Gentian

Gentian is a primary cooling bitter tonic that, like all bitters, stimulates the appetite and digestive function and reduces excess heat and toxicity (1). 

Energetically, gentian is considered a cold remedy in that it reduces excess heat and inflammation in the body, enhancing digestion and detoxification. It may be taken in combination with warming herbs such as ginger (Zingiber officinale) and horseradish (Armoracia rusticana) especially where it is being used to treat someone with a cold, debilitated constitution (3,6). Gentian is gently drying, helping to resolve dampness and stagnation associated with poor digestion or insufficient bile flow (6,7). 

Small doses of bitter herbs like gentian are particularly useful for increasing the appetite in malnourished and debilitated patients as it supports effective digestive response rather than a forceful stimulation (6,7).  Bitters increase digestive fire and where digestive secretions including  pepsin and stomach acid, enabling more efficient digestive processes. However, in excess, bitters weaken digestion and dry the system, so must be used with care (5–7). Gentian can be considered a regulating bitter. 

Gentian can be considered to support the body following a period of prolonged illness or fever, it acts to build endurance and fortify the body without being excessively stimulating (6,7).

On an energetic level, gentian can be seen to sharpen discernment, helping the body to distinguish what is nourishing and beneficial, versus what is not. This idea can also be extended to emotional discernment (7). 

Digestive system

Gentian is an excellent digestive medicine used for a wide range of conditions relating to the digestive system. It is used to stimulate digestive function, increasing saliva and digestive secretions in the stomach and also the production of bile which assists with the assimilation of dietary fats. It can be applied in cases of low stomach acid, poor protein digestion, bloating or a feeling of heaviness. By the same mechanism, gentian is also indicated for gallstones, however it is advised to consult with a medical herbalist in these cases to ascertain whether there is risk of obstruction(1,7).

As a primary bitter tonic, gentian can effectively support liver function and metabolism of toxins (1,9). This can also be applied to the metabolism of hormones, the excess of which can exacerbate symptoms of premenstrual syndrome (PMS), polycystic ovarian syndrome (PCOS) or endometriosis (1,8). 

Gentian may also be used to support in recovery from gastrointestinal infection and as an anti-inflammatory for peptic ulcers (4). It can be used where appetite is reduced or absent such as after illness, debility or chronic digestive weakness (2,6,9). By strengthening digestive function, gentian helps to improve nutrient absorption, helping to reduce feeling of fatigue, especially in cases of anaemia (1,8). 

Due to its energetic action of drying damp, it can be applied to resolve digestive dampness, which can present with symptoms including heaviness after meals, sluggishness, bloating or a white coating on the tongue (10). 

Immune system

As a cooling bitter remedy, gentian is sometimes indicated in treatment of infectious diseases, fever and post fever recuperation (2,4). There have also been reports of selective antifungal activity of gentian root extracts (11).

Nervous system

Gentian can be used, like other bitter remedies, to relieve congestion and stagnation, which often contributes to feelings of ‘melancholia’ or depression. In traditional medicine, this state was often linked to poor digestion or impaired liver function or ‘failure to digest life’ in the literal and metaphorical sense (7,8). This link between the gut and the brain now forms a fundamental viewpoint in medicine, and thus gentian can be applied to relieve feelings of low mood, sluggishness or ‘melancholia’ helping to lift the spirits and clear stagnation (7,8).

Gentiana lutea exerts anti-atherosclerotic effects by preventing endothelial inflammation and smooth muscle cell migration

This preclinical study investigated the anti-atherosclerotic effects of Gentiana lutea (GL) in the form of an aqueous root extract, root powder, and its flavonoid constituent isovitexin using human umbilical vein endothelial cells (HUVECs), rat aortic smooth muscle cells (RASMCs), and streptozotocin-induced diabetic rats. Results showed  in vitro, both GL extract (1 mg/mL) and isovitexin (5 µmol/L) significantly inhibited TNF-α–induced leukocyte adhesion and reactive oxygen species generation in HUVECs, alongside suppressing TNF-α–stimulated expression. In RASMCs, GL extract and isovitexin blocked PDGF-BB–induced cell migration, and intracellular calcium mobilisation.

In vivo, dietary supplementation with 2 % GL root powder in diabetic rats reduced total blood cholesterol, decreased lipid accumulation within the aortic wall, and attenuated thickening and collagen deposition. Results showed Gentiana lutea and isovitexin exert anti-atherosclerotic effects through combined anti-inflammatory, antioxidant, and lipid lowering actions in a preclinical setting (12). 

The healing bitterness of Gentiana lutea L., phytochemistry and biological activities: A systematic review 

A systematic review was carried out to evaluate the biological activities of Gentiana lutea L. The review encompassed 53 publications, including predominantly in vitro and in vivo studies and a small number of human investigations, examining the pharmacological actions of gentian root, rhizome, aerial parts, and its major constituents such as gentiopicroside, amarogentin, isovitexin, loganic acid, and xanthones.

Across experimental models, gentian extracts and isolated compounds demonstrated antioxidant, anti-inflammatory, anti-obesity, anti-atherosclerotic, antimicrobial, neurotrophic, gastroprotective, hepatoprotective, cytoprotective, and dermatological activities, mediated through mechanisms including modulation of oxidative stress, inhibition of inflammatory cytokines and adhesion molecules, regulation of lipid and glucose metabolism, activation of AMPK and eNOS signalling, inhibition of smooth muscle cell proliferation and migration, bitter taste receptor activation, and effects on neuronal survival and neurotransmission. These studies show promise for gentian as a supportive, bitter remedy and call for further investigation into human clinical trials (13). 

In vitro, ex vivo and clinical approaches to evaluate the potential effect of Gentiana lutea extract on skin

This mixed pre-clinical and human study investigated the effects of a Gentiana lutea extract (GIE) standardised to gentiopicroside (65%) on periocular skin parameters associated with dark circles. In vitro and ex-vivo experiments demonstrated that GIE modulated oxidative stress and angiogenesis pathways.

Ex-vivo skin explants treated topically with GIE showed reduced markers of glycation stress under basal and UVA-irradiated conditions. These mechanistic findings were complemented by a split-face, placebo-controlled clinical study in 22 subjects, in which a topical cream containing 147 μg mL⁻¹ GIE applied twice daily for 14 days significantly reduced upper eyelid skin roughness, surface relief, and redness of dark circles compared with placebo, as assessed by 3D imaging and skin colour measurements. Overall, the results suggest that Gentiana lutea extract exerts cosmetic and dermal benefits around the eye through combined antioxidant, anti-glycation, and anti-angiogenic mechanisms (14). 

Radioprotective activity of Gentiana lutea extract and mangiferin

An in vitro and exploratory human study investigating the radioprotective and radiosensitising actions of a gentian aqueous-ethanol extract on radiation-induced cellular damage was carried out. There was a focus on the decreasing survival of normal human immunocompetent cells, the survival of the malignant cells in vitro, and the survival of ex vivo irradiated cells before and after consumption of the extract by healthy volunteers.

Gentian extract consumed orally demonstrated a strong potential to reduce the damage effect of x-ray irradiation on normal healthy cells (which were peripheral blood mononuclear cells), in some healthy people, without changing the susceptibility of malignant cells to be destroyed by irradiation. Essentially it protected healthy human cells from radiation but did not protect malignant cells from being destroyed, and so potentially gentian could be a useful complementary therapy for cancer treatment. However, since the radioprotective effect was individually dependent, further clinical studies are needed to understand the effectiveness of this treatment combination (15).

Gentian is one of the strongest bitter cooling herbs in Western herbal medicine that can be applied for a number of conditions affecting the digestive system. The bitter constituents act via bitter taste receptors to stimulate salivary, gastric, and biliary secretions, helping to improve digestive function and efficiency (1,2). As a powerful hepatic, gentian helps to increase bile secretion, aiding in the digestion of fats and alleviating sluggish liver function or congestion (1,2,3).

Gentian is used to treat dyspepsia, as well as any accompanying abdominal discomfort or pain. Symptoms often associated with dyspepsia can be pain or burning sensations and bloating and nausea after eating, although in some people the symptoms may be relieved by eating or may occur unrelated to eating patterns.

As a digestive tonic, gentian is also used to help improve appetite. This application is referenced in the British Herbal Pharmacopoeia as a primary herb for those suffering with anorexia as it supports the function of the digestive tract (4).

Gentian is a herb that enhances digestive function and the assimilation of dietary nutrients. It would be well applied to support through convalescence, especially in cases where weakness is linked to poor nutrient assimilation. It can be used to support chronic fatigue, recovery from illness, anaemia or general constitutional weakness (1,2,3).

This bitter herb also has powerful anti-inflammatory actions . It may be useful where inflammations, such as those seen in inflammatory skin conditions, are linked with poor digestive or liver function (4,5).

Dioscorides wrote that Gentiana lutea was introduced into herbal medicine by King Gentius of Illyria, thus giving its name gentian (16). Gentian forms a key botanical ingredient in many European liqueurs including Aperol and Campari (17).

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