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A review on chinese herbal medicine used as carminative

Amitava Kabiraj , Rohitas Deshmukh

PII: S2667-1425(24)00052-6
DOI: https://doi.org/10.1016/j.prmcm.2024.100409
Reference: PRMCM 100409

To appear in: Pharmacological Research - Modern Chinese Medicine

Received date: 31 December 2023

Revised date: 28 February 2024
Accepted date: 1 March 2024

Please cite this article as: Amitava Kabiraj , Rohitas Deshmukh , A review on chinese herbal
medicine used as carminative, Pharmacological Research - Modern Chinese Medicine (2024), doi:
https://doi.org/10.1016/j.prmcm.2024.100409

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A review on chinese herbal medicine used as carminative

Amitava Kabiraj, Rohitas Deshmukh*

Department of Pharmaceutical Research, GLA University, Mathura, U.P., India

Running Title: “Chinese herbal medicine as carminative”

E-mail address of all authors:

1. Amitava Kabiraj: amitava.kabiraj_phd.pha21@gla.ac.in
2. Rohitas Deshmukh: rahi18rahi@gmail.com

*Corresponding Author
Rohitas Deshmukh
Associate Professor
Institute of Pharmaceutical Research,
GLA University, Mathura, U.P., India
Ph. +91-7724847691
Email- rahi18rah@gmail.com
Abstract
Introduction: The World Health Organization (WHO) recognizes traditional medicine's diverse
practices, including herbal remedies, as a significant component of global healthcare. Traditional
Chinese Medicine (TCM), originating over 3,000 years ago, incorporates herbal medicine,
acupuncture, and other techniques. The term "carminative" is derived from the Latin word
"carminare," meaning to cleanse. Carminatives can reduce lower esophageal pressure, thereby
potentially increasing the susceptibility to gastroesophageal reflux disease or heartburn.

Methods: The online databases including Scopus, PubMed, Web of Science, and Google Scholar
were searched using different via keywords: Carminatives, Chinese herb, and Herbal. The objective
of this review was to provide a concise summary of the herbal ingredients that have been previously
documented for their gastro-stimulating properties in carminative products.

Results: Medicinal plants are widely recognized as a crucial and valuable resource for the
development of pharmaceutical products. These herbal products possess carminative properties and
offer additional health benefits in a wide range of therapeutic uses of carminative like as Anti-
microbial, Diuretic, Irritable bowel syndrome, etc.

Discussion: With the increasing global interest in natural medicines, there is a potential for higher
demand for TCM as carminatives. Novel formulations with a blend of TCM can be created to
improve their effectiveness and convenience. This review can provide chances for more research and
increase understanding of TCM for usage as a carminative.

Conclusion: In conclusion traditional Chinese Medicine (TCM) incorporates herbal remedies, like
those with carminative properties, to address gastrointestinal discomfort and promote overall well-
being. TCM's global popularity reflects its effectiveness in integrating herbal medicine, acupuncture,
and other techniques. The use of carminatives in TCM aligns with their historical role in relieving
digestive issues and promoting balance in bodily humors.

Keywords: Carminatives, Chinese herb, Herbal, Traditional Chinese medicine

1. Introduction
For a long time, medicinal plants have been an important part of treating diseases. Early man
explored his near natural surroundings in search of ways to stay healthy and live longer, as well as
ways to ease pain and discomfort. This led to the use of many plants, animal products, minerals, and
other things, and the creation of a wide range of medicinal agents. People's interest in traditional
medicine has changed recently, which has led to more demand for the drug made from plants. A lot
of people think that "green medicine" is safer and cheaper than manufactured drugs, which can have
dangerous side effects [1]. This is the main reason for the renewed interest in plant drugs.

According to the World Health Organization (WHO), traditional medicine encompasses a wide range
of health practices, approaches, knowledge, and beliefs. These practices involve manual techniques,
spiritual therapies, exercises, and the use of medicines derived from animals, plants, or minerals.
They can be utilized individually or in combination to enhance well-being, as well as to address and
prevent diseases [2]. In October 1998, the National Institutes of Health (NIH) of the United States
developed the National Center for Complementary and Alternative Medicine. As part of this
initiative, conventional medicine was reclassified as complementary and alternative medicine.
According to the WHO, the current reliance on herbal medicine for primary health care exceeds 80
percent of the global population [3,4].

Chinese people have been practicing medicine for thousands of years, and their expertise and
wisdom have been combined to create traditional Chinese medicine or TCM. Shen Nong Shi
searched for hundreds of therapeutic herbs some 5000 years ago. The formal history of TCM's
inception is represented by the publication of Yellow Emperor's Inner Classic, the first written work
of TCM, during the Western Han dynasty. The four most significant ideas among the fundamental
theories of TCM are qi, yin/yang theory, meridian, and the five elements [5,6].

China has an abundance of plants, currently, about 13,000 herbal preparations are used, listed in the
Chinese Materia Medica (CMM), and accessible in China. The Chinese Pharmacopeia officially
recognizes and provides a detailed description of these preparations, which include commonly used
herbs, regional variations, and folk medicine variants. The numerous active chemicals in medicinal
herbs can affect multiple targets or pathways due to their multi-component nature, which enables
them to exert a more robust therapeutic effect than single components. China has thousands of
medicinal plants that yield a wide variety of compounds having medicinal properties, therefore this
treasure has aided in the creation of several chemically defined drugs like ephedrine and artemisinin
[7,8].

In Traditional Chinese Medicine (TCM), carminative properties play a significant role in addressing
digestive issues and promoting overall well-being. The term "carminative" is derived from the Latin
word "carminare," which means to cleanse. Carminatives are food substances that, when consumed,
create a sensation of warmth in the intestines and are believed to alleviate symptoms of bloating after
eating by promoting burping and passing gas [9,10]. The drugs used to relieve pain in the stomach
and intestine are Known as carminative. Carminatives have anti-flatulent properties. An anti-
flatulent, also known as a de-flatulent agent, is a pharmaceutical substance used to alleviate or
prevent the occurrence of excessive intestinal gas and flatulence. The most frequently utilized herbal
medicines recognized for their carminative properties include spearmint/peppermint oils, garlic, and
onion. The carminatives are prescribed in indigestion, gastric discomfort and loss of appetite.
Carminatives were historically thought to aid in the removal of excessive bodily humours.
Carminatives refer to food substances that, upon consumption, generate a sensation of warmth in the
intestines. These substances are believed to alleviate symptoms of bloating after meals by inducing
eructation (burping) and flatulence [9,10]. A contemporary and accurate definition of these
substances is that they alleviate sensations of discomfort and distension within the gastrointestinal
tract. Carminatives are one of the final drugs mentioned by Pliney and Hippocrates that have
continued to be included in the British Pharmacopoeia. When consuming a carminative, individuals
typically experience an initial sensation of a pleasant and occasionally invigorating flavor, which
subsequently leads to an increase in salivation. This is then followed by a sensation of internal
warmth. Eructation often manifests a few minutes subsequent to the initial event. In the event of
administration in large quantities, it is possible to experience gastro-intestinal irritation, which may
manifest as abdominal pain, vomiting, and diarrhoea. Fig. 1. represent the causes and symptoms of
carminatives herbals and Table 1 show the chemical structures of typical compounds from herbal
medicines to treat gastrointestinal disorder.

TCM herbal formulations often incorporate carminative herbs to harmonize the flow of Qi (vital
energy) and balance the digestive system. Common carminative herbs in Chinese medicine include
fennel, ginger, cardamom, and mint. These herbs are believed to have a warming effect that helps
dispel cold and dampness in the digestive organs, promoting proper digestion and absorption of
nutrients. TCM views digestive harmony as essential for overall health, as imbalances in the
digestive system can affect the flow of Qi and contribute to various health issues. By incorporating
carminative herbs, TCM seeks to restore balance, alleviate discomfort, and support the body's natural
processes, aligning with the holistic approach that characterizes traditional Chinese healing practices.
Individuals interested in utilizing carminative properties within the context of TCM should consult
with qualified practitioners to ensure a personalized and effective approach to their specific health
concerns.

Fig. 1. Causes and Symptoms of Gas Trouble.

 Table 1: List of the chemical structures of typical compounds from herbal medicines to treat gastrointestinal disorder.

Common Pharmacological
S. No. Active Constituent Chemical Structure References
Name Effect
CH3

Carminative, and
relief of
1. Anise trans-anethole [11]
gastrointestinal
spasms
H3C O
O OH
Upset stomach,
flatulence (gas),
2. Chamomile Apigenin ulcers, and [12]
O OH
Gastrointestinal
HO irritation

Gastric ulcers, [13]

3. Cinnamon Cinnamaldehyde
diarrhoea

O
H3C

Carminative effect,
OH
reduces intestinal
cramping, and
4. Ginger Gingerol [14–16]
O
prevents dyspepsia,
flatulence, and
bloating
HO O
H3C
 CH3

Anti spasmodic,
5. Fennel trans-anethole Antibacterial, [17]
Carminative, Diuretic

H3C O
O OH
O HO OH
H3C
H3C
O O OH
Bronchitis, Gastritis,
6. Liquorice Glycyrrhizin O
[18]
H3C H3C
CH3
CH3 O OH O and jaundice.
CH3 HO
HO OH
O
OH OH O
HO OH
OH
Dyspepsia,
7. Rikkunshito Hesperidin HO O
O O O
OH
Gastroesophageal [19]
O reflux disease
HO O
CH3 CH3
2. Methods
Online databases such as Scopus, Web of Science, Google Scholar, and PubMed were used for the
searches. This review provides comprehensive information on carminative, including investigations
and reviews conducted between 1920 and 2023. A comprehensive analysis was conducted on a total
of 180 reviews and research papers, out of which 81 were referenced. Hence, the objective of this
study was to provide a comprehensive summary of the phytoconstituents, pharmacological action of
the selected chinese medicine.

3. Mechanisms of action of Carminative herbs

The primary mechanism by which carminative herbs exert their effects is mostly attributed to the
presence of volatile oils inside them. These substances promote the process of gastric emptying and
have a little irritating effect on the lining of the stomach, which stimulates peristalsis and leads to
enhanced gastric emptying. This helps alleviate cramping and facilitates the expulsion of gas. Fig. 2
Illustrate the mechanisms of action of carminatives and Fig. 3. Shows schematic of molecular
antispasmodic mechanism of essential oil.

Fig. 2. Mechanisms of action of carminative herbs.

 Essential Essential
oil oil
Ca+2

+
VDDC KC GPCR

Gq/Gi

Adenylyl cyclase
+

Essential
Ca+2 Calmodulin PLC +

oil
cAMP

MLCK

Relaxation Contraction

cAMP + MLCP

NO

Fig. 3. Schematic of molecular antispasmodic mechanism of essential oil. The essential oil
suppressed the activity of voltage-dependent calcium ion channels and regulated the potassium ion
channels and intracellular cyclic adenosine monophosphate. Ca+2 refers to calcium ions, VDCC
stands for voltage dependent calcium channel, cGMP stands for cyclic guanosine monophosphate,
GPCR stands for G protein-coupled receptor, PLC stands for phospholipase, cAMP stands for cyclic
adenosine monophosphate, MLCK stands for myosin light chain kinase, and MLCP is for myosin
light chain phosphatase, NO stands for Nitric oxide.

4. Herbal therapies for Carminatives

Herbal therapies for carminatives involve the use of specific plants and their derivatives to alleviate
symptoms associated with flatulence, bloating, and abdominal discomfort. Carminative herbs are
chosen for their ability to promote the expulsion of gas from the gastrointestinal tract and provide
relief from digestive issues. Fig. 4. represent some examples herbal therapies commonly used for
carminative purposes and Herbal intervention used in the treatment of Carminative in Table 2.
  Carminative
 Antiseptic
 Astringent

Function
Cinnamon
 Digestive Function Function  Stomachic
 Stomachic properties Cardamon Coriander  Spasmolytic
 Anti-spasmodic  Carminative

 Antispasmodic Function Function  Flatulence reliever

 Carminative Carminatives
 Expectorant
Asafoetida Cloves  Antispasmodic
Herbs  Easing bloating
 Laxative

 Carminative Function Function  Gastric stimulant

 Astringent Nutmeg Fenugreek  Carminative
 Aphrodisiac  Laxative

Ginger
Function

 Dyspepsia
 Carminative
 Diaphoretic

Fig. 4. Some examples carminatives herbs and their function.

4.1 Anise
Pimpinella anisum, a member of the Umbelliferae family, is a fragrant plant that has been used in
traditional medicine, particularly for its fruits. Anise (Pimpinella anisum) is another herb that is
commonly used as a carminative, similar to fennel. It contains compounds such as anethole, which is
believed to contribute to its digestive and carminative properties. The pharmacological action of
anise is muscle-relaxing effects on the gastrointestinal tract, which can help alleviate gas and
bloating [11].

4.2 Asafoetida
An herbaceous plant in the umbelliferae family is called Ferula asafoetida. The plant's rhizome and
root are the source of this oleo gum resin. The primary active ingredients of the Asafetida plant are
gum (25%) and essential oils (10–17%), followed by resins (40–64%). The pharmacological action
of gum resin has sedative, carminative, expectorant, laxative, and antispasmodic properties [20].

4.3 Banxia Xiexin decoction

Banxia Xiexin decoction (BXD) is a traditional Chinese medicine (TCM) formula that has been
widely recognized in the field. The Banxia Xiexin decoction (BXD) is extensively utilized for the
management of various conditions, including acute and chronic gastritis, peptic ulcer, dyspepsia,
carminative gastrointestinal dysfunction, and other related ailments [21].

4.4 Black Peeper

Piper nigrum, belonging to the Piperaceae family, is a plant of significant medicinal value.
Numerous investigators have successfully isolated various types of compounds, including phenolics,
flavonoids, neolignans, alkaloids, amides, steroids, xterpenes, neolignans, chalcones etc. According
to traditional Chinese medicine, black pepper has a strong, hot taste. It is recommended for the
meridians of the large intestine and stomach. The compound exhibits a range of pharmacological
activities, including antitumor, antipyretic, anticonvulsant, antithyroid, larvicidal, antihypertensive,
anti-inflammatory, antidiabetic, antidiarrheal, bioavailability enhancement, immunomodulatory,
antiepileptic, antifertility, GI stimulant, and lipid metabolism acceleration properties [22].
4.5 Cardamom
Cardamom (Zingiberaceae) is a commonly utilized spice that is also employed as a flavoring agent.
The plant family consists of two genera known as Elettaria and AmomumThe green variety of
cardamom is commonly referred to as "elaichi" in Marathi Urdu, and Hindi languages in the South
Asian region. In Traditional Chinese Medicine, black or brown cardamom is more commonly used
medicinally. In Ayurveda, it is widely recognized for its carminative properties, diuretic effects,
ability to relieve coughs, alleviate cold symptoms, and stimulate cardiac function. Traditionally, it
has been utilized for the treatment of kidney and urinary disorders, as well as for its gastrointestinal
protective properties [23].

4.6 Cinnamon
Cinnamon is a broadly used spice in culinary applications. C. zeylanicum or Cinnamomum verum is
primarily found in Nepal, India, Sri Lanka, and Bangladesh [24]. In terms of Traditional Chinese
Medicine (TCM) Coriander Leaf (Cilantro) is known for its ability to regulate qi and blood
circulation. The cinnamon is recognized for its antipyretic properties, which help to reduce body
temperature. It also possesses diaphoretic, antiseptic, astringent, anti-inflammatory, stimulant,
carminative, fungicidal, and stomachic properties [25].

4.7 Coriander
Coriandrum sativum (C. sativum), a belongs of the Apiaceae (Umbelliferae) family, is well known
for its culinary and traditional medical applications. Coriandrum sativum includes a diverse range of
phytochemicals, such as polyphenols, phytosterols and vitamins [26]. The coriander is used as
medical application such as aromatic, carminative stimulant, controls spasmodic pain.

4.8 Cloves
The botanical name for the clove is Syzygium aromaticum, also known as Eugenia aromaticum or
Eugenia caryophyllata. It is highly regarded and esteemed as a valuable spice worldwide. The
utilized portion consists primarily of the dried aromatic flower buds from a tree belonging to the
Myrtaceae family. The flower buds of cloves are primarily sourced from Indonesia and are widely
utilized as a culinary spice across the world [27]. The name is derived from the French word "clou,"
which means "nail." This is because the buds of the plant bear a resemblance to small, irregularly
shaped nails [28]. In traditional Chinese and Indian medicine, cloves are used as a warming and
stimulating agent. Cloves have been reported to possess various properties, including carminative,
analgesic, antiseptic, antibacterial, antiparasitic, antiperspirant, deodorant, digestive disorder-
relieving, rubefacient, stimulant, and stomachic properties [29,30].

4.9 Fennel
Fennel seeds are often used in Traditional Chinese Medicine to induce muscular relaxation in the
digestive system and reduce symptoms of cramping and bloating. The plant classified by Karsten as
Foeniculum Foeniculutn is referred to as Foeniculum vulgare, which is the earliest valid name in the
genus Foeniculum [17]. Fennel contains compounds such as anethole, fenchone, and estragole,
which are believed to contribute to its carminative effects. These compounds may help relax the
muscles of the gastrointestinal tract, reduce spasms, and facilitate the passage of gas.

4.10 Fenugreek
Fenugreek is a variety of seed that is predominantly employed as a culinary spice in the country of
India. It is commonly referred to as maithray (Bangla, Gujarati), methi or mithi. In Latin, fenugreek
is known as "foenum-graecum," which translates to "Greek hay." It is used in the field of medicine
for its various properties, including aphrodisiac, stomachic, diuretic, astringent, emmenagogue,
demulcent action, carminative, and tonic effects [31]. Fenugreek is commonly utilized for a range of
health conditions, including digestive disorders [32].

4.11 Ginger
Ginger (Zingiber officinale Roscoe) is a well-known herbaceous plant that has been extensively used
for years as a flavoring ingredient and herbal medicine. Ginger has been used as a spice and
medicine for over 200 years in Traditional Chinese Medicine. The main families of chemicals found
in ginger are shogaols, zingiberene, Gingerol, and zingerone are t [33]. Terpenes, vitamins, and
minerals are among the less prevalent compounds found in ginger. Numerous relevant biological
activities, including those of antioxidant, antibacterial, and anti-neuroinflammation, carminative
stimulant have been investigated [34].

4.12 Lemon balm

Melissa officinalis L, often referred to as lemon balm, bee balm, or honey balm, is a perennial plant
[35]. Lemon balm (Melissa officinalis) is an aromatic herb that belongs to the mint family and is
known for its mild lemon scent. While it may not be as commonly associated with carminative
properties as fennel or anise, some people use lemon balm for its potential digestive benefits,
including its ability to alleviate gas and bloating. The herb contains compounds such as citronellal,
citral, and eugenol, which contribute to its aromatic and potential carminative properties [36].

4.13 Nutmeg
A comprehensive investigation was conducted on the ethnobotany of nutmeg (Myristica fragrans
Houtt.) (MF, Myristicaceae) in the provinces of Maluku and central and east Java [37]. Nutmeg seeds
are composed of various compounds, including myristic acid, fatty acid glycerides, and an essential
oil. These compounds may help to soothe the digestive tract, reduce gas formation, and ease
bloating.

4.14 Ziziphus jujuba

The fruits of Ziziphus jujuba, known as jujube or Chinese date, are being consumed all around the
world [38]. According to Chinese medicinal theory, jujube is considered as a medicinal herb. Jujuba,
also known as Ziziphus jujuba, has been used in the treatment of a range of diseases, including
respiratory system ailments such as asthma, cough, and laryngitis, as well as gastrointestinal issues
like constipation, colitis, and liver diseases [39].
 Table 2: Herbal intervention used in the treatment of Carminative [40]

S. No. Botanical Name Part of Plant Phytoconstituents Pharmacological Action References

Abelmoschus Leaves, roots, Carminatives, Astringent,
1. Essential oil, resin, fatty oil [41]
esculentus flowers, seeds Diuretics, Stomachic etc.
Acrid volatile oil, Starch, Carminatives, Anthelmintic,
2. Allium sativum Tuber, Bulb [42]
Aromatic oil Digestive, Gastric stimulant,
Albuminoids, Bulb, Acrid Carminatives, Expectorant,
3. Allium cepa Seed, Bulb [43]
Volatile oil Stomachic
Root, Plant, Pulp, Aloin, Chrysamic acid, Carminatives, Digestic tonic,
4. Aloe vera [44]
juice of dried leaf Emodin, Resin Purgatives
Leaf, Seed, Fruits, Azadirachtin, Bitter oil, Carminative, Stomachic,
5. Azadirachta indica [45]
Flowers Margosine Stimulant, Purgative
Carminative, Expectorant and
6. Bata vulgaris Leaves and Roots Betin [46]
Diuretics
Resin, Gum, Xylose, Carminatives, Astringent,
7. Boswellia serrata Oil, Resin and Gum [47]
Galactose Antidysentery, Emetic
8. Bombex ceiba ----- Gallic acid, Tannic acid Carminatives, Expectorant [48]
Cannabene, Canabidiolic, Antispasmodic, Carminatives,
9. Cannabis sativa Seeds, Flower, Seeds [49]
Volatile Astrigant
Capsacin, fatty acid, Resin, Stomachic, Local irritant,
10. Capsicum annum Fruit resin [50]
Fixed oil Carminatives, Rubefacient
Mallic acid, Albuminoids, Carminatives, Stimulant,
11. Coriandrum sativum Leaf, bark, Kernel [51]
tannic Diuretic
 Carminative, Astrigant,
12. Cuminum cminum Flower, fruits Resin, Thymine, oil [52]
Stomachic, Aromatic
Turmeric oil, turpenoids, Carminatives, Astrigant, [53]
13. Curcuma longa Tuber, Rhizome
Alkaloid Laxative, Stomachic
Carotene, Lignine, mallic Carminatives, Expectornt,
14. Daucus carota Seeds, roots [54]
acid, Iron Stomachic, Diuretic
Carminatives, Antipyretic,
15. Emblica officinalis Barks, leaves Ellagic acid, Linoleic acid [55]
Tonic alexiteric
Carminatives, Stomachic,
16. Ficus racemose Leaves, Latex, roots Tannin [56]
astringent
Ascorbic-acid, d- limonene. Carminatives, Antispasmodic,
17. Foeniculum vulgare Seeds, Leaves [57]
quercetin, Antiviral, Anticataract
Digestive, Antiscorbutic,
18. Garuga pinnata Leaves, Stem, Root ----- [58]
Carminative
Carminative, Hypotensive,
19. Hemidesmus indicus Stem, Leaves Lupeol, beta-sitosterol, [59]
Anticonvulsant
Beta-carotene, myristic- Carminative, Haematinitic,
20. Moringa oleifera Barks, Leaves, Seeds [60]
acid, choline, Emmenagogue, Digestive
Stearic-acid, beta-sitosterol, Carminative, Expectorant,
21. Nigella sativa Seeds [61]
myristicacid. Constipating, Appetizing
Carminative, Anodyne, Tonic,
22. Nyctanthes arbortristis Flowers, seeds ----- Laxative, Diuretic, [62]
Expectorant, Antibacterial.
 Aspartic acid, Apigenin, Digestive, Stomachic,
23. Ocimum basilicum Whole plant [63]
Acetic Acid Carminative
Piperlonguminine, sesamin, Carminative, Antidiarrheal,
24. Piper longum Fruits, Roots [64]
piperine Laxative
Carminative, Antiperiodic,
25. Piper nigrum Fruits ----- [65]
Emmenagogue
Emetic carminative,
26. Peganum harmala L. Seeds alkaloids, β-carbolines Anthelmintic, Aphrodisiac, [66]
Galactagogue, Diuretic
Ricin, Sugar, slimy Carminative, Depurative,
27. Ricinus communis Oil, Seeds, roots [67]
substance Emollient, Purgative
Carminative, Stomachic,
28. Vitex negundo Whole Plant Volatile essential oil, resin Anodyne, Antiseptic, [68]
Thermogenic, Anthelmintic.
Carminative, Constipating,
29. Wrightia tinctorial Leaves, bark, seeds ------------- [69]
Anthelmintic
Carminative, Rubefacient,
Borneol, beta-philandrene, Digestive, Stomachic,
30. Zingiber officinale Rhizome [70]
Camphene, Appetizer, Thermogenic,
Anodyne
5. Therapeutic uses of carminatives
Carminatives are substances that are used to relieve flatulence and promote the expulsion of gas from
the gastrointestinal tract. They are often used to alleviate symptoms such as bloating, discomfort, and
abdominal pain associated with excessive gas. Here are some therapeutic uses of carminatives:

5.1 Antimicrobial
Several herbs possess antimicrobial properties that can promote the restoration of gut microflora and
eliminate harmful bacteria. Sweet fennel is among the herbs known for these beneficial effects.
Carminatives have been utilized in the treatment of respiratory issues caused by infection as well as
gastrointestinal disorders [71].

5.2 Irritable bowel syndrome (IBS)

Clinical studies have demonstrated that oils derived from these herbs possess the potential to
alleviate symptoms associated with irritable bowel syndrome (IBS). Peppermint oil, specifically,
emits a potent menthol aroma that has been found to effectively enhance gastric flow and help
prevent constipation-related stagnation [72].

5.3 Relieves Symptoms of Nausea

Studies have demonstrated the efficacy of carminative herbs in alleviating nausea associated with
motion sickness as well as morning sickness. Several examples of herbs in this category include
cardamom, ginger, anise seed, and peppermint. Anise seed has the potential to enhance lactation in
breast-feeding mothers [73].

5.4 Diuretic
Sweet fennel is a highly beneficial plant that offers a rich supply of trace elements. It is particularly
important for its significant contribution of calcium and magnesium, two essential nutrients that play
a vital role in supporting overall well-being and growth. This herb possesses diuretic properties and
has been found to be both effective and safe for use in children and pregnant women [74].

5.5 Reduce Need for Medication:

The application of steam distillation techniques enables the extraction of volatile oils from
carminative herbs, resulting in their potent aromatic properties [75]. A study has demonstrated that a
combination of essential oils, specifically ginger, peppermint, and cardamom, may possess aromatic
properties that could be beneficial in the treatment of certain conditions [73]. The participants in this
study who utilized inhalation of the oil blends reported a reduced inclination to rely on prescribed
medication for alleviating post-operative nausea symptoms.
5.6 Treat Menstrual Symptoms
Cardamom and peppermint have the potential to effectively alleviate discomfort caused by cramping
and gas by numbing the nerves in the stomach and intestines [76]. Carminative herbs have the
potential to mitigate muscle cramping that may arise during a woman's menstrual cycle.

5.7 Chemo-Protectant
Carminative herbs are known to possess potent antioxidants that have the potential to inhibit the
development of cancer [77]. The flavonoids present in orange peel have been found to possess tissue-
repairing properties and the ability to enhance the strength of blood vessels.

5.8 Dyspepsia (Indigestion)

Carminatives are commonly used to treat dyspepsia, which is characterized by symptoms such as
bloating, belching, and discomfort in the upper abdomen.

6. Shortcoming of Traditional Chinese Medicine(TCM)

Traditional medicine therapies for carminative purposes, while often relied upon for their historical
use and perceived benefits, come with several shortcomings [78]. Unlike modern pharmaceuticals,
traditional remedies may not undergo rigorous clinical testing, making it difficult to assess their
reliability and appropriate dosages [79]. Additionally, the variability in quality and preparation
methods of traditional medicines can lead to inconsistent outcomes and potential risks for consumers.

a) Variability in Quality and Potency

Traditional medicines can vary widely in quality, potency, and purity due to differences in
sourcing, preparation, and storage methods [80].
b) Potential Side Effects and Allergic Reactions
Despite being natural, traditional remedies may still cause adverse effects or allergic reactions
in some individuals, especially if improperly prepared or administered [81].
c) Delayed Onset of Action
Traditional therapies may require prolonged use before noticeable effects on digestive
symptoms are observed, which can be less desirable for those seeking immediate relief [82].
d) Inadequate Regulation and Oversight
Traditional medicine practices may lack standardized regulations and oversight, leading to
concerns about product safety, labeling accuracy, and contamination risks [83].
e) Limited Integration with Modern Healthcare
In some cases, traditional medicine therapies may not be fully integrated into modern
healthcare systems, leading to potential gaps in comprehensive patient care and treatment.
f) Herb-Drug Interactions
 Some herbal remedies used as carminatives may interact with prescription medications,
altering their effectiveness or causing adverse reactions [59].

7. Future Prospectives of TCM on carminatives

The future prospects of TCM in the realm of carminatives are intriguing and hold significant
potential. Carminatives, which are compounds that alleviate gas and bloating in the digestive system,
have been used for millennia in many civilizations due to their digestive advantages [84]. Although
the core purpose of carminatives stays unchanged, their future outlook may include several
advancements and trends:

a) Integration with Modern Medicine: There is a growing interest in amalgamating TCM with
mainstream medical methods. Further scientific investigation should be conducted to
thoroughly examine the effectiveness and safety of carminatives derived from TCM. This
research has the potential to result in the integration of these carminatives into conventional
medical therapies for digestive diseases [85].
b) Research and Standardization: Further investigation into TCM formulae and the plants
used as carminatives may result in the discovery of distinct components accountable for their
therapeutic benefits. This study may also include efforts to establish uniformity in herbal
medicines in order to guarantee constant potency and quality [86].
c) Customized Medical Care: TCM has always prioritized individualized approaches to
treatment. In the future, technological progressions, such as genetic testing and microbiome
analysis, may enable the customization of TCM carminatives, taking into account an
individual's distinct constitution and health condition [87].
d) Innovative Formulations: Novel formulations of TCM carminatives may be created to
improve their effectiveness and convenience. Examples of this might include concentrated
extracts, topical treatments, or innovative delivery methods designed to specifically target
certain regions of the digestive tract.
e) International Market Growth: With the increasing global interest in natural medicines,
there is a potential for higher demand for TCM carminatives in markets that go beyond the
conventional ones. Enhancing knowledge and embracing the concepts and practices of TCM
in Western nations might aid in its widespread adoption.
f) Regulatory Challenges and Opportunities: Regulatory organizations may have difficulties
in establishing uniform standards and overseeing the regulation of TCM carminatives owing
to the intricate compositions and varied origins of these products [88]. Nevertheless, more
 explicit laws might also provide prospects for producers to showcase the safety and
effectiveness of their goods, therefore bolstering customer confidence.

8. Conclusion Remarks and Future Perspective

In the realm of Chinese Medicine, the application of carminatives transcends the mere alleviation of
digestive discomfort, it embodies a holistic philosophy deeply rooted in the balance of Yin and Yang
energies and the unimpeded flow of Qi. Carminatives, substances designed to mitigate flatulence and
facilitate the expulsion of gas, find their place within this traditional healing system as agents of
digestive harmony. Chinese herbal medicine, a cornerstone of this practice, has long employed herbs
such as fennel (Xiao Hui Xiang) and cardamom (Bai Dou Kou) for their potent carminative
properties. These herbs are believed to not only address symptoms but also rectify imbalances in Qi
flow, promoting overall well-being. Complementing this herbal approach, acupuncture and
acupressure techniques are employed to stimulate specific points that enhance digestive function and
restore energetic equilibrium. Moreover, Chinese Medicine emphasizes the significance of dietary
choices in maintaining health, offering guidelines that incorporate foods known for their carminative
qualities. This individualized and holistic approach to treatment, tailored to the unique constitution of
each patient, underscores the effectiveness of Chinese Medicine in addressing digestive issues
through the prism of carminatives. As the intersection of ancient wisdom and modern understanding
continues to be explored, scientific research supporting the efficacy of Chinese Medicine in
managing digestive concerns further solidifies its relevance.

In summary, the use of medicinal plants, particularly carminative herbs, has a long history in
traditional medicine across different cultures. These herbs are valued for their diverse
pharmacological activities, including antimicrobial, anticancer, cardiovascular, antioxidant, and
various other properties. Carminatives, specifically, play a crucial role in relieving symptoms
associated with gastrointestinal discomfort, such as bloating and abdominal pain (Table 3).

Carminative herbs exert their therapeutic effects through the volatile oils they contain, which
increase gastric emptying, mildly irritate the gastric mucosa, and promote peristalsis to relieve
cramping and expel gas. Some well-known carminative herbs include asafoetida, coriander, cloves,
fenugreek, cardamom, ginger, kalonji, and cinnamon. These herbs are incorporated into traditional
medicinal practices worldwide, including Traditional Chinese Medicine (TCM), which has gained
popularity globally. The World Health Organization recognizes traditional medicine's diversity,
encompassing various health practices, approaches, and beliefs, including the use of herbal
medicines.
In conclusion, the rich tradition of using medicinal plants, particularly carminative herbs, continues
to be a subject of interest and research in the field of healthcare. These natural remedies offer a
holistic approach to health and well-being, with potential benefits that extend beyond relieving
gastrointestinal symptoms.
Table 3: Active components and therapeutic effects of some Chinese medicine.

S. No. Chinese Medicine Active Components Therapeutic effects References

Polysaccharides, Diabetes, High blood
Astragalus
1. flavonoids, and pressure and [89]
membranaceus
saponins. as carminative
Crude protein, crude Carminative,
2. Crataegi fructus fat, ash, and antispasmotic, [90]
carbohydrates spasmolytic, digestive
Cortex magnoliae Lignans, alkaloids, Carminative, stimulant,
3. [91]
Officinalis volatile oils and digestive properties

Dioscorea Carminative, tonic, and

4. Diosgenin, Escin [92]
opposita aphrodisiac effects.

Carminatives, Stomach
Euodia rutaecarpa Beta-sitosterol, cold abdominalgia,
5. [93]
(Juss.) evodianinine, limonin abdominal distension,
vomiting, and diarrhe

Triterpene saponins Possess antitussive

6. Radix glycyrrhizae [94]
and flavonoids activities, Carminative
Semen pruni Armeniacae,
7. Ephedrae and Semen [95]
Armeniacae Carminative

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Declaration of interests

The authors declare that they have no known competing financial interests or personal relationships that
could have appeared to influence the work reported in this paper.