MATERIAL AND METHODS
STUDY DESIGN: An observational clinical study was conducted at the Drug Standardisation Unit, Hyderabad, under the Central Council of Research in Homoeopathy to ascertain the clinical utility of Ginkgo biloba (GB) in geriatric problems.
- After considering the inclusion criteria, the cases are selected for study.
- A complete case taking is made highlighting geriatric problems in anatomical manner.
- Complete blood picture; complete urine examination; fasting blood sugar; post lunch blood sugar; total cholesterol; blood urea; serum creatinine tests were conducted at entry and as when required till the study was over.
- Allopathic medication for diabetes and hypertension were allowed to continue.
- No other homoeopathic medicine was given in all the enrolled cases for a period of one year of the study.
- Improvement assessment was initiated after 1 month of the use of GB(Q ,1X).
- Not improved cases were dropped from the study.
- Improved cases were continued with GB (Q or 1X) and or followed up till next 11 months or earlier depending upon the improvement of the geriatric problems.
- Final assessment was made by compiling the data.
PARTICIPANTS: 30 geriatric subjects were selected from the OPD, in age group 60-74 years belonging to both sexes (M-19, F-21)
- Age above 60 years and below 75 years
- Suffering from common geriatric problems in less intensity
- Well controlled individuals with diabetes mellitus or hypertension under allopathic medication
- Age below 60 years and above 75 years
- Individuals with uncontrolled diabetes mellitus or hypertension under allopathic medication.
- Those suffering from any serious systemic illnesses.
- Those suffering from psychiatric problems and taking allopathic medication.
- Individuals using anti coagulants or anti depressants.
SELECTION OF MEDICINE: All selected cases are randomly given GB Q or 1X (10 cases Q and 20 cases 1X)
POTENCY, DOSAGE AND REPETITION: GB Q was given in 10 drops doses twice daily in half cup of drinking water. GB 1X was given in 1 tab (250mg) twice daily. The same dosage was continued if improvement was mild. If improvement was marked the dosage was gradually tapered and stopped.
OUT COME ASSESSMENTS: the improvement is assessed after 1 month of use of GB (Q or 1X) in the following way:
- If a patient did not improve in any of the geriatric problems he was suffering with, that case is considered as not improved and was dropped from the study.
- If patient improves in one or more geriatric problems, then such case is considered as improved and further follow up is made.
- The same dosage of medicine was continued till the patient markedly improved.
- Once marked improvement is observed in the geriatric problems, then the dosage is slowly tapered and then stopped.
- After 1 year of follow up the improvement status is tabulated in an anatomical manner starting from mind and ending with modalities i.e. from above downwards
RESULT: Out of 30 cases selected for study, 10 were given Q and 20 1X. The outcome result showed that 2 cases have improved by Q out of 10 cases and 17 cases with 1X out of 20, in various geriatric problems (see table -II).
2 cases had Hb less than 10g % and on treatment have improved by 1X; Out of 4 diabetic patients 2 have improved in their sugar level with 1X; 5 cases have increased pus cell in urine with urinary problems. 3 have improved with 1X and 1 case with Q; 4 cases had albumin in urine before treatment and 2 have improved with2X; Systolic and diastolic pressure was considerably decreased by 1X in 2 cases; 2 cases each with diabetic and hypertensive retinopathy showed improvement clinically (see table -III).
The minimum duration of treatment followed in Q and 1X was 1 month where as maximum duration of treatment followed in Q was 3 months and 1X was up to 1 year.
DISCUSSION: Ginko Biloba remains as a clinical remedy in homoeopathy. A small proving was carried out in 1993 by E.A. Maury and his team with the mother tincture and 6c potency, bringing out few fractional proving data. A large stock of clinical symptoms from various sources revealed a broad utility for the drug1-7. Extensive clinical trials have been conducted in which people took standardized GBE at doses of 120mg -240mg daily for up to 1 year without any side effects8-10. The present study verified the same with GB1X used in doses of 250mg -500mg for 1 year.
As cautioned in the study by De.Smet PA11, our study has excluded the cases who are under treatment with anti coagulants. Hahnemann suggested trituration as the superior method for preparing homoeopathic medicine in aphorism 271 of 6th edition of organon of medicine and the same was demonstrated in our study.
CONCLUSION : It is demonstrated from the clinical study that people suffering with disorders like loss of mental alertness, difficulty in concentration, heaviness of head, disturbed vision and hearing, paresthesia of the palms and soles, fissures and cracks in skin, angular stomatitis, cramps in calf muscles, impotency etc. are found to be immensely benefited with GB1X, by virtue of the drug increasing blood flow to brain and other parts of the body thereby delivering the required nutrients and oxygen to every cell. Further, it may also be considered in organ transplanted individuals to bring functional harmony
Table – I
|S.No||Gingko biloba tree||Gingko biloba patient|
|1||In the East it is considered a symbol of longevity, hope, resilience and peace.||Has a tendency to live long and hence a great hope for relatives and friends; they leap back with normal activities by taking this drug. By and large they are peace loving persons.|
|2||The tree is grown by Chinese monks in temple gardens||Basically these patients are from orthodox families and highly principled. They spend much time in religious gatherings.|
|3||Shimenawas or cords of rice straw are tied around trunk of the tree to fend of evil spirits||Patients due to their orthodox nature tie thread on arms and neck to the needed person for keeping away from evil spirits|
|4||Leaves which are fan-shaped have been prized for their beauty , hence copied by artist and heralded in literature||Patients are beautiful with joyful look, hence considered geriatric model.|
|5||In China it is a tradition that grandfathers plant the trees for their grandsons||Generally these patients are under the care of grand children due to the longevity of their life.|
|6||It is a national tree of China and its leaf is used in the logos of the city of Tokyo and Osaka University.||As an oldest member of the family he blesses on all occasions his grand children, thereby becoming an important person. All invitations and other write-ups are on his name.|
|7||The female Gingko produces oval orange fruit which produce rancid butter smell and hence male plants are planted in the urban area rather than the female plant||Basically due to the non adjusting nature with grand children and bad smell due to incontinence of urine she is not accepted by the grand children.|
|8||Fossil record of these trees indicate that it grows primarily in disturbed environment along stream and levees||These patient have history of living in disturbed environment such as after losing life partner , children, friends, relatives, and also property, and wealth.|
|9||Gingko’s tenacity may be seen in Hiroshima, Japan when due to an atom bomb explosion all plants were destroyed , but Gingko though charred, survived and very soon became healthy again||Due to the process of aging there is decrease in blood supply and O2 tension and it leads to onset of impaired function of brain, kidney, lungs etc. Added to this is suppressed emotion, stressful life due to loss of mate, children, friends relatives etc; non adjustment problem , unfulfilment of desired things and also due to loss in business, wealth etc, patient becomes depressed and soon becomes normal and gains health by simple counselling and medication.|
|10||It can withstand harsh condition and rarely suffers from disease||Though leading life in stressful way and with dissatisfactory living under the care of grand children they suffer with no major illness.|
|11||In China children are not allowed to eat cooked seeds due to their toxic nature.||It is rarely employed for the children in their any problems|
|12||Late reproductive maturity: it takes the plant 40-50 years to mature||Ginkgo helps in the individual having late marriage at 40 plus with erectile dysfunction, impotency, Oligospermia and no desire for sex|
|13||The bark is fireproof and regenerates quickly though charred||Ginkgo helps to increase circulation, prevent capillary fragility, helps collagen formation and create fibroblasts for making skin healthy. and young.|
Improvement assessment of Ginkgo biloba.
|S.No||Signs and Symptoms||Total No. of Cases Prescribed||Total No. of Cases Improved|
|Short term memory loss||2||4||0||3|
|loss of mental alertness||1||5||0||4|
|Difficulty in concentration||2||8||0||6|
|forget fullness of name, time, date, day, appointments and events||1||2||0||2|
|Fearful dreams, dreams of robbers||0||2||0||2|
|Dreams of wars, death, falling from a height||0||1||0||1|
|Ailments from suppressed anger/ emotion||1||4||0||3|
|Morose, dull and sadness||1||4||1||4|
|confusion making mistakes in speaking, writing and reading||1||5||0||4|
|raises late from bed, dislike to brush teeth and attend to daily activities including taking bath||1||2||0||2|
|imagine every thing is unreal||1||1||0||0|
|delusion being old||1||1||0||0|
|criticizes others and himself||1||1||0||1|
|Avoids people and also conversion||1||2||0||2|
|Heaviness in frontal region||1||1||0||1|
|pain in nose, supra orbital region and temples right|
headache with vertigo
|Headache with tears < cold, open air||0||1||0||1|
|Lachrymation ? during headache||0||1||0||1|
|pressing pain in eyeballs esp. looking upwards and to the rt. Side with dim vision||0||2||0||2|
|Useful in diabetic retinopathy||0||2||0||2|
|Useful in hypertensive retinopathy||0||2||0||2|
|neuralgia over the rt. eye||0||2||0||2|
|Nose blockage during cold||1||2||0||2|
|running nose < early morning||1||2||0||2|
|blocking of both ears||0||3||0||2|
|Aphthous ulcers with burning||0||1||0||1|
|excessive salivation or dryness of mouth, coated tongue esp. towards base, angular stomatitis||0||1||0||1|
|neuralgic pain in Rt.of the face, cracks and fissures in lips||0||1||0||1|
|herpetic eruptions around mouth||0||1||0||1|
|Burning sore throat||0||1||0||1|
|dryness of throat||1||1||0||1|
|difficulty in swallowing||0||1||0||1|
|swelling of the parotids||0||1||0||0|
|Anorexia with slight discomfort in epigastrium with nausea and eructation||1||2||1||2|
|Fullness of abdomen||1||2||0||2|
|discomfort in hypogastrium||0||1||0||1|
|cramping, griping pain in hypochondria||0||2||0||2|
|Constrictive pain in pericardium radiating to left arm with numbness||0||2||0||2|
|Cough with dyspnoea and difficult expectoration of the mucus||0||2||0||2|
|BACK & EXTREMITIES|
|Stiffness of neck and back with crackling sounds on movement||1||3||0||3|
|bruised pain in lumbar region as if beaten||1||2||1||2|
|trembling of both hands and legs||0||1||0||1|
|icy coldness of both feet||1||3||1||2|
|cramps in calf muscles||3||8||2||6|
|numbness of part laid on||1||2||1||2|
|Paresthesia of palms and soles||2||8||1||6|
|pain in urethra before and during urination||1||3||1||2|
|Incontinence of urine||2||4||1||3|
|discharge of prostatic fluid||0||1||0||1|
|Dryness of skin with cracks & fissures||1||5||0||4|
|herpetic eruptions with itching||0||1||0||1|
|Sleep disturbance between 2-3 AM||1||3||0||3|
|gets up late in the morning with un-refreshed sleep||1||3||0||3|
|Dreams of animals, insects, dead bodies , floods, robbers etc||0||2||0||2|
|Easily fatigue mentally and physically||3||6||1||6|
|likes stimulants like tea, coffee||1||3||0||3|
|Gingko biloba leaves contains allergen urushiols which is similar to poison Ivy hence used as antidote||0||2||0||2|
|MODALITIES||Total No. of Cases|
|2-3 AM <||1||3|
|cold open air <||1||2|
|looking up and to the right <||0||2|
|Tea, coffee >||1||3|
|DOSEAGE||Total No. of Cases Prescribed||Total No. of Cases Improved|
|recommended dose||(10 drops b.id)||1 tab (250mg) b.id|
|Duration of treatment||2||17|
|Minimum||1 month||1 month|
|Maximum||3 month||1 year|
Table -III response to treatment: laboratory and clinical parameters
|S. No||Laboratory parameters||At entry||At completion||Improved cases by GB|
|1||Hb g%||Min : 9|
Mix : 13
|Min : 11|
Mix : 13.5
|2||FBS in mg/dl||Min : 123|
Mix : 172
|Min : 110|
|3||PPBS in mg/dl||Min : 170|
Mix : 230
|Min : 160|
Mix : 210
|4||Pus cell in Urine||Min : 2-3/HPF|
Mix : plenty /HPF
|Min : 1-2/HPF|
Mix : 6-8/HPF
|5||Albumin in Urine||Min : Trace|
Mix : ++
|Min : nil|
Mix : +
|6||B.P||systolic||Min : 140|
Mix : 160
|Min : 130|
Mix : 150
|Diastolic||Min : 90|
Mix : 100
|Min : 88|
Mix : 94
Note: not mentioned parameters maybe consider normal before and after treatment
About the Ginko
The Ginkgo tree is the only living representative of the division- Ginkgophyta, comprising the single class Ginkgoopsida, order Ginkgoales, family Ginkgoaceae, genus Ginkgo and species biloba is the only extant species within this group. It is one of the best-known examples of a living fossil, because no species other than G. Biloba of Ginkgoales are known from the fossil record after the Pliocene. The tree normally reaches a height of 20-35 m. It is the national tree of China. It belongs to the era when dinosaurs existed 213 million years ago. The extinction of the dinosaurs as potential seed dispersers influenced their decline, according to fossil records. About 7 million years ago the Ginkgo disappeared from the fossil record of North America. It was gone from Europe from about 2.5 million years ago. The tree was widely cultivated and introduced, since an early in human history. It has various uses as a food and traditional medicine. It was once widespread throughout the world, but currently occurs in the wild only in the northwest of Zhejiang province in the Tianmu Shan mountain reserve in eastern China. Even its status as a naturally occurring species there is questionable.
The Ginko withstands harsh conditions and rarely suffers from disease. It’s tenacity may be seen in Hiroshima, Japan, where six trees from the 1945 atom bomb explosion were among the few living things in the area to survive the disaster. Though charred very badly, it grew healthy and was still alive. Its wood is insect resistant which makes it a long lived specimen. Male plants produce small pollen cones with sporophylls each bearing two microsporangia spirally arranged around a central axis. Female plants do not produce cones. Two ovules are formed at the end of a stalk, and after pollination, one or both develop into seeds. The seed is 1.5-2 cm long. Its fleshy outer layer is light yellow-brown, soft, and fruit-like. The seed has the size and appearance of a small apricot when mature and a silvery bloom on the fruit, hence called Ginkgo meaning “Silver apricot”. It is also popularly known as “Maidenhair tree” due to the leaves, which resemble some of the pinnae of the Maidenhair fern, which are fan shaped with a split in the middle, hence named biloba. The nut-like gametophytes inside the seeds are considered as traditional Chinese food, particularly served at special occasions like weddings and the Chinese New Year. Some people are sensitive to the chemicals in the sarcotesta, the outer fleshy coating. Hence the seeds are handled with care by wearing disposable glows while preparing for consumption.
Extracts of Ginkgo leaves contain flavonoid glycosides and terpenoids (ginkgolides, bilobalides) and have been used pharmaceutically. Ginkgo supplements are usually taken in the range of 40-200 mg per day. Although Chinese herbal medicine has used both the ginkgo leaf and seed for thousands of years, modern research has focused on the standardized Ginkgo biloba extract (GBE), which is prepared from the green leaves, as done also in Homoeopathy. This standardized extract is highly concentrated and seems to be clinically more effective.
Ginkgo extract may have three effects on the human body: improvement in blood flow (including microcirculation in small capillaries) to most tissues and organs; protection against oxidative cell damage from free radicals; and blockage of many of the effects of platelet-activating factor (platelet aggregation, blood clotting) that are related to the development of a number of cardiovascular, renal, respiratory and central nervous system disorders.
Ginkgo is found to have nootropic properties and is mainly used as memory and concentration enhancer. Studies have revealed prolye endopeptidase (PEP) activities are significantly higher in Alzheimer’s patients. Ginkgo exhibited inhibition of PEP suggestive of its role in learning and memory processes, major depression and senile dementia. Ginkgo is also used for intermittent claudication. The World Health Organization reports its clinical use in cerebrovascular insufficiency, peripheral arterial occlusive diseases.
Ginkgo eases the symptoms of tinnitus, benefits in multiple sclerosis and arrests the development of vitiligo. Ginkgo may have undesirable effects, especially for individuals using anticoagulants, antidepressants and during pregnancy, hence should be avoided. When any side effects like gastrointestinal discomfort, nausea, vomiting, diarrhoea, headaches, dizziness, heart palpitations, and restlessness occurs then medicine should be stopped immediately.
Clinical utility of Gingko biloba as a geriatric remedy
It is a remedy to increase blood flow to the brain and other parts of the body, thereby improving the delivery of necessary nutrients and oxygen to every cell. It increases metabolic efficiency, regulates neurotransmitters, and controls the transformation of cholesterol to plaque, associated with the hardening of arteries and relaxing constricted blood vessels.
- Universal Repertory By Dr.Roger Van Zandvoort
- Encylopaedia of Homoeopathic Pharmacopoeia By Dr.Verma and Dr.Vaid
- Dictionary of Homoeopathic Materia Medica By O.A.Julian.
- Oriental herbal Medicine,Vol -I, San Francisco, by Dr.Yu Min Chan.
- Chinese Herbal Medicine Materia Medica, by Lilian Lai Bensky.
- Plant Medica Vol.70, by Jung-Han Lee et.al;
- Encyclopedia of Medicinal plants by Andrew Chevallier & Dorlin Kindersley
- A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. North American EGb Study Group. By Le Bars PL,et.al JAMA. 1997 Oct 22-29;278(16):1327-32.
- Ginkgo for memory enhancement: a randomized controlled trial. By Solomon PR, et.al. JAMA. 2002 Aug 21;288(7):835-40.
- Effectiveness of Ginkgo biloba in treating tinnitus: double blind, placebo controlled trial. By Drew S, Davies E. BMJ. 2001 Jan 13;322(7278):73.
- Herbal remedies. By De Smet PA.N Engl J Medorrhinum 2002 Dec 19;347(25):2046-56.