Traditionally used for
- Dizziness
- Ears & hearing
- Cough & breathing
- Heart & circulation
- Energy & fatigue
Cautions & contraindications
- Seizure disorders
- Toxic — professional use only
☯ TCM Properties
Invigorates Blood and Dispels Stasis; Unblocks the Channels and Alleviates Pain; Astringes the Lungs and calms wheezing; Transforms Turbidity and Lowers Lipids
Traditional Chinese Uses
Yin Xing Ye (ginkgo leaf) is a neutral-cool herb used in Chinese medicine for conditions related to Heart and Lung function and Blood circulation. Its most notable applications are for cognitive support in the elderly and for cardiovascular health — improving Blood circulation to the brain and heart to address memory decline, dizziness, tinnitus, and chest pain from Blood stasis and Qi deficiency. The ginkgo tree is one of the oldest living trees on Earth and is considered a sacred longevity symbol.
Western Herbalism Properties
Relationships
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Botanical Description
Ginkgo biloba L. (Ginkgoaceae) is a long-lived, deciduous, dioecious tree reaching 20-35 m or more, with a straight trunk and an initially pyramidal crown that broadens with age. The grey, deeply furrowed bark covers wood with characteristic short spur shoots. The distinctive fan-shaped leaves 5-10 cm wide have parallel, dichotomously forking veins and are usually bilobed on long shoots; they turn brilliant yellow in autumn before falling. Male trees bear pollen catkins; female trees produce naked ovules that develop into yellow, plum-like seeds with a fleshy, malodorous outer coat. Now extinct in the wild but widely cultivated and possibly persisting in eastern China, Ginkgo is a living relict of an ancient lineage. The leaves (Yin Xing Ye) are used in TCM and standardised in modern Western phytotherapy for circulatory and cognitive support.
Active Constituents
Flavonol glycosides of quercetin, kaempferol and isorhamnetin
Flavonol O-glycosidesConcentration: standardised leaf extracts such as EGb 761 are adjusted to 22-27% flavonol glycosides
The dominant polyphenol fraction of the leaf and the basis of its antioxidant and microcirculatory claims. Standardisation to this range is what makes leaf extract trial data transferable between products; crude leaf tea is not equivalent to a standardised extract.
Ginkgolides A, B, C and J
Diterpene trilactonesConcentration: about 2.8-3.4% of EGb 761
Structurally unique cage diterpenes found only in this genus. Ginkgolide B is a potent antagonist of platelet-activating factor, which is the mechanistic basis for both the claimed circulatory benefit and the theoretical bleeding concern attached to leaf extracts.
Bilobalide
Sesquiterpene trilactoneConcentration: about 2.6-3.2% of EGb 761
The single most abundant terpene trilactone of the leaf, with neuroprotective activity in models of ischaemia and a documented modulating effect on GABAergic transmission, which is one reason ginkgo leaf products are discussed in relation to seizure threshold.
Ginkgolic acids (alkylphenols)
Alkylphenolic acidsConcentration: restricted to less than 5 parts per million in EGb 761 and in the standardised leaf extract monographs
Cytotoxic and strongly allergenic contact sensitisers concentrated in the leaf and fruit pulp. Their deliberate removal is the main safety step in manufacturing standardised leaf extract, and products that are not deacidified carry a real risk of allergic dermatitis and mucosal irritation.
Biflavones (amentoflavone, bilobetin, ginkgetin, isoginkgetin)
BiflavonoidsLeaf-specific dimeric flavones that inhibit several cytochrome P450 enzymes in vitro. They are substantially depleted in refined extracts, so crude leaf preparations carry a larger biflavone load and a correspondingly less predictable metabolic interaction profile than standardised extract.
Proanthocyanidins
Condensed tanninsConcentration: roughly 7% of standardised leaf extract
An antioxidant fraction of the leaf that contributes to free radical scavenging but is not thought to carry the specific pharmacology of the terpene trilactones.
⚠ Drug Interactions
Efavirenz
In a 47-year-old man stable for two years on efavirenz, emtricitabine and tenofovir, efavirenz concentrations fell from a therapeutic 1.26 mg/l to a non-therapeutic 0.48 mg/l during ginkgo leaf use, with virological failure. The authors proposed induction of CYP3A4 and P-glycoprotein by the extract, principally by the terpenoid fraction. A second published case reported the same pattern.
Clinical note: Do not combine ginkgo leaf with efavirenz. Extend the same caution to other antiretrovirals and to narrow-therapeutic-index CYP3A4 substrates such as transplant immunosuppressants, where a fall in exposure is not recoverable.
CYP2C19 substrates (omeprazole, and by extension clopidogrel activation)
Eighteen healthy Chinese volunteers pre-genotyped for CYP2C19 took a single 40 mg dose of omeprazole before and after 12 days of Ginkgo biloba 140 mg twice daily. Ginkgo induced omeprazole hydroxylation in a genotype-dependent manner and simultaneously reduced the renal clearance of 5-hydroxyomeprazole, so co-administration with CYP2C19 substrates may significantly reduce their effect. The direction is induction, not inhibition, which for clopidogrel would mean more rather than less active metabolite.
Clinical note: Expect reduced proton pump inhibitor effect. Where a CYP2C19-dependent drug is doing something important, either separate it from the ginkgo or monitor the clinical endpoint rather than assuming stability.
Antiplatelet drugs (aspirin, clopidogrel) and NSAIDs
Ginkgolide B is a platelet-activating factor antagonist, which supplies a plausible additive mechanism. A retrospective review of 2,647 prescriptions containing ginkgo leaf extract found interactions in 12.94%, most often with antiplatelets, anticoagulants and NSAIDs, with clopidogrel and aspirin each at 2.61%. Against this, controlled human studies have generally not shown a measurable haemostatic effect, and a secondary analysis of a randomised placebo-controlled trial in probable Alzheimer's dementia found no effect of EGb 761 on coagulation or bleeding time. The residual concern rests on case reports rather than on demonstrated pharmacodynamic change.
Clinical note: There is no need to panic about aspirin plus a standardised leaf extract, but stop ginkgo one to two weeks before elective surgery or neuraxial procedures, and take any new bruising, epistaxis or unexplained headache seriously.
Warfarin
In an open-label three-way crossover study, 12 healthy men received a single 25 mg dose of warfarin alone or after seven days of ginkgo or ginger at recommended doses, with dosing continued for seven days afterwards. Platelet aggregation, INR, warfarin enantiomer protein binding and plasma concentrations, and urinary S-7-hydroxywarfarin were all measured, and neither ginkgo nor ginger altered INR or platelet aggregation. A separate crossover study in 21 warfarin-stabilised patients taking ginkgo 100 mg daily for four weeks likewise found no change in INR or warfarin dose requirement.
Clinical note: This is one of the herb-drug interactions that the evidence has largely retired. Continued INR monitoring is sensible on starting or stopping any herb, but a warfarin patient does not need to be told ginkgo leaf is forbidden.
Antiepileptic drugs (valproate, phenytoin)
A fatal breakthrough seizure was reported in an epileptic patient whose valproate and phenytoin concentrations were subtherapeutic while taking a ginkgo product, and a separate case described ginkgo precipitating epileptic seizures in an older patient. Two mechanisms are debated: induction of the metabolism of the anticonvulsants, and the pyridoxine antimetabolite 4'-O-methylpyridoxine, called ginkgotoxin. It is important to be exact about the second. Ginkgotoxin is a hazard of the ginkgo SEED, where it and its 5'-glucoside accumulate; total ginkgotoxin in 131 Chinese seed samples ranged from about 141 to 537 micrograms per gram. Leaf material carries far less, and leaf extract is not a recognised cause of the classical ginkgo-seed convulsant poisoning. The seizure reports involving leaf products are therefore a signal to respect, not an instance of seed toxicity.
Clinical note: Avoid ginkgo leaf in poorly controlled epilepsy. If a patient with epilepsy is already taking it, check anticonvulsant levels rather than assuming they are unchanged, and never substitute the seed (Bai Guo) where the leaf is intended.
Crude leaf preparations that have not been deacidified
Ginkgolic acids are allergenic alkylphenols present in the leaf and heavily concentrated in the fruit pulp. Standardised extract monographs cap them below 5 parts per million precisely because of this, so a homemade leaf tea, a non-standardised powder or any preparation involving the fleshy seed coat delivers an exposure that the clinical trial literature was designed to exclude.
Clinical note: Prescribe a deacidified standardised leaf extract where the intent is to reproduce trial results. Handle fresh leaves and especially the fruit pulp with gloves; cross-sensitivity with urushiol-type allergens is described for the fruit.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 9–12 g | Daily | — | — | 中国药典 2020 【用法与用量】9～12g。 【注意】有实邪者忌用。 【性味与归经】甘、苦、涩，平。归心、肺经。 — Chinese Pharmacopoeia 2020, quoted verbatim; route and cautions preserved. Replaces a cleared category-filler value. |
Evidence Tier
Strong evidence · 6 studiesRecorded studies by study design, strongest design at the top. This is a study-design tier only, not a GRADE rating: it does not weigh risk of bias, consistency or precision.
Systematic review / meta-analysis
2
0 verified · 2 unverified
Randomized controlled trial
3
1 verified · 2 unverified
Show 3 studies
- Ginkgo biloba for Prevention of Dementia: A Randomized Controlled Trial
- Long-term use of standardised ginkgo biloba extract for the prevention of Alzheimer's disease (GuidAge): a randomised placebo-controlled trial
- Effect of ginkgo and ginger on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects
Other clinical trial
0
Observational / case report
1
0 verified · 1 unverified
In vitro / animal
0
Other / unclassified
0
Verified: design read from PubMed for a DOI that resolves to the cited paper Unverified: taken from the study's recorded description
Clinical Studies
Ginkgo biloba for Prevention of Dementia: A Randomized Controlled Trial
The Ginkgo Evaluation of Memory study randomised 3,069 community volunteers aged 75 or older, 2,587 with normal cognition and 482 with mild cognitive impairment, to EGb 761 120 mg twice daily or placebo across five United States academic centres, with a median follow-up of 6.1 years. Ginkgo leaf extract did not reduce the incidence of all-cause dementia or Alzheimer's disease, and did not slow progression in those who began with mild cognitive impairment.
Long-term use of standardised ginkgo biloba extract for the prevention of Alzheimer's disease (GuidAge): a randomised placebo-controlled trial
A long-term randomised placebo-controlled prevention trial of standardised ginkgo leaf extract in older adults reporting memory complaints. Long-term use did not reduce the risk of progression to Alzheimer's disease, reinforcing the negative prevention result seen in the Ginkgo Evaluation of Memory study.
Ginkgo biloba for cognitive impairment and dementia
The Cochrane review of randomised trials of ginkgo leaf extract in cognitive impairment and dementia concluded that the evidence of benefit is inconsistent and unreliable, while ginkgo appears safe in use with no excess of adverse events compared with placebo. It is the standard counterweight to the more favourable manufacturer-linked meta-analyses.
Ginkgo biloba extract EGb 761 is safe and effective in the treatment of mild dementia – a meta-analysis of patient subgroups in randomised controlled trials
Pooling patients with mild dementia, defined by a Short Cognitive Performance Test total score of 9 to 15, from four eligible randomised placebo-controlled trials and totalling 782 patients, EGb 761 at 240 mg daily was superior to placebo for cognition (p = 0.04), global assessment (p = 0.01), activities of daily living (p = 0.01) and quality of life (p = 0.02). The result applies to treatment of established mild dementia, not to prevention, and the author group includes the extract manufacturer.
Effect of ginkgo and ginger on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects
Open-label three-way crossover in 12 healthy men given a single 25 mg dose of warfarin alone or after seven days of ginkgo or ginger, with herb dosing continued for a further seven days. Neither herb altered INR, platelet aggregation, warfarin enantiomer protein binding or plasma concentrations, or urinary S-7-hydroxywarfarin. The study is the main reason the ginkgo-warfarin interaction is now regarded as far weaker than early case reports suggested.
Impact of Ginkgo biloba drug interactions on bleeding risk and coagulation profiles: A comprehensive analysis
Retrospective review of 2,647 prescriptions containing ginkgo leaf extract at a Vietnamese hospital between January 2022 and December 2023 identified potential interactions in 342, a prevalence of 12.94%. The most frequent partners were antiplatelets, anticoagulants and NSAIDs, with clopidogrel and aspirin each at 2.61%; interactions with direct oral anticoagulants and acenocoumarol were not statistically significant in the analysis.
Historical Texts
Dian Nan Ben Cao
Ming dynasty, 1436Ben Cao Pin Hui Jing Yao
Ming dynasty, 1505Ben Cao Gang Mu
Ming dynasty, 1596References
- Wiegman DJ, Brinkman K, Franssen EJF. Interaction of Ginkgo biloba with efavirenz . AIDS (2009) [DOI]
- Naccarato M, Yoong D, Gough K. A Potential Drug–Herbal Interaction between Ginkgo biloba and Efavirenz . Journal of the International Association of Physicians in AIDS Care (2012) [DOI]
- Kupiec T, Raj V. Fatal Seizures Due to Potential Herb-Drug Interactions with Ginkgo Biloba . Journal of Analytical Toxicology (2005) [DOI]
- Granger AS. Ginkgo biloba precipitating epileptic seizures . Age and Ageing (2001) [DOI]
- Liu Y, Xin H, Zhang Y, Che F, Shen N, Cui Y. Leaves, seeds and exocarp of Ginkgo biloba L. (Ginkgoaceae): A Comprehensive Review of Traditional Uses, phytochemistry, pharmacology, resource utilization and toxicity . Journal of Ethnopharmacology (2022) [DOI]
- Yin OQP, Tomlinson B, Waye MMY, Chow AHL, Chow MSS. Pharmacogenetics and herb-drug interactions: experience with Ginkgo biloba and omeprazole. . Pharmacogenetics (2004) [DOI]
This information is for educational purposes only and is not intended to replace professional medical advice. Always consult a qualified healthcare provider before using any herbal remedy, especially if you are pregnant, nursing, or taking medications.
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