Properties: Sweet, bitter, astringent, neutral, slightly toxic

Meridans Entered:
Primary: Lung and Kidney

1. Astringes Lung, expels Phlegm and stops wheezing
   Phlegm in the Lungs with wheezing and coughing (especially useful for chronic coughs or those with copious Phlegm)
   Lung Heat asthma
2. Stabilizes the Lower Jiao, eliminates Dampness, stops discharge and astringes the urine
   Lower Jiao Deficiency with vaginal discharge and turbid urine (used for both Deficiency and Damp-Heat)

Suggested Daily Dosage: 5-10g in decoction.

Cautions: It is contraindicated for raw use because this unprocessed herb is toxic. Overdose of stir-baked herb can also induce neurotoxic and cyanotic effects, especially for infants. Being astringe property, it should be used with cautions for cough and dyspnea with thick phlegm and difficult in spitting out.

Interactions:

• Anticoagulants: May have additive effects on all anticoagulants including warfarin, aspirin & NSAIDS,
• Medications changed by the liver (Cytochrome P450): Affects substrates 1A2, 2C9, 2C19, 2D6 and 3A4 which may increase the effects of medications broken down by these enzymes.
• Alprazolam: May decrease the effect.
• Buspirone and Fluoxetine: Excessive excitation has been reported although uncertain if this is due to ginkgo or other interactions.
• Trazodone: May cause serious side effects in the brain.
• Antidiabetes drugs: May affect blood glucose so should be monitored and adjusted accordingly.
• Anticonvulsants and medications that increase the chance of seizures: may increase the chance of seizures.
• Efavirenz: May decrease effectiveness.
• Omeprazole: May decrease effect.
• Tolbutamide: Decreases tolbutamide blood concentration.
• Talinolol: Increases talinolol blood concentration.
• Hydrochlorothiazide: May increase blood pressure.
• Recommended to stop 36 hours before surgery due to increased risk of bleeding, increased sedation and decrease efficiency of anticonvulsants (Ang-Lee, Moss & Yuan, 2001; Yilmaz & Çifci, 2018).

• Ginkgolide A
  Terpene lactone platelet aggregating factor agonist cage molecule with potential in a wide variety of inflammatory and immunological disorders.
• Ginkgolide B
  Terpene lactone with potentially similar effects to Ginkgolide A.
• Ginkgolide C
  Terpene lactone with potentially similar effects to Ginkgolide A.
• Bilobalide
  Terpenoid trilactone with potentially similar effects to Ginkgolide A.
• Quercetin
  Pentahydroxyflavonone common in plants with roles as an antibacterial agent, an antioxidant, a protein kinase inhibitor, an antineoplastic agent and phytoestrogen.
• Kaempherol
  Tetrahydroxyflavone common in plants with a roles as an antioxidant, antibacterial agent and potential anticancer agent.
• Isorhamnetin
  Monomethoxyflavone similar to quercetin but where the hydroxy group at position 3' is replaced by a methoxy group. It has a role as an tyrosinase inhibitor and an anticoagulant.
• Ginkgolic Acids
  Hydroxybenzoic acid functionally related to salicylic acid that is responsible for the toxic effects of ginkgo leaves. It is required to be below 5ppm in standardised extracts. It is thought to work via inhibition of mitochondrial biogenesis (Wang et al., 2019).
• Ginkgotoxin
  Pyridine (4'-O-methylpyridoxine) antivitamin neurotoxin that can induce epileptic seizures. It is structurally related to vitamin B6 and so may interfere with its synthesis leading to decreasing the activity of pyridoxal kinase, then decreased availability of glutamate decarboxylase and imbalance between excitation and inhibition of neurotransmitters. It can be relieved by taking vitamin B6 supplements.
• Cyanogenic Glycolysides
  Glycosides that are metabolised into hydrogen cyanide on consumption. Once converted into a cyanide, it acts as an inhibitor of cytochrome c oxidase in the fourth complex of the electron transport chain of the mitochondrial membrane. It complexes with the ferric iron atom in this enzyme preventing the transport of electrons from cytochrome c oxidase to oxygen, resulting in disruption of the electron transport chain and the cell being no longer able to produce ATP aerobically.
  
  Cho et al. (2013) found 4 cyanogenic glycosides in Ginkgo seeds at releasing 0.25 - 0.5 µg CN–/g dry wt. by acid hydrolysis (compared to 1679.27 by apricot seed and 299.82 by linseed) making this a negligible toxin.