Properties: Sweet, bitter, astringent, neutral

Meridans Entered:
Primary: Heart and Lung

1. Invigorates Blood and disperses Stasis
   Palpitations, cardiac pain, high cholesterol
   Poor memory, cognitive symptoms of dementia (especially Alzheimer's)
2. Astringes the Lung
   Cough with Phlegm
   Wheezing
   Choking sensation in chest

Suggested Daily Dosage: 3-12g in decoction.

Cautions: Strong inhibitor of platelet aggregation factor so it may increase bleeding time in pregnancy so should be avoided in the last trimester.

The leaves also contain ginkgoic acids which are highly allergenic long-chain alkylphenols so should be avoided in people who have had strong allergic reactions to poison ivy, mangoes, cashews and other alkylphenol-producing plants in the past.

Excess consumption may cause muscle twitching and dilated pupils.

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.
• Isorhamnetin
  Monomethoxyflavone related to quercetin with roles as a tyrosinase inhibitor and anticoagulant which may be responsible for some if the cerebroprotective effects through antiinflammatory and antioxidant activities (Gong et al., 2020).
• Kaempherol
  Tetrahydroxyflavone common in plants with a roles as an antioxidant, antibacterial agent and potential anticancer agent.
• 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).