• Clinical data 90%
  • Efficacy 80%
  • Security 70%
  • Toxicity 30%

Ginger Zingiber officinale
Rhizoma Zingiberis

Synonyms

Amomum zingiber L. (1, 6), Zingiber blancoi Massk.

General appearance

Ginger occurs in horizontal, laterally flattened, irregularly branching pieces; 3–16cm long, 3–4cm wide, up to 2 cm thick; sometimes split longitudinally; pale yellowish buff or light brown externally, longitudinally striated, somewhat fibrous; branches known as “fingers” arise obliquely from the rhizomes, are flattish, obovate, short, about 1–3cm long; fracture, short and starchy with projecting fibres. Internally, yellowish brown, showing a yellow endodermis separating the narrow cortex from the wide stele, and numerous scattered fibrovascular bundles, abundant scattered oleoresin cells with yellow contents and numerous larger greyish points, vascular bundles, scattered on the whole surface.

Major chemical constituents
The rhizome contains 1–4% essential oil and an oleoresin. The composition of the essential oil varies as a function of geographical origin, but the chief constituent sesquiterpene hydrocarbons (responsible for the aroma) seem to remain constant. These compounds include (-) zingiberene, (+)-ar-curcumene, (-)--sesquiphellandrene, and -bisabolene. Monoterpene aldehydes and alcohols are also present. The constituents responsible for the pungent taste of the drug and possibly part of its anti-emetic properties have been identified as 1-(3- methoxy-4-hydroxyphenyl)-5-hydroxyalkan-3-ones, known as [3–6]-, [8]-, [10]-, and [12]-gingerols (having a side-chain with 7–10, 12, 14, or 16 carbon atoms, respectively) and their corresponding dehydration products, which are known as shogaols.

Medicinal uses
Uses supported by clinical data
The prophylaxis of nausea and vomiting associated with motion sickness, postoperative nausea, pernicious vomiting in pregnancy, and seasickness.
Uses described in pharmacopoeias and in traditional systems of medicine
The treatment of dyspepsia, flatulence, colic, vomiting, diarrhoea, spasms, and other stomach complaints. Powdered ginger is further employed in the treatment of colds and flu, to stimulate the appetite, as a narcotic antagonist, and as an anti inflammatory agent in the treatment of migraine headache and rheumatic and muscular disorders.
Uses described in folk medicine, not supported by experimental or clinical data
To treat cataracts, toothache, insomnia, baldness, and haemorrhoids, and to increase longevity.

Pharmacology
Experimental pharmacology
Cholagogic activity
Intraduodenal administration of an acetone extract (mainly essential oils) of ginger root to rats increased bile secretion for 3 hours after dosing, while the aqueous extract was not active. The active constituents of the essential oil were identified as [6]- and [10]-gingerol. Oral administration of an acetone extract of ginger (75 mg/kg), [6]-shogaol (2.5 mg/kg), or [6]-, [8]-, or [10]-gingerol enhanced gastrointestinal motility in mice, and the activity was comparable to or slightly weaker than that of metoclopramide (10mg/kg) and domperidone. The [6]-, [8]-, or [10]- gingerols are reported to have antiserotoninergic activity, and it has been suggested that the effects of ginger on gastrointestinal motility may be due to this activity. The mode of administration appears to play a critical role in studies on gastrointestinal motility. For example, both [6]-gingerol and [6]- shogaol inhibited intestinal motility when administered intravenously but accentuated gastrointestinal motility after oral administration.
Antiemetic activity
The emetic action of the peripherally acting agent copper sulfate was inhibited in dogs given an intragastric dose of ginger extract, but emesis in pigeons treated with centrally acting emetics such as apomorphine and digitalis could not be inhibited by a ginger extract. These results suggest that ginger’s antiemetic activity is peripheral and does not involve the central nervous system. The antiemetic action of ginger has been attributed to the combined action of zingerones and shogaols.
Anti-inflammatory activity
One of the mechanisms of inflammation is increased oxygenation of arachidonic acid, which is metabolized by cyclooxygenase and 5 lipoxygenase, leading to prostaglandin E2 and leukotriene B4, two potent mediators of inflammation. In vitro studies have demonstrated that a hot-water extract of ginger inhibited the activities of cyclooxygenase and lipoxygenase in the arachidonic acid cascade; thus its anti-inflammatory effects may be due to a decrease in the formation of prostaglandins and leukotrienes. The drug was also a potent inhibitor of thromboxane synthase, and raised prostacyclin levels without a concomitant rise in prostaglandins E2 or F2α. In vivo studies have shown that oral administration of ginger extracts decreased rat paw oedema. The potency of the extracts was comparable to that of acetylsalicylic acid. [6]- Shogaol inhibited carrageenin-induced paw oedema in rats by inhibiting cyclooxygenase activity. Recently, two labdane-type diterpene dialdehydes isolated from ginger extracts have been shown to be inhibitors of human 5- lipoxygenase in vitro.
Clinical pharmacology
Antinausea and antiemetic activities
Clinical studies have demonstrated that oral administration of powdered gingerroot (940 mg) was more effective than dimenhydrinate (100 mg) in preventing the gastrointestinal symptoms of kinetosis (motion sickness). The results of this study further suggested that ginger did not act centrally on the vomiting centre, but had a direct effect on the gastrointestinal tract through its aromatic, carminative, and absorbent properties, by increasing gastric motility and adsorption of toxins and acids.
In clinical double-blind randomized studies, the effect of powdered ginger root was tested as a prophylactic treatment for seasickness.
The results of one study demonstrated that orally administered ginger was statistically better than a placebo in decreasing the incidence of vomiting and cold sweating 4 hours after ingestion. The other investigation compared the effects of seven over-the-counter and prescription antiemetic drugs on prevention of seasickness in 1489 subjects. This study concluded that ginger was as effective as the other antiemetic drugs tested.
At least eight clinical studies have assessed the effects of ginger root on the symptoms of motion sickness. Four of these investigations showed that orally administered ginger root was effective for prophylactic therapy of nausea and vomiting. The other three studies showed that ginger was no more effective than a placebo in treating motion sickness. The conflicting results appear to be a function of the focus of these studies. Clinical studies that focused on the gastrointestinal reactions involved in motion sickness recorded better responses than those studies that concentrated primarily on responses involving the central nervous system.
The hypothesis that an increase in gastric emptying may be involved in the antiemetic effects of ginger has recently come under scrutiny. Two clinical studies demonstrated that oral doses of ginger did not affect the gastric emptying rate, as measured by sequential gastric scintigraphy or the paracetamol absorption technique.
In a double-blind, randomized, cross-over trial, oral administration of powdered ginger (250 mg, 4 times daily) effectively treated pernicious vomiting in pregnancy. Both the degree of nausea and the number of vomiting attacks were significantly reduced. Furthermore, in a prospective, randomized, double-blind study, there were statistically significantly fewer cases of postoperative nausea and vomiting in 60 patients receiving ginger compared to a placebo. The effect of ginger on postoperative nausea and vomiting was reported to be as good as or better than that of metoclopramide. In contrast, another double-blind randomized study concluded that orally administered ginger BP (prepared according to the British Pharmacopoeia) was ineffective in reducing the incidence of postoperative nausea and vomiting.
Anti-inflammatory activity
One study in China reported that 113 patients with rheumatic pain and chronic lower back pain, injected with a 5–10% ginger extract into the painful points or reaction nodules, experienced full or partial relief of pain, decrease in joint swelling, and improvement or recovery in joint function. Oral administration of powdered ginger to patients with rheumatism and musculoskeletal disorders has been reported to provide varying degrees of relief from pain and swelling.

Contraindications 
No information available.

Warnings
No information available.

References
1. Standard of ASEAN herbal medicine, Vol. I. Jakarta, ASEAN Countries, 1993.
2. Pharmacopoeia of the People’s Republic of China (English ed.). Guangzhou, Guangdong
Science and Technology Press, 1992.
3. British pharmacopoeia. London, Her Majesty’s Stationery Office, 1993.
4. African pharmacopoeia, Vol. 1. 1st ed. Lagos, Organization of African Unity, Scientific,
Technical & Research Commission, 1985.
5. The Japanese pharmacopoeia XIII. Tokyo, Ministry of Health and Welfare, 1996.
6. Bisset NG. Max Wichtl’s herbal drugs & phytopharmaceuticals. Boca Raton, FL, CRC
Press, 1994.
7. Keys JD. Chinese herbs, their botany, chemistry and pharmacodynamics. Rutland, VT, CE
Tuttle, 1976.
8. Youngken HW. Textbook of pharmacognosy, 6th ed. Philadelphia, Blakiston, 1950.
9. Farnsworth NR, ed. NAPRALERT database. Chicago, University of Illinois at
Chicago, IL, March 15, 1995 production (an on-line database available directly
through the University of Illinois at Chicago or through the Scientific and Technical
Network (STN) of Chemical Abstracts Services).
10. Kapoor LD. Handbook of Ayurvedic medicinal plants. Boca Raton, FL, CRC Press, 1990.
11. Ghazanfar SA. Handbook of Arabian medicinal plants. Boca Raton, FL, CRC Press, 1994.
12. Chang HM, But PPH, eds. Pharmacology and applications of Chinese materia medica, Vol.
1. Singapore, World Scientific Publishing, 1986.
13. Farnsworth NR, Bunayapraphatsara N, eds. Thai medicinal plants. Bangkok,
Prachachon, 1992.
14. Awang DVC. Ginger. Canadian pharmaceutical journal, 1982, 125:309–311.
15. Quality control methods for medicinal plant materials. Geneva, World Health Organization,
1998.
16. Deutsches Arzneibuch 1996. Vol. 2. Methoden der Biologie. Stuttgart, Deutscher
Apotheker Verlag, 1996.
17. European pharmacopoeia, 3rd ed. Strasbourg, Council of Europe, 1997.
18. Guidelines for predicting dietary intake of pesticide residues, 2nd rev. ed. Geneva, World
Health Organization, 1997 (unpublished document WHO/FSF/FOS/97.7; available
from Food Safety, 1211 Geneva 27, Switzerland).
19. Yoshikawa M et al. Qualitative and quantitative analysis of bioactive principles in
Zingiberis rhizoma by means of high performance liquid chromatography and gas
liquid chromatography. Yakugaku zasshi, 1993, 113:307–315.
20. Reynolds JEF, ed. Martindale, the extra pharmacopoeia, 30th ed. London, Pharmaceutical
Press, 1993:885.
21. German Commission E Monograph, Zingiberis rhizoma. Bundesanzeiger, 1988, 85:5
May.
22. Mowrey DB, Clayson DE. Motion sickness, ginger, and psychophysics. Lancet, 1982,
i:655–657.
23. Holtmann S et al. The anti-motion sickness mechanism of ginger. A comparative
study with placebo and dimenhydrinate. Acta otolaryngology, 1989, 108:168–174.
WHO monographs on selected medicinal plants
286
24. Bone ME et al. Ginger root, a new antiemetic. The effect of ginger root on postoperative
nausea and vomiting after major gynaecological surgery. Anaesthesia, 1990,
45:669–671.
25. Fischer-Rasmussen W et al. Ginger treatment of hyperemesis gravidarum. European
journal of obstetrics, gynecology and reproductive biology, 1991, 38:19–24.
26. Schmid R et al. Comparison of seven commonly used agents for prophylaxis of
seasickness. Journal of travel medicine, 1994, 1:203–206.
27. Grontved A et al. Ginger root against seasickness. A controlled trial on the open sea.
Acta otolaryngology, 1988, 105:45–49.
28. Srivastava KC, Mustafa T. Ginger (Zingiber officinale) in rheumatism and musculoskeletal
disorders. Medical hypotheses, 1992, 39:342–348.
29. Yamahara J et al. Cholagogic effect of ginger and its active constituents. Journal of
ethnopharmacology, 1985, 13:217–225.
30. Yamahara J et al. Gastrointestinal motility enhancing effect of ginger and its active
constituents. Chemical and pharmaceutical bulletin, 1991, 38:430–431.
31. Yamahara J et al. Inhibition of cytotoxic drug-induced vomiting in suncus by a
ginger constituent. Journal of ethnopharmacology, 1989, 27:353–355.
32. Suekawa M et al. Pharmacological studies on ginger. I. Pharmacological actions of
pungent components, (6)-gingerol and (6)-shogaol. Journal of pharmacobio-dynamics,
1984, 7:836–848.
33. Japan centra revuo medicina, 1954, 112:669.
34. Zhou JG. Tianjin medical journal, 1960, 2:131.
35. Mustafa T, Srivastava KC, Jensen KB. Drug development report 9. Pharmacology of
ginger, Zingiber officinale. Journal of drug development, 1993, 6:25–39.
36. Srivastava KC. Aqueous extracts of onion, garlic and ginger inhibit platelet aggregation
and alter arachidonic acid metabolism. Biomedica biochimica acta, 1984, 43:335–
346.
37. Mascolo N et al. Ethnopharmacologic investigation of ginger (Zingiber officinale).
Journal of ethnopharmacology, 1989, 27:129–140.
38. Sharma JN, Srivastava KC, Gan EK. Suppressive effects of eugenol and ginger oil on
arthritic rats. Pharmacology, 1994, 49:314–318.
39. Suekawa M, Yuasa K, Isono M. Pharmacological studies on ginger: IV. Effects of (6)-
shogaol on the arachidonic cascade. Folia pharmacologia Japan, 1986, 88:236–270.
40. Kawakishi S, Morimitsu Y, Osawa T. Chemistry of ginger components and inhibitory
factors of the arachidonic acid cascade. American Chemical Society Symposium
series, 1994, 547:244–250.
41. Stott JR, Hubble MP, Spencer MB. A double-blind comparative trial of powdered
ginger root, hyosine hydrobromide, and cinnarizine in the prophylaxis of motion
sickness induced by cross coupled stimulation. Advisory Group for Aerospace
Research Development conference proceedings, 1984, 39:1–6.
42. Wood CD et al. Comparison of the efficacy of ginger with various antimotion
sickness drugs. Clinical research practice and drug regulatory affairs, 1988, 6:129–136.
43. Stewart JJ et al. Effects of ginger on motion sickness susceptibility and gastric
function. Pharmacology, 1991, 42:111–120.
44. Phillips S, Hutchinson S, Ruggier R. Zingiber officinale does not affect gastric emptying
rate. Anaesthesia, 1993, 48:393–395.
45. Phillips S, Ruggier R, Hutchinson SE. Zingiber officinale (Ginger), an antiemetic for day
case surgery. Anaesthesia, 1993, 48:715–717.
46. Arfeen Z et al. A double-blind randomized controlled trial of ginger for the prevention
of postoperative nausea and vomiting. Anaesthesia and intensive care, 1995,
23:449–452.
47. Backon J. Ginger: inhibition of thromboxane synthetase and stimulation of
prostacyclin; relevance for medicine and psychiatry. Medical hypotheses, 1986,
20:271–278.
Rhizoma Zingiberis
287
48. Backon J. Ginger as an antiemetic: possible side effects due to its thromboxane
synthetase activity. Anaesthesia, 1991, 46:705–706.
49. Srivastava KC. Isolation and effects of some ginger components on platelet aggregation
and eicosanoid biosynthesis. Prostaglandins and leukotrienes in medicine, 1986,
25:187–198.
50. Lumb AB. Effect of ginger on human platelet function. Thrombosis and haemostasis,
1994, 71:110–111.
51. Yamamoto H, Mizutani T, Nomura H. Studies on the mutagenicity of crude drug
extracts. Yakugaku zasshi, 1982, 102:596–601.
52. Nagabhushan M, Amonkar AJ, Bhide SV. Mutagenicity of gingerol and shogoal and
antimutagenicity of zingerone in Salmonella/microsome assay. Cancer letters, 1987,
36:221–233.
53. Nakamura H, Yamamoto T. Mutagen and anti-mutagen in ginger, Zingiber officinale.
Mutation research, 1982, 103:119–126.
54. Kada T, Morita M, Inoue T. Antimutagenic action of vegetable factor(s) on the
mutagenic principle of tryptophan pyrolysate. Mutation research, 1978, 53:351–353.
55. Morita K, Hara M, Kada T. Studies on natural desmutagens: screening for vegetable
and fruit factors active in inactivation of mutagenic pyrolysis products from amino
acids. Agricultural and biological chemistry, 1978, 42:1235–1238.
56. Seetharam KA, Pasricha JS. Condiments and contact dermatitis of the finger tips.
Indian journal of dermatology, venereology and leprology, 1987, 53:325–328.