Pinellia ternate

Nausea*

The processed product of P. ternata has antiemetic activity that may be related to the alkaloids and proteins. Intragastric administration of alkaloids of P. ternata to minks at a dose of 30 mg/kg showed significant inhibition on the emesis model induced by cisplatin (7.5 mg/kg, intraperitoneal injection) and apomorphine (1.6 mg/kg, subcutaneous injection) compared with a control group (P b 0.05), while it showed an indistinctive inhibition on the emesis model induced by copper sulfate and rotation. The mechanism may be related to its inhibiting property on the central nervous system. 6KDP is one of the major proteins in the tubers of P. ternata. Oral administration of 6KDP at a dose of 50 mg/kg to male young chickens with vomiting induced by copper sulfate showed moderately anti-emetic activity, and the inhibition rate was 49.8%.[1]*

Motion sickness*

Pinellia has antitussive, expectorant, antiemetic, antitumor, antibacterial, anti-inflammatory, antioxidant, anticonvulsant and sedative hypnotic activity. Motion sickness is the body cannot adapt to the acceleration, vision and deep feeling of dizziness, vertigo, stimulation and nausea, vomiting, pale and a series of vestibular and reaction disease.*

The experimental results showed that 3 prescriptions of pinellia extracts have anti motion sickness effect, the effect is better than dimenhydrinate and no side effects, its mechanism and further pharmacodynamics is underway to study.[2]*

Magnolia officinalis

Diseases of the GI tract are highly common and varied, including irritable bowel syndrome, functional dyspepsia, abdominal pain, abdominal bloating, nausea, vomiting, diarrhoea, constipation, etc., which have a substantial effect on quality of life and health-care costs. M. officinalis is commonly used in TCM for treating such GI disorders, probably through an antispasmodic effect that results in relaxation of GI tract smooth muscles.*

Among various regulatory factors that modulate smooth muscle motility in GI tracts, ACH and serotonin (5-hydroxytryptamine, 5-HT) are considered as major neurotransmitters that regulate the GI motility. Magnolol and honokiol significantly inhibit the contractility of isolated gastric fundus strips of rats treated with ACH or serotonin, and of isolated ileum in guinea pigs treated with ACH or CaCl2; both behave as non-competitive muscarinic antagonists. Magnolol and honokiol inhibited contractions induced by ACH (in Ca2+-free medium) and extracellular Ca2+-dependent contractions induced by ACH.[3]*

Functional dyspepsia (FD)*

In the present study, the effect of magnoloside A (MA), a main phenylethanoid glycoside in Hou po, on FD was firstly evaluated and its potential mechanism was concluded.*

Key findings: MA exhibited anti-FD activities by fastening the delayed gut emptying rate of FD rat and increasing the levels of gastrin, motilin, and calcitonin gene related protein; and decreasing the levels of 5-hydroxytryptamine, nitric oxide synthase, and vasoactive intestinal peptide. On the other hand, MA can modulate the composition of gut microbiota, resulting in the variation of the short chain fat acids. The changed gut microbiota was found to have positive relation, including acetic acid (AA), propanoic acid (PA), butyric acid (BA). MA ameliorated FD rats by modulating of the secretion of related brain-gut peptides and altering the composition of intestinal microbiota.[4]*

Nausea*

Magnolol and honokiol, biphenyl compounds, were isolated as anti-emetic principles from the methanolic extract of Magnolia obovata bark. [6]-, [8]-, and [10]-shogaols and [6]-, [8]-, and [10]-gingerols were isolated from the methanolic extract of Zingiber officinale rhizome as anti-emetic principles. Some phenyl-propanoids with allyl side-chains were found to show the same activity. They inhibited the emetic action induced by the oral administration of copper sulfate pentahydrate.[5]*

Panax ginseng

Nausea*

The 5HT3 receptor is well-known to mediate the nausea and vomiting associated with anaesthesia and surgery, and anticancer chemotherapy. This study was designed to elucidate the effect of ginseng saponins on the recombinant 5HT3A receptor expressed in the xenopus oocyte.*

All saponin fractions (TS, PD, PT fraction, as well as ginsenoside-Rb1 and -Rg1) inhibited the peak current induced by the agonist 5HT on the 5HT3A receptor in a concentration-dependent, reversible, and voltage-independent manner. The PT fraction inhibited 5HT-induced currents in 5HT3A receptor more than the PD fraction; meanwhile, there was a similar degree of inhibition between ginsenoside-Rg1 and -Rb1, the main substitutes of PT fraction and PD saponin fractions, respectively.*

The inhibitory effect of ginseng saponin on 5HT3A receptor suggests a new and interesting approach to the management of nausea and vomiting in patients with cancer or those receiving anaesthesia during surgery as well as patients with gastrointestinal problems such as irritable bowel syndrome.[6]*

Chemotherapy*

Ginseng helps to boost the antitumor effect of epirubicin and paclitaxel drugs by increasing the mitochondrial accumulation of Bax and Bak that mediate cell death by apoptosis. Alopecia is one of the major stressful and negative psychological effect on patient undergoing chemotherapy. It is reported that Korean ginseng helps to promote the hair growth.[7] Cyclophosphamide is a chemo preventive drug which formed metabolite 4-hydroxycyclophosphamide (4-HC) by liver cytochrome P450 (CYP) enzyme and exhibited an anti-cancer effect. 4-HC clogged human hair growth by enhancing apoptosis of hair matrix keratinocytes and cause premature catagen development. Korean ginseng may help to prevent against 4-HC-induced alopecia.[8]*

Ginsenoside in the ginseng has strong affinity to combine with anti-apoptotic protein. It can decrease the activity of anti-apoptotic protein (BCL-2, BCL-XL, and MCL) and induced apoptosis mechanisms in the cancer cell of the human body.[9] Chemotherapy causes weakness and chronic fatigue to the patient and ginseng helps to improve the symptom of fatigue by oral administration. In a study, 2000 mg American ginseng extract was given to cancer patients for eight weeks and change was measured by MFSI-SF (multi-dimensional fatigue symptom inventory short form). Cisplatin, another chemotherapy drug causes nausea in patients; red ginseng saponin and non-saponin fractions promoted the suppression of the gastric motility in cancer patients who were on this drug.[10] [11]*

Gastroprotective*

This study demonstrated that GRb1 isolated from Panax ginseng head exhibited gastroprotective activity against gastric damages. Fractions and subfractions from the BuOH fraction of the Panax ginseng head, as well as the final ginsenoside product GRb1,inhibited the ulcerogenesis induced by HCI ethanol, and the inhibitory effect of GRb1 was consistent with the gross and histological examinations. GRb1 showed better inhibition of the gastric damage induced by the HCI ethanol and pyloric ligation (Shay ulcer) than that observed in the indomethacin model. The positive control drug, ranitidine, did not show any inhibition of the indomethacin-induced gastric ulcer because ranitidine only antagonizes the H2 receptor to reduce acid secretion, and is not related to the endogenous PGE2.*

In the gastric secretion study, the effect of GRb1 differed from that of ranitidine. It has been established that the inhibition of acid secretion is the most important factor for treating gastric ulcers. While ranitidine decreased both the gastric fluid volume and the total acidity in the stomach, GRb1 enhanced the former but decreased the latter. This suggests that GRb1 decreased gastric acidity by promoting mucus or bicarbonate secretion. Furthermore, GRb1 significantly increased the gastric mucus in the EtOH-induced mucus secretion model in rats. In the mucus secretion model, even though EtOH was induced in the rats to reduce the secretion, GRb1 enhanced it. This finding confirmed that the gastroprotective activity of GRb1 originated from the stimulation of mucus secretion.[12]*

Bambusa breviflora

Bambusa breviflora has been used in traditional Chinese medicines for treatment of stomach-ache, diarrhoea or vomiting, chest diaphragm inflammation, phlegm, restlessness, excessive thirst, which had been described in the Chinese Materia Medica for over 1000 years. Bambusa breviflora is rich in natural bioactive chemicals, including phenolic acids and flavonoids, such as caffeic acid, chlorogenic acid, ferulic acid, p-coumaric acid, orientin, homoorientin, vitexin and isovitexin.[13]*

Gut microbiota*

A study showed that O acetyl-arabinoxylan (a polysaccharide from Bamboo) remarkably modulated the composition of human colonic microbiota, mainly by increasing the growth of potential beneficial genera (i.e. Bifidobacterium, Lactobacillus, Bacteroides, Prevotella_7, Parabacteroides) and by decreasing the growth of potential harmful genera (i.e. Fusobacterium, Lachnospiraceae_UCG-008, Bilophila and Desulfovibrio). O acetyl-arabinoxylan significantly promoted the production of short-chain fatty acids, especially acetic, propionic and n-butyric acids. After 48 h fermentation, the concentration of n-butyric acid in BSH-1 fermentation culture was increased by 2.41 times compared to the blank.[14] A study by Chen Y, demonstrated that high molecular weight polysaccharide derived from bamboo shavings exhibited anti-obesogenic, antidiabetic and anti-inflammatory properties in an animal model of HFD-induced obesity.[15]*

Chemotherapy immune modulation*

It was found that cyclophosphamide markedly down-regulated the mRNA expression of T-bet/GATA-3 in mice splenocytes, whereas bamboo shavings could restore them to normal level. Therefore, it was deduced that bamboo shavings might modulate Th1/Th2 cytokine secretion via the regulation of T-bet/GATA-3 mRNA expression in mice. The present study demonstrated that bamboo shavings could alleviate cyclophosphamide induced immunosuppression in mice, and it has the potential to be implemented in antineoplastic immunotherapy combined with chemotherapeutic agents.*

Zingiber officinale

Nausea and vomiting of pregnancy*

Ginger is considered a medicinal herb used for the treatment of nausea of pregnancy, improving the symptoms of premenstrual syndrome[16], reducing nausea and vomiting after surgery[17] [18], and after chemotherapy.[19]  In a review with ten clinical trials with 1059 participants, evaluated the effectiveness of ginger for Nausea and vomiting of pregnancy (NVP). Some studies have shown that ginger acts through antiserotonin-3 (5HT3).[20] [21] Saberi et al. found that ginger led to more significant mitigation of NVP compared to the control group and placebo.[22] Firouzbakht et al. found that ginger was as effective as Vitamin B6 in alleviating NVP.[23] In another study, Saberi et al. demonstrated that ginger is more effective than acupressure in reducing NVP.[24] Ozgoli et al. showed that 1000 mg of daily ginger intake was more effective than placebo in reducing NVP (85% vs. 56%, respectively; P < 0.01).[25] Hosseinkhani and Sadeghi found ginger to be effective in reducing nausea of pregnancy.[26]*

Chemotherapy-Induced Nausea and Vomiting*

A meta-analysis to determine whether ginger could be used to treat Chemotherapy-Induced Nausea and Vomiting (CINV), found that the odds ratio (OR) of ginger in controlling CINV was 0.71 (95% confidence interval [CI], 0.54-0.94; P = .015). Heterogeneity existed among the samples; therefore, a subgroup analysis was performed and divided nausea and vomiting into acute or delayed. The results revealed that ginger could reduce acute CINV in patients (OR, 0.60; 95% CI, 0.42-0.86; P = .006), particularly acute vomiting (OR, 0.58; 95% CI, 0.37-0.94; P = .025).  In conclusion, Ginger displayed significant efficacy with regard to controlling CINV in the experimental groups.[27]*

Patients with Advanced Cancer*

Anorexia-cachexia syndrome (ACS) is a complex condition in advanced cancer patients, defined by disproportionate loss of skeletal muscle mass, and a lack or loss of appetite. ACS is commonly associated with gastrointestinal symptoms such as nausea and vomiting. Ginger was studied and there was statistically significant improvements noted in nausea (p < 0.02), anxiety (p < 0.01), drowsiness (p < 0.01), appetite (p < 0.01), and well-being (p < 0.05). Although not statistically significant, there was decreased pain, improved tiredness, and improved shortness of breath. Dysmotility-like symptoms: went from 16.00 to 6.66 (P < 0.01), Reflux-like symptoms: went from 4.06 to 1.53 (P < 0.01) and Ulcer-like symptoms: went from 2.93 to 1.67 (P = 0.05).[28]*

References

[1] Ji X, Huang B, Wang G, Zhang C. The ethnobotanical, phytochemical and pharmacological profile of the genus Pinellia. Fitoterapia. 2014;93:1-17. doi:10.1016/j.fitote.2013.12.010

[2] Wang H et al. Study on the anti-motion sickness action of volatile oil constituents in Pinellia ternate. Biomedical Research (2015) Volume 26, Issue 2

[3] Poivre M, Duez P. Biological activity and toxicity of the Chinese herb Magnolia officinalis Rehder & E. Wilson (Houpo) and its constituents. J Zhejiang Univ Sci B. 2017;18(3):194-214. doi:10.1631/jzus.B1600299

[4] Xue Z, Wu C, Wei J, et al. An orally administered magnoloside A ameliorates functional dyspepsia by modulating brain-gut peptides and gut microbiota. Life Sci. 2019;233:116749. doi:10.1016/j.lfs.2019.116749

[5] Kawai T, Kinoshita K, Koyama K, Takahashi K. Anti-emetic principles of Magnolia obovata bark and Zingiber officinale rhizome. Planta Med. 1994;60(1):17-20. doi:10.1055/s-2006-959399

[6] Min, K. T., Koo, B. N., Kang, J. W., Bai, S. J., Ko, S. R., & Cho, Z.-H. (2003). Effect of Ginseng Saponins on the Recombinant Serotonin Type 3A Receptor Expressed in Xenopus Oocytes: Implication of Possible Application as an Antiemetic. The Journal of Alternative and Complementary Medicine, 9(4), 505–510. doi:10.1089/107555303322284794

[7] G.N. Oh, S.W. Son, Efficacy of Korean red Ginseng in the treatment of alopecia areata, J. Ginseng Res. 36 (4) (2012) 391.

[8] DI Keum, LQ Pi, ST Hwang, WS Lee. Protective effect of Korean red Ginseng against chemotherapeutic drug-induced premature catagen development assessed with human hair follicle organ culture model, J. Ginseng Res. 40 (2) (2016)

[9] N. Sathishkumar, S. Sathiyamoorthy, M. Ramya, D.-U. Yang, H.N. Lee, D.-C. Yang, Molecular docking studies of anti-apoptotic BCL-2, BCL-XL, and MCL-1 proteins with ginsenosides from Panax ginseng, J. Enzyme Inhib. Med. Chem. 27 (5) (2012) 685–692.

[10] R. Sathyanath, B.R. Hanumantha Rao, H.-G. Kim, J.-H. Cho, C.-G. Son, Saponin and non-saponin fractions of red ginseng ameliorate cisplatin-induced pica in rats, Pharm. Biol. 51 (8) (2013) 1052–1060.

[11] Majeed F, Malik FZ, Ahmed Z et al. (2018). Ginseng phytochemicals as therapeutics in oncology: Recent perspectives. Biomedicine & Pharmacotherapy, 100, 52–63. doi:10.1016/j.biopha.2018.01.155

[12] Jeong CS, Hyun JE, Kim YS, Lee ES. (2003). Ginsenoside RB1 the anti-ulcer constituent from the head of Panax ginseng. Archives of Pharmacal Research, 26(11), 906–911. doi:10.1007/bf02980198

[13] Gong J, Huang J, Xiao G, et al. Antioxidant Capacities of Fractions of Bamboo Shaving Extract and Their Antioxidant Components. Molecules. 2016;21(8):996. Published 2016 Jul 30. doi:10.3390/molecules21080996

[14] Huang J, Wang Q, Xu Q, et al. (2018). In vitro fermentation of O‑acetyl‑arabinoxylan from bamboo shavings by human colonic microbiota. International Journal of Biological Macromolecules. doi:10.1016/j.ijbiomac.2018.12.024

[15] Chen, Y., Jin, L., Li, Y., Xia, G., Chen, C., & Zhang, Y. (2018). Bamboo-shaving polysaccharide protects against high-diet induced obesity and modulates the gut microbiota of mice. Journal of Functional Foods, 49, 20–31. doi:10.1016/j.jff.2018.08.015

[16] Khayat S, Kheirkhah M, Behboodi Moghadam Z, Fanaei H, Kasaeian A, Javadimehr M, et al. Effect of treatment with ginger on the severity of premenstrual syndrome symptoms. ISRN Obstet Gynecol. 2014;2014:792708

[17] Mandal P, Das A, Majumdar S, Bhattacharyya T, Mitra T, Kundu R, et al. The efficacy of ginger added to ondansetron for preventing postoperative nausea and vomiting in ambulatory surgery. Pharmacognosy Res. 2014;6:52–7.

[18] Montazeri AS, Hamidzadeh A, Raei M, Mohammadiun M, Montazeri AS, Mirshahi R, et al. Evaluation of oral ginger efficacy against postoperative nausea and vomiting: A randomized, double-blinded clinical trial. Iran Red Crescent Med J. 2013;15:e12268.

[19] Panahi Y, Saadat A, Sahebkar A, Hashemian F, Taghikhani M, Abolhasani E, et al. Effect of ginger on acute and delayed chemotherapy-induced nausea and vomiting: A pilot, randomized, open-label clinical trial. Integr Cancer Ther. 2012;11:204–11.

[20] Yamahara J, Rong H, Iwamoto M, Kobayashi G, Matsuda H, Fujimura H. Active components of ginger exhibiting anti-serotonergic action. Phytother Res. 1989;3:70–1.

[21] Marx W, Kiss N, Isenring L. Is ginger beneficial for nausea and vomiting? An MERGE of the literature. Curr Opin Support Palliat Care. 2015;9:189–95.

[22] Saberi F, Sadat Z, Abedzadeh-Kalahroudi M, Taebi M. Effect of ginger on relieving nausea and vomiting in pregnancy: A randomized, placebo-controlled trial. Nurs Midwifery Stud. 2014;3:e11841.

[23] Firouzbakht M, Nikpour M, Jamali B, Omidvar S. Comparison of ginger with Vitamin B6 in relieving nausea and vomiting during pregnancy. Ayu. 2014;35:289–93.

[24] Saberi F, Sadat Z, Abedzadeh-Kalahroudi M, Taebi M. Acupressure and ginger to relieve nausea and vomiting in pregnancy: A randomized study. Iran Red Crescent Med J. 2013;15:854–61.

[25] Ozgoli G, Goli M, Simbar M. Effects of ginger capsules on pregnancy, nausea, and vomiting. J Altern Complement Med. 2009;15:243–6.

[26] Hosseinkhani N, Sadeghi T. The effect of ginger on pregnancy-induced nausea during first trimester. [Last accessed on 2015 Apr 07];Iran J Nurs. 2009 22:75–83.

[27] Chang WP, Peng YX. Does the Oral Administration of Ginger Reduce Chemotherapy-Induced Nausea and Vomiting?: A Meta-analysis of 10 Randomized Controlled Trials. Cancer Nurs. 2019;42(6):E14-E23. doi:10.1097/NCC.0000000000000648

[28] Bhargava R, Chasen M, Elten M, MacDonald N. (2019). The effect of ginger (Zingiber officinale Roscoe) in patients with advanced cancer. Supportive Care in Cancer. doi:10.1007/s00520-019-05129-w

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