A voice for
herbal medicine

We share traditional, scientific and practical insights written by experienced herbalists and health experts from the world of herbal medicine and natural health

  • Herb overview

    Safety

    Ginkgo has several drug interactions and allergy risk. It should also be avoided in pregnancy and lactation.

    Sustainability

    Status:
    Critically endangered

    Key constituents

    Flavonoids: Flavones, biflavones
    Sesquiterpene lactones: Bilobalides
    Ginkgolides
    Ginkgolic acids

    Quality

    Native to China
    Commercial sources are cultivated
    Adulteration risk

    Key actions

    Neuroprotective
    Nootropic
    Antioxidant
    Vasodilator

    Key indications

    Dementia
    Poor circulation
    Tinnitus
    Anxiety

    Key energetics summary

    Cool
    Dry
    Sweet
    Astringent

    See below for discipline-specific energetics

    Preperation and dosage

    Leaf
    4–8g dried leaf daily
    Tincture (1:3 | 45 %): 6–9 ml daily

  • How does it feel?

    The overwhelming taste of ginkgo leaf is bitterness with a lingering astringency that follows. It is immediate, direct and persists for a long time in the mouth. Being such a modern medicine, the majority of research is centred around its constituents and pharmacological activity with little information on its traditional therapeutic qualities.

    Ginkgo leaf (Ginkgo biloba)
    Ginkgo leaves (Ginkgo biloba)
    Ginkgo leaves and fruit (Ginkgo biloba)

    The taste of ginkgo

    The below qualities are derived from organoleptic assessment.

  • Into the heart of ginkgo

    Ginkgo leaves and fruit (Ginkgo biloba)
    Ginkgo leaves and fruit (Ginkgo biloba)

    In traditional Chinese medicine (TCM), it was originally the ginkgo nuts (seeds) which were used for lung and kidney ailments. Ginkgo was first introduced to the Western world in 1692 by a Dutch explorer. The medicinal value of the leaf was later discovered in 1965 by German scientists. The initial focus of the discovery was on improving peripheral circulation, and its neuroprotective qualities only materialised later on.  

    In traditional German healthcare, circulatory disturbances have been default explanations for a wide range of illnesses, including ageing and cognitive decline. Perhaps attracted by the heart-shaped leaves, they investigated further and developed a concentrated ginkgo extract. This was standardised for flavonoid content and patented soon after.

    The original therapeutic focus was improving peripheral circulation to the brain. This correlates with another popular concept in Germany of cerebral insufficiency. These symptoms include difficulties in concentration and memory, absentmindedness, confusion, lack of energy, tiredness, decreased physical performance, depressive mood, anxiety, dizziness, tinnitus and headaches. These symptoms have also been associated with the early stages of dementia. The reasoning is that by improving circulation to the brain, this alleviates symptoms of cerebral insufficiency.

    Ginkgo was also prescribed for tinnitus and for reducing clotting in cardiovascular diseases. Cerebral insufficiency is not much recognised outside continental Europe and the use of ginkgo as a prescription medicine is largely confined to these countries. This idea is, however, consistent with the herbal therapeutic method.  

    In TCM, ginkgo is also used to assist Lung qi and astringe the lungs to ease dyspnea, chronic cough and asthma. Ginkgo is also used to resolve dampness or stagnation in the body which is caused by congestion in the tissue and poor blood movement.

    Ginkgo preparations are also indicated in TCM to tonify the Heart, remove Blood stasis and relieve the pain of stagnation in the tissues. Ginkgo is also used for the stagnation of fluids such as an over accumulation of phlegm. It is thought to be neutral in nature meaning that it does not affect the yin–yang balance.

    Ginkgo leaf was traditionally, if perhaps infrequently, used in TCM to support lung health in cases of cough and wheeze with pain from Lung qi deficiency. The nut of the ginkgo plant (bai guo), also used in TCM to support the Lungs, was more readily prescribed and used in cases of cough with copious sputum. 

    The modern application of ginkgo leaf in Chinese herbalism, that of benefitting the “sea of Marrow” (the brain), was only borne out of observing its use in the West for this purpose.  

    The contemporary TCM formula yin guo ye wan, of which gingko leaf is the chief medicinal, is a striking example of modern research and herbalism, in this case from the West, can be integrated into TCM classical knowledge. Here, yin guo ye is added in large doses to a formula of TCM herbs traditionally held to benefit and nourish the brain to strengthen and enhance its effects (2). 

  • What practitioners say

    Cardiovascular systemCardiovascular system

    Ginkgo has a broad range of actions in the cardiovascular system. Its cardioprotective effects are largely as a result of its high flavonoid content and terpene lactones. Ginkgo works to benefit a wide range of  factors regarding the cardiovascular system including vasodilation and vascular tone regulation, endothelial protection, vascular permeability and antioxidant actions. It is indicated for hypertension, Raynaud’s syndrome and intermittent claudication (7).

    Ginkgo improves both the movement of blood as well as perfusion in different vascular beds, namely ocular, cochlear, cutaneous, cerebral, and coronary. The leaves also increase organ perfusion, which means its effects work to improve the health of internal organs (8).

    Ginkgo stimulates the circulation and dilates the capillaries, an action that lends the herb well to supporting individuals with hypertension. Ginkgo is sometimes used to improve symptoms of atherosclerosis, such as intermittent claudication (pain in the lower legs on walking short distances) (7).

    Nervous system

    Ginkgo has a long history of use for conditions of the nervous system. This is largely due to its ability to increase peripheral and cerebral blood flow. Ginkgo contains multiple compounds such as flavonoids and terpenoids that are thought to contribute to its neuroprotective and vasotropic effects. Some of the specific mechanisms exerted by ginkgo for this neuroprotective effect relates to its ability to support dilation of the blood vessels resulting in improved cellular redox state and nitric oxide levels. It also interacts with neurotransmitter systems (9).

    Ginkgo is also classified as a nootropic (improves cognitive performance and memory) herb. Herbs such as ginkgo may be of use by a herbalist as part of an integrative and supportive approach for the treatment of neurodevelopmental conditions such as ADHD (10). Ginkgo is often indicated for conditions that present with cognitive impairment for example, that which is experienced by patients with Alzheimer’s disease or vascular dementia (9,11).

    Ginkgo is also often used for conditions affecting the inner ear, such as vertigo or tinnitus (10,12). There are many different causes of tinnitus including blood pressure dysregulation, hearing loss, head and neck injuries, medications, infection or wax build up. Ginkgo may benefit these by a number of different mechanisms, as it is both a nervous and cardiovascular tonic. Additionally ginkgo is also used sometimes to improve retinal blood flow and as a remedy to manage glaucoma and age-related macular degeneration (13).

    To treat headaches that are caused by poor movement of blood to the brain, ginkgo can be used as part of a multi-herb prescription. Headaches caused by poor circulation to the head may be accompanied by symptoms of poor circulation elsewhere in the body —i.e., cold hands and feet. 

    Safety note: Medical attention should be sought if headaches become frequent or persist over weeks or months, come on severely and suddenly, or last more than 72 hours without easing for more than a few hours.

    Respiratory system

    Ginkgo is used in cases of asthma, particularly when it is related to allergies. It is believed to be effective for the inhibition of asthma associated inflammation. Studies have identified that this effect may be in part due to ginkgo’s anti-inflammatory capacity linked to a compound called ginkgolide B. There are also a number of references for ginkgo’s therapeutic potential in the treatment of other inflammatory lung conditions (14).

    Alternative herbs

    Although Ginkgo biloba is endangered in the wild, commercial supplies come almost entirely from cultivated plantations. Product quality, however, is: ginkgo extracts are among the botanicals most often adulterated, so choosing a reputable product is important. Ginkgo is also not suitable for everyone, particularly people taking anticoagulant or antiplatelet medication or preparing for surgery, owing to its potential to increase bleeding risk. Where ginkgo is unsuitable, the following herbs may be considered:

    • Gotu kola (Centella asiatica) is also used to improve brain and other mental functions, especially when suffering from stress.
    • Rosemary (Salvia rosmarinus) has an important crossover with ginkgo as it is a powerful antioxidant with neuroprotective and cardiotonic qualities.
    • Maca (Lepidium meyenii) is another herb with potent neuroprotective effects. With some interesting studies on use for depression, altitude sickness and athletic performance.
    • Saffron (Crocus sativus) is used to support the nervous system, and improve cardiovascular health by nourishing and regenerating the blood and the soft tissues in the body.

  • Ginkgo research

    Ginkgo (Ginkgo biloba)
    Ginkgo (Ginkgo biloba)

    Ginkgo is one of the most well researched herbs in modern herbal healthcare. Much of the clinical research on ginkgo relates to the patented 50:1 extract called EGb761 (which contains 24% flavone glycosides and 6% terpenoids) at a daily dose typically corresponding to 4–16 g of leaf. There is a considerable body of this evidence, with over 400 clinical trials published in the scientific literature.

    Much of this work has focused on the potential effects of ginkgo and of the ginkgo extract EGb761 on cognitive decline and dementia, and on various measures of cognitive performance in healthy subjects, including memory (15,16,17,18). Other benefits of the extract have been demonstrated, including reduced stress responses (19).

    Safety and effectiveness of a traditional ginkgo fresh plant extract — results from a clinical trial

    There is very little published evidence for any effects of other ginkgo leaf preparations, this prospective, open-label, multicentre clinical trial examined the safety and effectiveness of a ginkgo extract. It involved a 3–5:1 fresh leaf extract (at 90 mg/day equating to 300–400 mg of fresh leaf) given to 59 elderly patients over 60 years of age with mild age-related cognitive impairment over the course of six weeks. Cognitive function was assessed by the DemTect score and results showed an improvement in memory, concentration and a reduction in forgetfulness (20).

    Wider acceptance of ginkgo has followed recognition of its potential neuroprotective effects and EGb761 is emerging as an important phytomedical treatment for dementia and Alzheimer’s disease. In support of its benefit for Alzheimer’s, there is laboratory evidence for a reduction in platelet-activating factor (PAF), especially by the terpenes (ginkgolides), which could also suggest therapeutic benefit for asthma, allergic and immunological reactions. Laboratory evidence also points to a significant effect in protecting mitochondria and other intracellular functions against oxidative stress.

    An updated review of randomized clinical trials testing the improvement of cognitive function of Ginkgo biloba extract in healthy people and Alzheimer’s patients

    Many studies have been carried out to investigate the efficacy of ginkgo to improve outcomes in dementia and Alzheimer’s disease. A meta-analysis was carried out to evaluate 22 studies including single dose and long term studies on ginkgo. This paper concludes the positive evidence for ginkgo as a therapy for cognitive function in patients suffering from mild dementia during administration were best demonstrated in long term studies of more than 24 weeks at a dosage of 240 mg per day.

    This paper also discusses the nature of such diseases as long course; the effects of the medications may change over time. Studies taken over 18 months of treatment provide a more firm outcome of improved measures for Alzheimer’s and dementia. Clinical trials of less than 24 weeks were more likely to result in lower incidence of improvements, which reaffirms the need for ongoing appropriate prescribing of herbal medicines (11).

    Ginkgo biloba in the treatment of attention-deficit/hyperactivity disorder in children and adolescents. A randomised, placebo-controlled trial

    This six week, randomised, double-blind, placebo controlled trial investigated the effect of Ginkgo biloba as an adjunct treatment for attention-deficit/hyperactivity disorder (ADHD) in 66 children and adolescents. Participants were randomised to receive either methylphenidate (20–30 mg/day) alongside either Ginkgo biloba extract (80–120 mg/day) or placebo. ADHD symptoms were assessed using parent- and teacher-rated ADHD Rating Scale-IV (ADHD-RS-IV) questionnaires at baseline, two weeks and six weeks.

    Results showed that compared with placebo, the ginkgo group showed significantly greater reductions in parent-rated inattention (p<0.001), total ADHD symptom scores (p=0.001) and teacher-rated inattention (p=0.004). Parent-rated treatment response, defined as at least a 27% improvement in ADHD-RS-IV scores, was also significantly higher in the ginkgo group (93.5% versus 58.6%; p=0.002). Authors concluded that this suggests Ginkgo biloba may prove beneficial for the treatment of ADHD when combined with methylphenidate, but larger and longer trials are needed to confirm its efficacy (21).

    Ginkgo biloba extract in the treatment of tinnitus: A systematic review

    A systematic review identified seven review articles and four randomised controlled trials relating to the treatment of tinnitus with ginkgo extract. There are several further randomised, placebo-controlled trials using EGb 761® extract.

    The studies vary in quality and dosage. The review concludes that the current available literature shows that there is evidence for the successful treatment of tinnitus with ginkgo extract- with significant outcomes in the extract EGb 761® (22).

    Ginkgo biloba for the treatment of vitiligo vulgaris: An open label pilot clinical trial

    An open-label pilot trial was carried out to investigate the effects of ginkgo on 12 participants between the age of 18 to 35 years old with vitiligo. The subjects were treated with 60 mg of standardised ginkgo twice a day for 12 weeks for a period of two months.

    The study showed that in all participants the progression of vitiligo stopped, as well as a decrease in total vitiligo lesion area. The study concludes that ginkgo shows a significant improvement in vitiligo measures. Larger, randomised double-blind clinical studies are required to validate these preliminary findings (23).

  • Historical use of ginkgo

    Ginkgo is a herb native to China, where the earliest references for its use derive from the traditional Chinese medical texts. The seeds were the part most referenced for medical use until more recent research on ginkgo leaf developed over the past five decades. Ginkgo seeds were traditionally used for respiratory conditions such as coughing and wheezing (3).

    The references for use in asthma are seen in some modern texts too, with preparations made from the leaf. 

    A 16th-century Chinese text, the Ben Cao Gang Mu by Li Shi-Zhen, discusses a prescription of ginkgo seeds for infections. Modern research has further confirmed the antimicrobial activity of ginkgo seeds (6).

    Ginkgo seeds are still eaten and used in TCM today. However, they can cause nausea and vomiting among other toxic reactions if eaten in moderate quantities. Modern Western herbalism focuses on the use of ginkgo leaves rather than the seed.

  • Ginkgo’s herbal actions

    Herbal actions describe therapeutic changes that occur in the body in response to taking a herb. These actions are used to express how a herb physiologically influences cells, tissues, organs or systems. Clinical observations are traditionally what have defined these actions: an increase in urine output, diuretic; improved wound healing, vulnerary; or a reduction in fever, antipyretic. These descriptors too have become a means to group herbs by their effects on the body — herbs with a nervine action have become the nervines, herbs with a bitter action are the bitters. Recognising herbs as members of these groups provides a preliminary familiarity with their mechanisms from which to then develop an understanding of their affinities and nuance and discern their clinical significance.

    Western actions

    Chinese actions

  • Ginkgo’s energetic qualities

    Herbal energetics are the description that herbalists have given to plants, mushrooms, lichens, foods and some minerals based on the direct experience of how they taste, feel and affect the body. All traditional health systems use these principles to explain how the environment impacts health, according to each of their philosophies and frameworks. These assessments of individual herbs, though they often do align, can differ from one another due to cultural differences regarding perspectives on how herbs taste versus their physiological effects. Find out more about traditional energetics in our article An introduction to herbal energetics.

  • What can I use ginkgo for?

    Ginkgo (Ginkgo biloba)
    Ginkgo (Ginkgo biloba)

    Ginkgo is an endangered species that is threatened with extinction, with very few wild populations of ginkgo surviving in China. Population decline is mainly due to deforestation and its limited natural range. Commercially available supplies are from widely cultivated supplies, ensuring the species’ future despite conservation concerns.

    Ginkgo is rich in antioxidant compounds that benefit cardiovascular health, in particular the micro-capillaries that deliver oxygen and nutrients to the body’s cells.

    Ginkgo can be used to improve blood flow and tissue oxygenation. It is particularly helpful for poor movement of blood to the periphery and where this lack of circulation causes brain fog and fatigue. Ginkgo is both neuroprotective and helps to improve cerebral circulation. It is often used to help improve memory and cognitive function, especially in the elderly (1,2,3).

    Ginkgo may also be used to support individuals with acute depression or anxiety. The mechanism through which ginkgo likely ameliorates these conditions is via its ability to increase blood circulation to the brain, delivering more oxygen and nutrients, thereby improving function. Other herbs that work similarly, supporting cerebral perfusion, are gotu kola (Centella asiatica) and rosemary (Rosmarinus officinalis).

  • Did you know?

    For many years, EGb761 was the most frequently used medicine in Germany, routinely given to elderly patients, with the costs, as is usual for medical prescriptions there, largely covered by the state. When this reimbursement was withdrawn in the 1990s, prescription levels initially fell; however, they later recovered substantially, despite the lack of reimbursement (1).

  • Botanical description

    Ginkgo biloba is the only member of its family, a gymnosperm that has survived unchanged from the Triassic period.

    It can grow to a height of over 100 m, and some trees have been shown to be over 1000 years old.

    Ginkgo is dioecious (possessing male and female flowers on separate trees) and its bright green leaves have a characteristic fan-like appearance with two lobes (biloba).

  • Common names

    • Maidenhair tree (Eng)
    • Ginkgoblätter (Ger)
    • Arbre aux quarante écus (Fr)
    • Bai Guo Ye (Mand)
    • Baak Gwo Yop (Cant)

  • Habitat

    Fossils of the tree have been found across North America and Europe, but, in the current era, the tree is native only to China (29).

  • How to grow ginkgo

    Ginkgo is a slow-growing tree that prefers to grow in a location with full or partial sunlight exposure. The best soil types for ginkgo are loamy, sandy, moist, well-drained or clay and a soil pH of acidic, neutral or alkaline. It is said that female seeds can complicate the growing process, therefore, using male cuttings to start new growth is recommended. It is still possible to grow ginkgo trees from seeds, but it is a more advanced process.

    Cuttings

    Ginkgo can be propagated by seed; however, it is most often grown from softwood or hardwood cuttings. 

    Start by cutting the tip ends of growing branches in the summer. Use a sharp knife or pruner to cut a six to seven-inch long branch. Remove stems from male trees as the female trees produce foul-smelling seed sacks that won’t yield good results. An organic rooting solution is often used to stimulate growth.

    Plant the cuttings into fine compost, they should be placed in good light but not direct, scorching sunlight. Once rooted, harden off the cuttings for about two weeks and pot them on individually.

    Keep them watered whilst they develop their roots over a period of 2–4 weeks.

    If potted by mid-summer, they will most likely develop sufficient roots to survive the winter. Otherwise pot up in the following spring. 

    Once the cuttings are well established, plant out directly into the garden.

    From seed

    Start with ginkgo seeds from the dropped fruit, or a seed packet.

    Seeds need cold stratification (exposure to cold temperatures) before planting so germination can occur. Place seeds in a refrigerator or moist, sandy container pots outside during the winter.

    Remove seeds and place them in a horticultural soil mixture containing sand or sand and perlite. Additional soil options include peat moss or vermiculite.

    Plant seeds in a few inches of soil. Cover and keep in a warm location with moist soil for one to two months. Remove seeds once the sprouts appear.

    Finally, plant new growth in its final location or continue to grow in a container.

    Ginkgo grows best in temperate climes — not too hot in the summer or cold in the winter. It should not be planted where there is consistent dry heat. Ginkgo is fairly drought-resistant once established, but the soil should be kept moist during  their first few years of growth. Water a few times a week. Ginkgo trees only need pruning once a year during their dormancy in late winter (38).

  • Herbal preparation of ginkgo

    • Tincture 
    • Infusion 
    • Capsule

  • Plant parts used

    Leaf

  • Dosage

    • Tincture (1:3 | 45 %): Take between 2–3 ml in a little water up to three times a day.
    • Infusion / decoction: 4–8 g of dried ginkgo leaf can be taken daily in divided doses. To make an infusion, place between 1–2 teaspoons of dried material into a cup of boiling water and infuse for 10–15 minutes. This may be drunk hot three times a day (1,3,5).
    • Capsules / tablets: 40 mg per tablet or capsule, making the daily dose 3 ml or three tablets/ capsules per day.
    • Standardised extract: The daily dose of the 50:1 standardised extract (EGb761) is 120 to 240 mg in divided doses. This corresponds to 4 to 16 g of leaf (3,4,5).

  • Constituents

    • Flavonoids: Flavones — kaempferol, quercetin, rutin and isorhamnetin; biflavones — ginkgetin, bilobetin and amentoflavone
    • Terpene lactones: Diterpene lactones (ginkgolides)
    • Sesquiterpene lactones: Bilobalide
    • Other constituents: Phenolic acids — vanillic and caffeic acids, proanthocyanidins, ginkgolic acids and amino acids
    • Vitamins A, B6, C and E (2,4)

    The European Pharmacopoeia definitive monograph on dried ginkgo leaf requires a minimum 0.5% flavonoids, calculated as flavone glycosides.

    By contrast EGb761 is standardised to 24% ginkgo-flavone glycosides and 6% terpenoids (e.g., bilobalide, ginkgolides A, B, C, and J).

    Ginkgo leaf also contains ginkgolic acid. This is a strong allergen and in assured extracts levels are specified to be less than five parts per million.

    Other constituents include procyanidins.

  • Ginkgo recipe

    Ginkgo infusion

    This fragrant and uplifting infusion helps support cognition, mental clarity and memory whilst also offering calming effects for the nervous system.

    Ingredients

    • 1 tsp dried lemon balm (Melissa officinalis)
    • ½ tsp dried rosemary (Salvia rosmarinus)
    • ½ tsp dried ginkgo leaf (Ginkgo biloba)
    • 250 ml freshly boiled water
    • Honey or lemon, optional

    How to make a ginkgo infusion

    1. Combine the dried herbs in a teapot or infuser.
    2. Pour over the freshly boiled water.
    3. Cover and leave to infuse for 10 minutes.
    4. Strain and add honey or lemon to taste.
A guide for herb-drug interactions 

A guide for herb-drug interactions 

  • Safety

    Ginkgo should be avoided during pregnancy due its potential effect on hormone levels, which could induce labour. Its antiplatelet effects could also impact bleeding time if taken around labour or surgery. There is a lack of evidence to support its use in lactation, so it is best avoided (24). 

    Ginkgo has been known to cause headaches in some individuals (1). 

    Owing to potential allergic reactions to ginkgolic acids — with reported allergic contact dermatitis, the use of tinctures or fluid extracts is not recommended unless under the supervision of a medical professional (5). Most commercial ginkgo products, other than EGb761, have been shown to contain very high levels of these allergens (25).

    The seeds contain the neurotoxic compound 4′-O-methylpyridoxine (ginkgotoxin) which interferes with vitamin B6 metabolism and may cause seizures. There have been cases of poisoning, particularly amongst children. In TCM, the seeds are prescribed at doses of 4.5–9 g per day, following appropriate preparation so it is recommended to only use the seeds under the guidance of a professional (26,27).

  • Interactions

    There is very little record or case reports of problems associated with the use of ginkgo extracts. There is, however, a theoretical risk of a bleeding event or interaction with antiplatelet and anticoagulant (blood thinning) drugs, because of its platelet aggravating factor (PAF) activity, but this is neither supported by controlled clinical trials nor by mandatory adverse reporting schemes in Germany and other parts of Europe. Caution is advised taking ginkgo alongside NSAIDs due to the same mechanism. 

    Ginkgo may decrease the effects of anticonvulsant medication, and increase blood levels of talinolol as well as enhance hypoglycemic activity of metformin (4,25). 

    Ginkgo can reduce levels of omeprazole, and this mechanism could be extended to other proton pump inhibitors. It is best avoided in conjunction with these medications (25,28). 

  • Contraindications

    For anyone who is at high risk of cardiovascular accident (CVA), a stroke, working with a qualified medical herbalist before using ginkgo is advised (20). Ginkgo should be avoided before surgery or in cases of haemophilia (5,6).

  • Sustainability status of ginkgo

    According to the IUCN Red List of Threatened Plants Status ginkgo is classed as rare and endangered (30). This plant is under threat due to a number of circumstances. There is a lack of ginkgo trees surviving in the wild in undomesticated form. It is classed as ‘critically imperilled on Nature Serve (31). It has been given high priority conservation status by the Evolutionary Distinct and Globally Endangered (EDGE) method (32). 

    Read our article on Herbal quality & safety: What to know before you buy and Sustainable sourcing of herbs to learn more about what to look for and questions to ask suppliers about sustainability.

  • Quality control

    Ginkgo biloba is a herb with a long-established history of medicinal use, although its popularity in the West is a more recent occurrence. There are many constituents of interest in G. biloba but the diterpene lactones and flavonoids are the most important from a therapeutic perspective (33). It is these constituents for which there are limits set within various national pharmacopoeias. 

    The British Pharmacopoeia (BP) requires no less than 0.5% for the flavonoids in the herbal monograph for gingko leaf (34). There are also monographs available for ginkgo extracts, which are often used in ginkgo supplements and herbal products. The BP has a monograph for a standardised (50:1) extract of ginkgo, which sets the following requirements for flavonoids: 22–27%, bilobalide: 2.6–3.2%, ginkgolides A, B, C: 2.8–3.4% and ginkgolic acids: maximum of 5 ppm (34).

    Being a high-value herbal commodity, ginkgo extracts are often subject to issues with adulteration. There are numerous studies which have been carried out on ginkgo supplements supplied into various markets around the world such as North America, Europe and Japan which have found ample evidence of adulteration within the ginkgo supply chain (35,36,37).

    Adulteration issues primarily involve the addition of pure flavonols such as rutin, quercetin and kaempferol or flavonol glycoside-rich extracts that come from plants such as Styphnolobium japonicum or Fagopyrum esculentum (33). These substances are much cheaper so the consensus within industry is that the adulteration is intentional and economically driven (35). 

    Although there are analytical methods set within national pharmacopoeias for detecting adulteration, sometimes these are not always sufficient and unscrupulous manufacturers and suppliers will try to find ways to evade detection. The adulteration of ginkgo extracts with free flavonol aglycones was documented as an example where pharmacopoeial methods needed to adapt to identify this form of adulteration (37).  It is particularly important with ginkgo extracts to stay up to date with the latest analytical approaches to ensure that the ginkgo is free from adulteration.

  • References

    1. Mcintyre A. Complete Herbal Tutor : The Definitive Guide to the Principles and Practices of Herbal Medicine (Second Edition). Aeon Books Limited; 2019.
    2. Chen JK, Chen TT, Crampton L. Chinese Medical Herbology and Pharmacology. Art Of Medicine Press, Inc; 2004.
    3. Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine. 2nd ed. Edinburgh Churchill Livingstone, Elsevier; 2013. https://ebookcentral.proquest.com/lib/think/detail.action?docID=1723553 
    4. Thomsen M. Phytotherapy Desk Reference. 6th ed. Aeon Books; 2022.
    5. Fisher C. Materia Medica of Western Herbs. Aeon Books; 2018.
    6. Chassagne F, Huang X, Lyles JT, Quave CL. Validation of a 16th Century Traditional Chinese Medicine Use of Ginkgo biloba as a Topical Antimicrobial. Frontiers in Microbiology. 2019;10. https://doi.org/10.3389/fmicb.2019.00775 
    7. Menzies-Trull C. Herbal Medicine Keys to Physiomedicalism Including Pharmacopoeia. Faculty Of Physiomedical Herbal Medicine (Fphm; 2013.
    8. Silva H, Martins FG. Cardiovascular Activity of Ginkgo biloba—An Insight from Healthy Subjects. Biology. 2023;12(1):15. https://doi.org/10.3390/biology12010015 
    9. Ahlemeyer B, Krieglstein J. Neuroprotective effects of Ginkgo biloba extract. Cellular and Molecular Life Sciences CMLS. 2003;60(9):1779-1792. https://doi.org/10.1007/s00018-003-3080-1 
    10. Yarnell E. Herbal nootropics: potential use in Attention Deficit Hyperactivity Disorder – ESCOP. ESCOP. Published April 8, 2019. Accessed October 30, 2024. https://www.escop.com/herbal-nootropics-potential-use-attention-deficit-hyperactivity-disorder/ 
    11. Liu H, Ye M, Guo H. An Updated Review of Randomized Clinical Trials Testing the Improvement of Cognitive Function of Ginkgo biloba Extract in Healthy People and Alzheimer’s Patients. Frontiers in Pharmacology. 2020;10. https://doi.org/10.3389/fphar.2019.01688 
    12. von Boetticher A. Ginkgo biloba extract in the treatment of tinnitus: a systematic review. Neuropsychiatric Disease and Treatment. Published online July 2011:441. https://doi.org/10.2147/ndt.s22793 
    13. Dubey A-K, Shankar P-R, Upadhyaya D, Deshpande V-Y. Ginkgo biloba–an appraisal. Kathmandu University medical journal (KUMJ). 2004;2(3):225-229. Accessed July 27, 2023. https://europepmc.org/article/med/16400219 
    14. Chu X, Ci X, He J, et al. A novel anti-inflammatory role for ginkgolide B in asthma via inhibition of the ERK/MAPK signaling pathway. Molecules (Basel, Switzerland). 2011;16(9):7634-7648. https://doi.org/10.3390/molecules16097634 
    15. Shakibaei F, Radmanesh M, Salari E, Mahaki B. Ginkgo biloba in the treatment of attention-deficit/hyperactivity disorder in children and adolescents: a randomised, placebo-controlled trial. Complement Ther Clin Pract. 2015;21(2):61-67. doi:10.1016/j.ctcp.2015.04.001
    16. Kennedy DO, Scholey AB, Wesnes KA. The dose-dependent cognitive effects of acute administration of Ginkgo biloba to healthy young volunteers. Psychopharmacology. 2000;151(4):416-423. https://doi.org/10.1007/s002130000501 
    17. Cieza A, Maier P, Pöppel E. Effects of Ginkgo biloba on mental functioning in healthy volunteers. Archives of Medical Research. 2003;34(5):373-381. https://doi.org/10.1016/j.arcmed.2003.05.001 
    18. Kaschel R. Specific memory effects of Ginkgo biloba extract EGb 761 in middle-aged healthy volunteers. Phytomedicine : international journal of phytotherapy and phytopharmacology. 2011;18(14):1202-1207. https://doi.org/10.1016/j.phymed.2011.06.021 
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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
The astringent 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 (e.g. 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.
Bland
Blandness refers to a mild, plain, non-stimulating taste and an energetic action that neither irritates nor strongly activates physiological processes. In traditional Chinese medicine, bland substances gently drain dampness and promote urination, relieving excess fluid whilst also preserving qi and yin. Western traditional medicine similarly associates healing with bland substances that avoid extremes of heat or cold and promote restoration of balance. Blandness signifies regulation by supporting elimination and normal tissue function without forceful stimulation, helping to create a gentle and balanced state of homeostasis.
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, horseradish 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.
Neutral
Neutral herbs are characterised as by balanced temperature and energetics — neither warming nor cooling, nor strongly dispersing nor consolidating, and are, therefore, used across a wide spectrum of constitutional and pathological states. In Chinese medicine, this level, calm quality supports the centre, and gently strengthens digestion, regulates fluids, and resolves damp without provoking too much heat or cold. In Western medicine, neutral herbs are regarded as equal in relation to hot/cold or damp/dry and capable of maintaining a state of equilibrium. Neutral herbs can be seen as moderating reactivity, and supporting homeostasis rather than forcing change.
Pungent
The pungent flavour refers to the powerful taste of hot spices including mustard (Brassica spp.), ginger (Zingiber officinale), horseradish (Amoracia rusticana), chilli (Capsicum spp.), and garlic (Allium sativum). These herbs act to enliven and invigorate the senses, and they often also have heating qualities. Unlike other tastes, the effect is not linked to a specific receptor on the tongue and instead acts through direct irritation of tissues and nerve endings. Energetically, pungent herbs are known to disperse energy (qi) throughout the body. Pharmacologically, pungent herbs dry excess moisture and mucus, as well as stimulate digestion and metabolism.
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'.
Sharp
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.
Sour
The sour taste occurs because of the stimulation of hydrogen ions which trigger the sour taste receptors on the tongue. The more acidic a substance, the more hydrogen ions will be released. The sour taste comes from acidic substances including citrus, fermented foods, tannins, and vinegars. Sour foods and herbs absorb excess moisture, whilst also increasing the production of saliva. Energetically, sour substances tonify the lungs, playing a role in disease prevention. Excessive use, however, can result in malabsorption of nutrients. Examples of sour herbs include, rosehips (Rosa canina), raspberry (Rubus idaeus), rhubarb (Rheum palmatum), schisandra (Schisandra chinensis), hawthorn (Crataegus monogyna) and ginkgo (Ginkgo biloba).
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.
Umami
The umami taste was originally discovered in 1985 in Japan and is directly translated from the Japanese as a ‘pleasant savoury taste’. It is referred to as the ‘fifth taste’ and is a salty, rich, and meaty flavour. The umami flavour is produced by amino acids (glutamic acid and aspartic acid) found in many food and plant sources including tomatoes, mushrooms, seaweeds and soy-based foods. Umami foods can improve nutritional absorption and digestion as there are also umami receptors in the gut as well as the mouth. Examples of umami herbs include green tea (Camellia sinensis), reishi (Ganoderma lucidum), nettle (Urtica dioica), cordyceps (Ophiocordyceps sinensis), shitake (Lentinula edodes) and bladderwrack (Fucus vesiculosus).

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