130

Zingiber officinale (Ginger)

Michael T. Murray, ND, and John Nowicki, ND

OUTLINE
General Description, 965 Thermogenic Properties, 967
Chemical Composition, 965 Antibiotic Activity, 967
History and Folk Use, 965 Anticancer Effects, 967
Pharmacology, 966 Effects on Insulin and Blood Glucose, 968
Antioxidant Effects, 966 Clinical Applications, 968
Effects on Prostaglandin and Leukotriene Metabolism, 966 Motion Sickness, 968
Effects on Platelets and Fibrinolysis, 966 Nausea and Vomiting, 969
Cholesterol-Lowering and Hepatic Effects, 967 Inflammatory Conditions, 969
Cardiotonic and Hypotensive Properties, 967 Dosage, 970
Analgesic Effects, 967 Toxicology, 970
Gastrointestinal Smooth Muscle Effects, 967 Drug Interactions, 970
Antiulcer Effects, 967

Zingiber officinale (family: Zingiberaceae)
Common name: ginger
GENERAL DESCRIPTION
Ginger is an erect perennial herb with thick tuberous rhizomes (under-
ground stems) from which the aerial stem grows to a height of 2 to 4
ft. Grasslike alternate leaves 6 to 12 in. long and 0.75 in. wide shoot
off from the aerial stem. Wild ginger produces a beautiful flower, but
cultivated ginger rarely flowers.
Although ginger is native to southern Asia, it is now extensively cul-
tivated throughout the tropics (e.g., India, China, Jamaica, Haiti, and
Nigeria). Jamaica is the major producer, with exports to all parts of the
world amounting to more than 2 million pounds annually.
The knotted and branched rhizome, commonly called the root, is the
portion of ginger used for culinary and medicinal purposes (Fig. 130.1A
and B). Extracts and the oleoresin are produced from dried unpeeled
ginger because peeled ginger loses much of its essential oil content.1,2
Ginger oil is produced from the fresh ginger via steam distillation.  it was used to treat the following conditions1:
CHEMICAL COMPOSITION
The following compounds have been isolated from ginger1,2:
• Starch (up to 50%)
• Protein (about 9%)
• Lipids (6%–8%) composed of triglycerides, phosphatidic acid, lec-
ithins, and free fatty acids
• A protease (2%)
• Volatile oils (1%–3%), the principal components of which are ses-
quiterpenes (bisabolene, zingiberene, and zingiberol) and various
“pungent” principles, aromatic ketones, known collectively as gin-
gerols vitamins (especially niacin and vitamin A)
• Resins
The pungent principles are thought to be the most pharmaco-
logically active components of ginger. Gingerol and its derivatives
can be found in concentrations as high as 33% in ginger oleoresin
(Fig. 130.2). The fresh oleoresin will have a higher percentage of the
more pungent gingerol because gingerol can be dehydrated during
storage to form shogaol or have its fatty-acid moiety cleaved to
form zingerone (Figs. 130.3 and 130.4). The oleoresin is made by
extracting the oily and resinous materials with the aid of a solvent
(alcohol, hexane, or acetone). Pharmacokinetic studies in humans
show that the major pungent principles are absorbed after oral dos-
ing and can be detected as glucuronide and sulfate conjugates in
the blood.3 
HISTORY AND FOLK USE
Ginger has been used for thousands of years in China for medicinal
purposes. Chinese records dating from the 4th century bc indicate that
• Stomachache
• Diarrhea
• Nausea
• Cholera
• Hemorrhage
• Rheumatism
• Toothache
It was used by eclectic physicians in the United States in the late
1800s as a carminative, diaphoretic, appetite stimulant, and local
counterirritant.4
Ginger is widely used as a spice, especially in Asian and Indian
cuisine. It is also used in many baked goods, beverages (ginger ale),
candy, liqueurs, and cosmetic products (perfumes, soaps, creams,
etc.). 

965
966 SECTION 4  Pharmacology of Natural Medicines

A B
Fig. 130.1 (A) Zingiber officinale root. (B) Z. officinale rhizome. (B, From ValentynVolkov/iStock.com.)

O OH
• G astrointestinal actions
• Thermogenic properties
• Antibiotic activities

Antioxidant Effects
HO Ginger has shown antioxidant effects in experimental studies.5 In a
OCH3 study in rats, ginger significantly lowered lipid peroxidation by main-
taining the activities of the antioxidant enzymes superoxide dismutase,
Fig. 130.2 Gingerol.
catalase, and glutathione peroxidase. The blood glutathione content
was significantly increased in ginger-fed rats. To achieve a similar effect
O with vitamin C, the dosage required was 100 mg/kg body weight.6
Ginger’s strong antioxidant properties have led to its being investi-
gated for preventing the development of rancidity in meat products.7
Ginger has been shown to prolong the shelf life of fresh, frozen, and
precooked pork patties. Because the use of many synthetic antioxi-
dants is prohibited by law, ginger may one day be used commercially
HO to extend the shelf lives of meats and other foods. 
O Effects on Prostaglandin and Leukotriene Metabolism
Fig. 130.3 Zingerone.
Numerous constituents in ginger have been shown to be potent inhib-
itors of prostaglandin and leukotriene synthesis through blocking of
the cyclooxygenase (COX) enzymes.8–13 The most potent components
O appear to be the pungent principles, although the aqueous extract has
also demonstrated inhibition. Inhibition of prostaglandin and leu-
kotriene formation could explain some of ginger’s historical use as an
anti-inflammatory agent. However, ginger and its extracts also have
HO strong antioxidant activities, and fresh ginger contains a protease with
action that may be similar to that of other plant proteases (e.g., brome-
O lain, ficin, papain) on inflammation.1 Repeated ginger administration
Fig. 130.4 Shogaol. to mice augmented corticosteroid secretion, indicating that chronic
ingestion may produce an anti-inflammatory effect via this mechanism
as well.14 
PHARMACOLOGY Effects on Platelets and Fibrinolysis
Ginger possesses numerous pharmacological properties; the following Ginger, like garlic and onions, is an inhibitor of platelet aggregation.11
are the most relevant: However, ginger’s effects may be far more powerful. In a comparison,
• Antioxidant effects an aqueous extract of ginger was shown to exert greater inhibitory
• Inhibition of prostaglandin, thromboxane, and leukotriene synthe- effects on platelet aggregation than aqueous garlic and onion extracts.15
sis Ginger was shown to produce a greater inhibition of thromboxane for-
• Inhibition of platelet aggregation mation and proaggregatory prostaglandins. Ginger, but not onion or
• Cholesterol-lowering actions garlic, also significantly reduced platelet lipid peroxide formation. In
• Choleretic effects another model, gingerol compounds and their derivatives were more
• Cardiotonic effects potent antiplatelet agents than aspirin.11
 CHAPTER 130  Zingiber officinale (Ginger)
The superiority of ginger over onions was also demonstrated in a
controlled study.16 Female volunteers given either 70 g raw onion or
5 g raw ginger demonstrated that ginger has a pronounced effect in
lowering platelet thromboxane production, whereas onion actually
produced a mild elevation (pooled results).
In addition to acting on platelets, ginger promotes fibrinolysis.
In one study, administration of 50 g of fat to 30 healthy adult volun-
teers decreased fibrinolytic activity from a mean of 64.20 to 52.10 U.17
Supplementation of 5 g of ginger powder with the fatty meal not only
prevented the drop in fibrinolytic activity but actually increased the
activity significantly.  study, roasted ginger inhibited ulcer formation in three gastric ulcer
Cholesterol-Lowering and Hepatic Effects
Ginger has been shown to significantly reduce serum and hepatic
cholesterol levels in cholesterol-fed rats by impairing cholesterol
absorption as well as stimulating cholesterol-7-alpha-hydroxylase,
the rate-limiting enzyme of bile acid synthesis.18–20 In addition, gin-
ger has been shown to increase bile secretion.21 Therefore ginger
works to lower cholesterol by promoting excretion and impairing
absorption.  growth of all strains with a minimum inhibitory concentration range
Cardiotonic and Hypotensive Properties
Gingerol has shown potent cardiotonic activity (positive inotropic and
chronotropic effects) on isolated guinea pig left atria.22,23 These effects
are a result of the acceleration of calcium uptake by the sarcoplasmic
reticulum. Gingerol was the first substance shown to produce these
effects.
Individuals with heart problems or high blood pressure may bene-
fit more from using fresh ginger rather than a dried preparation. This
recommendation is based not only on the fact that gingerol is the more
potent cardiotonic but also because animal studies demonstrate that
shogaol has a blood pressure–elevating effect.24 Gingerol is found pre-
dominantly in fresh ginger, whereas shogaol is rarely found in dried
ginger.  with a meal had no significant effect on metabolic rate.41 However,
Analgesic Effects
Ginger has demonstrated analgesic effects in experimental studies in
animals.25 This effect is thought to be a result of inhibition by shogaol
of the release of substance P, much like that by capsaicin, the pungent
principle of red pepper (Capsicum frutescens).  tific investigations appear to support its use as a diaphoretic and ther-
Gastrointestinal Smooth Muscle Effects
Another aspect of ginger is its ability to simultaneously improve gas-
tric motility and exert antispasmodic effects. This action is consis-
tent with its use as a gastrointestinal tonic. A lipophilic ginger extract
was shown in one study to enhance gastric motility, as evidenced by
increased intestinal transport of a charcoal meal fed to rats,26 and var-
ious fat-soluble components of ginger, such as galanolactone, demon-
strated antagonism of serotonin receptor sites.27 This latter mechanism
may be responsible for ginger’s antispasmodic effects on visceral and
vascular smooth muscle.
In a human study, 1000 mg of dried ginger did not affect lower
esophageal sphincter (LES) pressure at rest or esophageal contractile
amplitude and duration when swallowing but caused more relaxation
of the LES (after 90, 150, and 180 minutes, when swallowing) and
decreased the esophageal contraction velocity, which may produce the
expulsion of gastric gas or have an antiflatulent effect.28 Ginger has
also been shown to inhibit serotonin-induced diarrhea and exert anti-
emetic effects in experimental models.29,30
Via inhibition of prostaglandin production, ginger also prevents
the slow-wave dysrhythmias produced by acute gastrointestinal
hyperglycemia.31
967
Ginger accelerates gastric emptying and stimulates antral contrac-
tions in healthy volunteers.32 Oral ginger extract was also shown to
improve gastroduodenal motility in the fasting state and after a stan-
dard test meal in healthy human volunteers.33 
Antiulcer Effects
Ginger has demonstrated significant antiulcer effects in a variety of
animal models.34–36 Ginger prevents ulcer formation from ethanol,
indomethacin, aspirin, and other common ulcerogenic compounds.
The pungent principles appear to be responsible for this effect. In one
models, but dry ginger had no such effect.37
A methanol extract of the dried powdered ginger rhizome, fractions
of the extract, and the isolated constituents gingerol and shogaol were
tested against 19 strains of Helicobacter pylori—a bacterium associated
with peptic ulcers and gastric cancer. The methanol extract of ginger
rhizome inhibited the growth of all 19 strains in vitro, with a minimum
inhibitory concentration range of 6.25 to 50 mg/mL. One fraction of
the crude extract, containing the gingerols, was active and inhibited the
of 0.78 to 12.5 μg/mL.38 
Thermogenic Properties
Ginger is noted for its ability to subjectively warm the body and has
historically been used as a diaphoretic. In animal studies, ginger has
been shown to help maintain body temperature and to inhibit sero-
tonin-induced hypothermia.29,39
Crude extracts and the pungent components of ginger have been
shown to increase oxygen consumption, perfusion pressure, and lac-
tate production in the perfused rat hind limb.40 These effects signify
increased thermogenesis. Gingerol is the most potent thermogenic
component of ginger. A human study demonstrated that consuming
a ginger sauce (containing unspecified amounts of ginger principles)
there were two problems with this study: (1) the concentration of gin-
gerol in the preparation used was probably low or zero, and (2) the
effective concentration range of gingerol for its thermogenic effects is
quite narrow.
Given ginger’s historical use as a “warming” substance, these scien-
mogenic aid, although confirmation in humans is still lacking. 
Antibiotic Activity
Ginger, shogaol, and zingerone have been shown to be strongly inhib-
itory against Salmonella typhi, Vibrio cholerae, and Trichophyton viola-
ceum, whereas aqueous extracts at 2.5%, 5%, and 25% concentrations
have been shown to be effective against Trichomonas vaginalis.42
Ginger and its pungent principles were also demonstrated to possess
significant antifungal activity against pathogenic yeast.43 
Anticancer Effects
Ginger extracts and some pungent constituents present in ginger have
exhibited antitumor activity in experimental models of carcinogene-
sis.44 In 2018 a comprehensive review examined the literature pertain-
ing to the use of ginger extract and [6]-gingerol against tumorigenic
and oxidative and inflammatory processes associated with cancer, along
with the underlying mechanisms of action involved in signaling path-
ways.45 Data collected from in vitro or in vivo experiments and clinical
studies indicate that ginger extract and [6]-gingerol exert their action
through important mediators and pathways of cell signaling, includ-
ing Bax/Bcl2, p38/MAPK, Nrf2, p65/nuclear factor (NF)-κB, tumor
necrosis factor-α (TNF)-α, ERK ½, SAPK/JNK, ROS/NF-κB/­COX-2,
968 SECTION 4  Pharmacology of Natural Medicines
caspase-3 and caspase-9, and p53. This suggests that ginger derivatives
(extract or isolated compounds) exhibit relevant antiproliferative,
antitumor, invasive, and anti-inflammatory activities.  including the digestive, hepatobiliary, and cardiovascular systems.
Effects on Insulin and Blood Glucose
Patients with type 2 diabetes mellitus (T2DM) or metabolic syn-
drome (MetS) share common characteristics of raised blood sugar,
decreased insulin sensitivity, obesity, dyslipidemia, and hypertension,
which often appear simultaneously rather than alone. Ginger has been
documented to ameliorate hyperlipidemia, hyperglycemia, oxidative
stress, and inflammation and may therefore be a promising therapy
for T2DM and MetS mediated by transcription factors, such as peroxi-
some proliferator-activated receptors, adenosine monophosphate-ac-
tivated protein kinase, and NF-κB.46 Additional proposed mechanisms
of ginger include the inhibition of hepatic phosphorylase preventing
glycogenolysis in hepatic cells, inhibition of hepatic glucose-6-phos-
phatase activity, and increasing glucose transporter type 4 (GLUT-4)
to promote glucose uptake in adipocytes and skeletal muscle cells.
A thorough review and meta-analysis of randomized controlled
trials revealed that ginger significantly reduces fasting blood glucose
and HbA1c, significantly improves fasting insulin and Homeostatic
Model Assessment of Insulin Resistance (HOMA-IR), and ameliorates
most of the MetS risk factors.47 As an example, one randomized, dou-
ble-blind, placebo-controlled trial of 88 patients with T2DM investi-
gated the effect of ginger supplementation on insulin resistance and
glycemic indices.48 The cohort was randomly assigned to ginger or pla-
cebo groups. The ginger group consumed three 1-g capsules contain-
ing ginger powder daily, whereas the placebo group received capsules
of the same color and number but containing cellulose microcrystal-
line. After 8 weeks, fasting blood sugar mean showed a decrease of
10.5% in the ginger group, whereas the mean had an increase of 21%
in the placebo group. Variations in HbA1c mean correlated with that
of fasting blood sugar. A statistical difference was also found before
and after the intervention in the median of fasting insulin level, insulin
sensitivity, and HOMA-IR.
Two additional randomized, double-blind, placebo-controlled tri-
als evaluated the effects of ginger on glycemic indices in patients with
T2DM. The first study involved 64 patients with T2DM randomly
assigned to either ginger (2 g/day) or placebo (2 g/day) groups.49 After
2 months of intervention, ginger supplementation significantly low-
ered the levels of insulin, low-density lipoprotein (LDL) cholesterol,
triglycerides, and the HOMA-IR. However, no significant changes
were observed in fasting blood glucose, total cholesterol, high-density
lipoprotein (HDL), and HbA1c. In the second study, 20- to 60-year-old
patients with T2DM who did not receive insulin were given 3 g of pow-
dered ginger (intervention group) or 3 g of lactose (placebo group)
daily for 3 months.50 In addition to glycemic indices, the researchers
also examined the effects of ginger on total antioxidant capacity (TAC),
malondialdehyde (MDA), C-reactive protein (CRP), and serum para-
oxonase (PON-1). At the end of the study, compared with placebo, the
intervention (ginger) group had statistically significant reductions in
serum glucose, HbA1c percentage, insulin, insulin resistance, high-sen-
sitive CRP, and MDA as well as statistically increased TAC and PON-1
activity. Although promising, further high-quality studies with larger
sample sizes and longer duration of treatment are needed to examine
these findings and evaluate discrepancies.  pressin release induced by circular vection.
CLINICAL APPLICATIONS
Ginger is widely used as a condiment for its unique flavors, but from
the previously described pharmacology, it obviously has important
medicinal effects as well. In general, like many other culinary herbs and
spices, such as garlic and onions, ginger provides many health-promot-
ing effects. Specifically, ginger provides benefit to many body systems,
Historically, the majority of complaints for which ginger was used
concerned the gastrointestinal system. A clue to ginger’s efficacy in
alleviating gastrointestinal distress is offered in several double-blind
studies on motion sickness, hyperemesis gravidum, and postoperative
nausea and vomiting. Human studies have also shown a positive effect
in arthritis and migraine headaches.
Motion Sickness
Ginger was first shown to be effective in treating motion sickness by
Mowrey and Clayson in 1982.51 In their study, ginger (940 mg) was
shown to be far superior to dimenhydrinate (Dramamine) 100 mg in
relieving symptoms of nausea and vomiting. Since this initial study,
several better-designed follow-up studies have evaluated the effective-
ness of ginger as a motion sickness medication.
The appearance of motion sickness trials using ginger prompted
an interest in ginger by the National Aeronautics and Space
Administration, which subsequently funded a study at Louisiana State
University. This study compared ginger, both fresh and dried pow-
dered, with scopolamine by measuring the number of head move-
ments experimental subjects could make in a rotating chair until they
reached an end point defined as motion sickness short of vomiting.
Ginger was not shown to produce any protection against motion sick-
ness in this model or in two additional protocols (vestibular stimula-
tion only and combined vestibular-visual stimulation).52 However, in
a double-blind trial, perhaps a more “real-life” test, ginger (1 g) given
to naval cadets unaccustomed to sailing in heavy seas was shown to
reduce the tendency toward vomiting and cold sweating in comparison
with a placebo.53
Mowrey and Clayson51 proposed that the anti–motion sickness
effects of ginger were due to local gastrointestinal tract effects rather
than to central nervous system effects. Although ginger’s mechanism
of action in alleviating gastrointestinal distress has yet to be fully elu-
cidated, there is evidence to support this hypothesis. Ginger has been
shown to partially inhibit the excessive gastric motility characteristic of
motion sickness.52 To further support a gastric versus a central nervous
system mechanism of action, one study clearly demonstrated that nei-
ther the vestibular system nor the oculomotor system, both of which
are critical in the occurrence of motion sickness, was influenced by
ginger (1 g).54 However, in a double-blind, crossover, placebo-con-
trolled study, ginger (1 g) was shown to significantly reduce induced
vertigo but not nystagmus.55
It has been hypothesized by others that ginger ameliorates the nau-
sea associated with motion sickness by preventing the development of
gastric dysrhythmias and the elevation of plasma vasopressin. To test
this hypothesis, 13 volunteers with a history of motion sickness under-
went circular vection, during which nausea (scored 0–3, i.e., none to
severe), electrogastrographic recordings, and plasma vasopressin lev-
els were assessed with or without ginger pretreatment in a crossover,
double-blind, randomized, placebo-controlled study.56 Circular vec-
tion induced a maximal nausea score of 2.5 and increased tachygastric
activity and plasma vasopressin. Pretreatment with ginger (1000 and
2000 mg) effectively reduced nausea, tachygastric activity, and vaso-
The overall effectiveness of ginger in motion sickness has yet to be
definitively determined. Issues that the studies have raised include the
variability in the quality of commercial ginger preparations and the
time required for ginger to produce its effects. Commercial prepara-
tions vary widely in chemical composition and often contain adul-
terants, and in the ginger study conducted at sea, ginger reduced
 CHAPTER 130  Zingiber officinale (Ginger)
symptoms of cold sweating and vomiting only at the end of 4 hours.
In other words, it appears that ginger may prove to be more effec-
tive when well-defined preparations are given at least 4 hours before
motion is experienced.  the use of ginger for nausea and vomiting in pregnancy. This recom-
Nausea and Vomiting
The mechanisms of action underlying ginger’s efficiency in reduc-
ing nausea and vomiting have been investigated, and dual antiemetic
actions have been highlighted: (1) gingerols and shogaols act as antag-
onists of cholinergic M3 and serotonin 5-HT3 receptors of the cen-
tral nervous system; and (2) ginger’s constituents improve the gastric
tonus, motility, and emptying due to peripheral anticholinergic and
antiserotonergic actions.57 Ginger’s antiemetic action has been studied
in hyperemesis gravidum, the most severe form of pregnancy-related
nausea and vomiting. This condition usually requires hospitalization.
In a double-blind, randomized, crossover trial, ginger root powder at a
dose of 250 mg four times a day brought about a significant reduction
in both the severity of the nausea and the number of attacks of vomit-
ing in 19 of 27 patients in the early stages of pregnancy (<20 weeks).58
Another natural approach to nausea and vomiting of pregnancy is
vitamin B6. In one double-blind study, 138 women were given either
500 mg of ginger or 10 mg of vitamin B6 three times daily for 3 days.59
Subjects graded the severity of their nausea using visual analog scales
before treatment and recorded the number of vomiting episodes in the
previous 24 hours and again during 3 consecutive days of treatment.
The ginger and vitamin B6 significantly reduced the nausea scores from
5 to 3.6 and 5.3 to 3.3, respectively, and the number of vomiting epi-
sodes from 1.9 to 1.2 and 1.7 to 1.2, respectively. There was no signif-
icant difference between ginger and vitamin B6 for the treatment of
nausea and vomiting during pregnancy. However, in another study,
ginger was shown to be more effective.60 In that study, 70 women
were randomized to receive either ginger 1 g/day or vitamin B6 40
mg/day for 4 days. Subjects graded the severity of their nausea using
a visual analog scale and recorded the number of vomiting episodes
in the 24 hours before treatment and during 4 consecutive days while
taking treatment. Compared with baseline, the decrease in scores of
posttherapy nausea in the ginger group was significantly greater than
that for the vitamin B6 group. In the ginger group, 29 of 35 women
reported an improvement in nausea symptoms compared with 23 of
34 women in the vitamin B6 group. These results indicate that ginger is
more effective than vitamin B6 for relieving the severity of nausea and
is equally effective for decreasing the number of vomiting episodes in
early pregnancy.
In a placebo-controlled study, 70 women with nausea and vomiting
of pregnancy were randomly assigned to receive either oral ginger 1 g/
day or an identical placebo for 4 days.61 Subjects graded the severity
of their nausea using visual analog scales and recorded the number of
vomiting episodes in the 24 hours before treatment and again during 4
consecutive days during treatment. At a follow-up visit 7 days later, the
number of vomiting episodes had decreased significantly in the ginger
group; 28 of 32 in the ginger group had an improvement in nausea
symptoms, compared with 10 of 35 in the placebo group.
In a double-blind study comparing ginger with dimenhydrinate, 170
pregnant women with the symptoms of nausea and vomiting in preg-
nancy were randomly allocated to take one capsule of ginger twice daily
(one capsule contained 0.5 g of ginger powder), whereas the patients in
group B received an identical capsule of 50 mg dimenhydrinate twice
daily.62 The results showed that ginger is as effective as dimenhydrinate
in the treatment of nausea and vomiting during pregnancy and has fewer
side effects. Specifically, there was a statistically significant difference in
the side effect of drowsiness after treatment in diphenhydramine group
compared with the ginger group (78% vs. 6%, respectively).
969
These clinical results and those reported by others,63–67 along with
the safety and the relatively small dose of ginger required and the prob-
lems (e.g., teratogenicity) with antiemetic drugs in pregnancy, support
mendation is becoming a well-accepted prescription even in orthodox
obstetrical practices.
Ginger appears to be very safe for use during pregnancy. A sys-
tematic review evaluating the efficacy and safety of ginger for nausea
and vomiting of pregnancy did not identify any major toxicities from
in vivo studies, and after observations of clinical studies, the use of
ginger showed a significant decrease in nausea and vomiting and no
risk for the mother or her future baby.68
The antiemetic action of ginger has also been observed in women
who had undergone major gynecological surgery. In four double-blind
studies, 1000 to 1500 mg of dried powdered ginger root per day was
shown to significantly reduce the incidence of nausea compared with
placebo in a manner similar to the drug metoclopramide.69–72
Ginger also has shown good results in alleviating chemotherapy-in-
duced nausea and vomiting. In one study, 60 chemotherapy cycles of
cisplatin/doxorubicin in patients with bone sarcoma were randomized
to ginger root powder capsules or placebo capsules as an additional
antiemetic to ondansetron and dexamethasone in a double-blind
design.73 Acute moderate to severe nausea was observed in 28 of 30
(93.3%) cycles in the control group compared with 15 of 27 (55.6%)
cycles in the ginger group. In a study in women receiving cisplatin for
gynecological cancers, the addition of ginger to a standard antiemetic
regimen had no advantage in reducing nausea or vomiting in the acute
phase of cisplatin-induced emesis.74 However, after the initial 24 hours
after cisplatin, ginger was shown to be equal to metoclopramide. In
still another study, ginger provided no additional benefit in reducing
the prevalence or severity of acute or delayed chemotherapy-induced
nausea and vomiting when given with 5-HT3 receptor antagonists
and/or aprepitant (Emend).75 
Inflammatory Conditions
Ginger’s ability to inhibit the formation of inflammatory prosta-
glandins, thromboxanes, and leukotrienes and its strong antioxidant
activities and protease component suggest a possible benefit in inflam-
matory conditions. To test this hypothesis, a preliminary clinical study
was conducted in seven patients with rheumatoid arthritis, in whom
conventional drugs had provided only temporary or partial relief.76
One patient took 50 g/day of lightly cooked ginger, and the other
six took either 5 g of fresh or 0.1 to 1 g of powdered ginger daily. All
patients reported substantial improvement, including relief of pain,
greater joint mobility, and decreased swelling and morning stiffness.
In the follow-up to this study, 28 patients with rheumatoid arthritis,
18 with osteoarthritis, and 10 with muscular discomfort who had been
taking powdered ginger for periods ranging from 3 months to 2.5 years
were evaluated. On the basis of their clinical observations, Srivastava
and Mustafa77 reported that 75% of the patients with arthritis and
100% of the patients with muscular discomfort experienced relief in
pain or swelling. The recommended dosage was 500 to 1000 mg/day,
but many patients took three to four times this amount. Patients taking
the higher dosages also reported quicker and better relief.
Three double-blind studies with standardized and highly concen-
trated extracts of ginger provide additional support for the usefulness of
ginger in osteoarthritis, although in one study ginger was effective only
after 3 months of use.78–80 In the largest of the three studies, 261 patients
with osteoarthritis of the knee were given either ginger extract or placebo
twice daily, with acetaminophen allowed as rescue medication.79 The
primary efficacy variable was the proportion of responders experiencing
a reduction in “knee pain on standing,” with the use of an intent-to-treat
970 SECTION 4  Pharmacology of Natural Medicines
analysis. The percentage of responders experiencing a reduction in knee
pain on standing was superior in the ginger extract group to that in the
control group (63% vs. 50%). Analysis of the secondary efficacy variables
revealed a consistently greater response in the ginger extract group com-
pared with the control group in the following mean values: reduction in
knee pain on standing (24.5 vs. 16.4 mm), reduction in knee pain after
walking 50 ft (15.1 vs. 8.7 mm), and reduction in the Western Ontario
and McMaster Universities’ Osteoarthritis Composite Index (12.9 vs. 9
mm). Change in global status and reduction in intake of rescue medica-
tion were also numerically greater in the ginger extract group.
The effect of ginger on proinflammatory cytokines in patients with
osteoarthritis was examined in a randomized, double-blind, placebo-
controlled, 3-month clinical trial.81 120 participants were assigned to
one of two groups: the ginger group (500 mg ginger powder) or the
placebo group (500 mg starch). Although proinflammatory cytokine
levels did not differ by group at baseline, at the end of the trial, serum
levels of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β)
decreased in the ginger group relative to placebo.
One evaluation looking at ginger’s ability to reduce muscle pain
consisted of two identical double-blind, placebo-controlled random-
ized studies with participants consuming either 2 g of raw (study 1) or
heated (study 2) ginger or placebo for 11 consecutive days.82 Participants
performed 18 eccentric actions of the elbow flexors to induce pain and
inflammation. Pain intensity, perceived effort, plasma prostaglandin
E(2), arm volume, range of motion, and isometric strength were assessed
before and for 3 days after exercise. Raw and heat-treated ginger resulted
in similar pain reductions 24 hours after eccentric exercise compared
with placebo (25% and 23% reduction, respectively). In another study,
a single 2-g dose of ginger did not attenuate eccentric exercise-induced
muscle pain, inflammation, or dysfunction 45 minutes after ingestion,
indicating that ginger’s effects are likely more cumulative in reducing the
day-to-day progression of muscle pain.83
It has also been reported that ginger is beneficial in migraine head-
ache.84 A double-blind, placebo-controlled, randomized clinical trial
evaluated the potential of ginger to improve acute migraine as an add-on
strategy to standard treatment.85 Sixty participants were randomized
into two groups in which they received 400 mg of ginger extract (5%
active ingredient) or placebo (cellulose), in addition to an intravenous
drug (100 mg of ketoprofen) to treat the migraine attack. Patients
treated with ginger showed a significantly better clinical response after 1
hour, 1.5 hours, and 2 hours. Furthermore, ginger treatment promoted
a reduction in pain and improvement in functional status at all times
assessed. Given ginger’s effects on platelets, eicosanoids, and serotonin
inhibition, this recommendation makes sense.  istration had no such effect in 12 healthy male subjects who received
DOSAGE
Many questions remain concerning the best form of ginger and the
proper dosage. Most research studies have used 1 g of dried powdered
ginger root. Practically speaking, this is a small dose. For example,
ginger is commonly consumed in India at a daily dose of 8 to 10 g.
Furthermore, although most studies have used powdered ginger root,
fresh (or possibly freeze-dried) ginger root or extracts (concentrated
for gingerol) at an equivalent dosage may yield even better results
because they may deliver higher levels of gingerol as well as the active
protease.
In the treatment of nausea and vomiting due to motion sickness
or pregnancy or after surgery, a dosage of 1 to 2 g of dried powdered
ginger may be effective. This would be equivalent to approximately 10 g
or 1/3 oz of fresh ginger root, roughly a ¼-in. slice. For inflammatory
conditions like rheumatoid arthritis, the dosage should be double this
amount.
For ginger extracts standardized to contain 20% gingerol and
shogaol, an equivalent dosage in treating motion sickness or nausea
and vomiting would be 100 to 200 mg. For other applications, the dos-
age is 100 to 200 mg three times daily. 
TOXICOLOGY
Ginger does not appear to produce any toxicity problems when used
at normal dosages. Although ginger extracts and several components
in ginger have been shown to possess potent mutagenic activity, gin-
ger also contains several equally potent antimutagenic substances.86,87
The significance of this mutagenicity (the study was conducted in
Escherichia coli and did not use the Ames test) has not been entirely
determined, but the long history of ginger’s use and the lack of carcino-
genic or toxic effect in animals suggest that toxicity is not a problem.
In acute toxicity tests in mice, ginger extract administered as a
lavage was tolerated up to 2.5 g/kg with no mortality or side effects
during a 7-day trial period.88 Increasing the dosage to 3 to 3.5 g/kg
resulted in a 10% to 30% mortality rate. In comparison, 0.6 g/kg of
aspirin produced mortality in 25%, stomach ulcers in 40%, and hypo-
thermia in 60% of subjects.
Some individuals consuming high doses—more than the equiv-
alent of 6 g of dried powdered ginger—alone on an empty stomach
may experience some gastrointestinal discomfort. Administration of
6 g of dried powdered ginger has been shown to increase the exfolia-
tion of gastric surface epithelial cells in human subjects.89 This effect
may cause some gastric distress and ultimately could lead to ulcer for-
mation. Therefore it is recommended that dosages consumed on an
empty stomach be less than 6 g. 
DRUG INTERACTIONS
Ginger may potentiate antiplatelet therapy.90 However, ginger admin-
coumadin alone or with ginger. No changes in platelet aggregation, the
international normalized ratio of prothrombin time, warfarin enantio-
mer protein binding, warfarin enantiomer concentrations in plasma,
or S-7-hydroxywarfarin concentration in urine were seen.91
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