptoms made worse in the cold. .
Mucilaginous
Mucilages are complex carbohydrate based plant constituents with a slimy or ‘unctuous’ feel especially when chewed or macerated in water. Their effect is due simply to their physical coating exposed surfaces. From prehistory they were most often used as wound remedies for their soothing and healing effects on damaged tissues. Nowadays they are used more for these effects on the digestive lining, from the throat to the stomach, where they can relieve irritation and inflammation such as pharyngitis and gastritis. Some of the prominent mucilaginous remedies like slippery elm, aloe vera and the seaweeds can be used as physical buffers to reduce the harm and pain caused by reflux of excess stomach acid. Mucilages are also widely used to reduce dry coughing. Here the effect seems to be by reflex through embryonic nerve connections: reduced signals from the upper digestive wall appear to translate as reduced activity of airway muscles and increased activity of airway mucus cells. Some seed mucilages, such as in psyllium seed, flaxseed (linseed) or guar bean survive digestion to provide bulking laxative effects in the bowel. These can also reduce rate of absorption of sugar and cholesterol. .
New-mown hay aroma
The familiar country odour of haymaking, of drying grass and other plants, is largely produced by coumarins (originally isolated from tonka beans – in French coumarou) and widely used in perfumery. They are chemically categorised as benzopyrone lactones and are important phytochemicals, with strong antioxidant activity in the laboratory and likely effects in modulating inflammation. They were most often associated with the calming effect linked to their use in stuffing mattresses and pillows and plants, high In coumarins were commonly used for these properties.
Resinous
Resins are most familiar as tacky discharges from pine trees (and as the substance in amber, and rosin for violin bows). They were most valued however as the basis of ancient commodities like frankincense and myrrh (two of the three gifts of the Three Wise Men to the baby Jesus) and getting access to their source was one benefit to Solomon for marrying the Queen of Sheba (now Ethiopia). Resins were the original antiseptic remedies, ground and applied as powders or pastes to wounds or inflamed tissues, and were also used for mummification. With alcohol distillation it was found that they could be dissolved in 90% alcohol and in this form they remain a most powerful mouthwash and gargle, for infected sore throats and gum disease. They never attracted much early research interest because they permanently coat expensive glassware! For use in the mouth, gums and throat hey are best combined with concentrated licorice extracts to keep the resins in suspension and add extra soothing properties. It appears that they work both as local antiseptics and by stimulating white blood cell activity under the mucosal surface. They feel extremely effective!
Salty
The salty flavour is immediately distinctive. A grain dropped onto the tongue is instantly moistening and a sprinkle on food enkindles digestion. This easily recognisable flavour has its receptors right at the front of the tongue. The salty flavor creates moisture and heat, a sinking and heavy effect which is very grounding for the nervous system and encourages stability. People who are solid and reliable become known as ‘the salt of the earth'.
Sharpness
The sharp taste of some fruits, and almost all unripe fruits, as well as vinegar and fermented foods, is produced by weak acids (the taste is generated by H+ ions from acids stimulating the sour taste buds). Sour taste buds are hard-wired to generate immediate reflex responses elsewhere in the body. Anyone who likes the refreshing taste of lemon or other citrus in the morning will know that one reflex effect is increased saliva production. Other effects are subjective rather than confirmed by research but there is a consistent view that they include increased digestive activity and contraction of the gallbladder.
Sweet
In the days when most people never tasted sugar, ‘sweetness’ was associated with the taste of basic foods: that of cooked vegetables, cereals and meat. In other words sweet was the quality of nourishment, and ‘tonic’ remedies. Describing a remedy as sweet generally led to that remedy being used in convalescence or recovery from illness. Interestingly, the plant constituents most often found in classic tonics like licorice, ginseng are plant steroids including saponins, which also have a sweet taste.

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