Izvrstan prikaz prastare kineske legende o nimfi iz rijeke Lou gdje su u rukopisu od prije tisuću i više godina naslikana stabla ginka! Možda je ovo neobićno, međutim ginko u Hrvatskoj raste već više od 230 godina - prema tome važno je predstaviti ovu izvanrednu obradu navedene legende, odnosno pjesme ! SJAJNO! Više vidi OVDJE! Ovakva je priča: "Nimfa rijeke Lou (Luo)" - kopija originalnog slikovnog prikaza iz oko 1100. godine (dinastije Song) pjesme kineskog pjesnika Cao Zhi (192-232. g. prije n. e.) - je u podlozi ovog spota. Stara kineska pjesma govori o susretu, razmišljanjima i nemogućoj ljubavi pjesnika sa nimfom kineske rijeke Lou (Luo). Na slici su u više navrata prikazana stabla ginka. To je pjesma poznata pod originalnim nazivom "LuoShenFu". Originalni i najstariji slikovni prikaz iste pjesme potječe iz 4. stoljeća kineskog slikara-pjesnika Gu Kaizhi-a (cca.344-405. g.). U ovom video-foto spotu prikazana je ta pjesma na moderan način - digitalno obrađena. Watch and listen & enjoy!
• Za sve informacije u vezi uzgoja ginka (nabave i uzgoja sadnica, sadnje...) nazovite 098 1365 893 ili se javite na e-mail:
ginkgo.begovic@gmail.com
11. lipnja 2013.
by • Branko Begović - Bego •

Za rast i regeneraciju (korijena) kose.
 
1. Terapiju počnite sa nekom standardnom vitaminskom kremom (ili sl. najbolje na bazi vode) za jačanje vlasišta i rast kose. I u Hrvatskoj se, čini mi se, može nači i vitaminska Ultra Mega krema za kosu http://members.fortunecity.com/fifty1/hair.htm, ali može poslužiti i bilo koja druga. Slijedite uputstva proizvođača kreme narednih dva tjedna (15 dana) da vlasište, korijen dobije vitaminsku i mineralnu podlogu.
 
2. Nakon 15 dana počnite sa ginkom. Dva puta dnevno u isto vrijeme (odredite si sami termine 2x/dan).
Sudeći prema raznim privatnim iskustvima koja se temelje i na podacima sa nekih web stranica kosu, odnosno na problematični dio glave nanesite dva puta dnevno kremu sa ginkom i držite cca 15-20-ak minuta, nakon čega isperite kremu standardnim šamponom za kosu ili onime kojega inaće koristite.
Nakon tjedan dana prekinite, a opet nakon 3 dana ponovo stavljajte kremu tjedan dana. Dakle 7 dana se stavlja 2x/dan, 3 ne stavlja, 7 stavlja, 3 ne stavlja. Nakon cca 60 dana trebali bi osjetiti pikanje na mjestima gdje kose nije bilo. Nešto poput početka rasta brade kod muškaraca drugi ili treći dan nakon ne brijanja.
 
Kremu sa ginkom možete načiniti vrlo jednostavno (prema zbiru kineskih recepata). Kao prvo uzmite bilo koju kremu koja pospješuje rast kose ili jača korijen (najbolje na bazi vode). Večina ih i jest danas na toj bazi (ali ima nekih na bazi alkohola, vazelina, parafina itd.). U biti i nije previše važno koja je baza, no voda je voda. Ne uništava ginkolide (kvarcetin, izoramnetin, kemferol i dr.) iz ginka. Recimo neka to bude krema koju ste 15 dana već koristili. Kako dodati ginko? Za 100 ml (ili 1 dcl). Uzmete 10-12 sjemenki ginka (za 1000 ml. ili 1 l. = 100-120 sjemenki) - list treba biti suhi ili svježi ubran nešto prije dobivanja žute boje, tj. cca  rujan/listopad (ovisi o godini). Skinete ljusku što se radi vrlo lako. Zatim u jednoj litri vode skuhate normalan čaj od ginkovog lista (bez šečera-stavite 9-10 listova, i držite u vodi 4-5 min.). Ocijedite čaj i kasnije stavite u frižider ako ne mislite raditi veću količinu kreme. Očišćene sjemenke izmiksajte tako da dobijete pastu (kremu) i dodajite u mix navedeni čaj do te mjere dok ne dobijete cca 60 ml (ili 0,6 dcl. - ako se radi cijela litra onda do 6 dcl - ili ukupno 60% količine). Izmiksajte tako da dobijete rijetku kremu - polugustu lijepu zelenkasto-žućkasto-bijelu tekućinu (svježi ginko nije tvrd pa se to radi zaista lako i brzo). Ostalih 40% nadomjestite sa onom kremom što ste mazali kosu i vlasište prvih 15 dana. I sve skupa izmiksajte. Možete odmah složiti ne 1 dcl, već 0,5 l. ili više, a kremu možete držati u frižideru.
Nemojte misliti da je ovo mala koncentracija ginka jer ćete se prevariti. Ekstrakt ginka (tzv. Gbe) koji se radi od lista sadrži (baza) točno 24% flavonoid glikozida, oko 6% terpen laktona i nešto ginkolidne kiseline. Taj se ekstrakt (Gbe) koristi u tabletama i drugim proizvodima u omjeru isključivo čak 50:1 (1 dio Gbe). Onda znadete kako je to mali omjer, a djelotvoran. Sjeme ima iste sastojke (ginkolide, 4-methoxypyridoxin...) samo u drugom, pristupaćnijem obliku u odnosu na list. Npr. djetetu ni za Boga ne dati dvije ili tri sjemenke sirovog sjemena ginka da pojede. Kuhanog, pečenog, prženog može, ali ne mnogo (samo nekoliko sjemenki). Kazat ću Vam i ovo. Jedna od glavnih karakteristika ginka je ta da svi ginkovi sastojci (ginkolidi kojih ima samo u ginku) povečavaju, odnosno smanjuju učinkovitost raznih lijekova, kako antibiotika, anpiretika i dr. čak i antidepresiva (naravno ako se ginko pije u bilo kojem obliku). Ako se jede ginko (sjeme) je super - pržen kao kesten. Otrovan je navedeni 4-methoxypyridoxin (koji uništava vitamin B) ali nije termostabilan.

19. ožujka 2012.
by • Branko Begović - Bego •

• GINKGO BILOBA L. 1771. • • GINKGO BILOBA L. 1771. • • GINKGO BILOBA L. 1771. •

Budući da imam mnogo upita kako se radi i upotrebljava tinktura od ginka objasnit ću osnove za izradu i upotrebu i dr. s time u vezi

Tinktura od lista ginka (Ginkgo biloba)


Odličan je prirodni lijek koji se koristi poput ginkovog ekstrata, odnosno u ovom obliku ovo i jest jedna vrsta ekstrata ljekovite biljke Ginkgo biloba. Klasični GBE, odnosno ginkgov ekstrat danas se na tržištu može naći uglavnom u obliku praha koji se izrađuje od ginkovog lista.

Tinktura se koristi protiv vrlo mnogo bolesti, odnosno protiv tegoba koje liječe ginkgolibi i svi ostali sastojci ginka: prvenstveno se to odnosi na sve ono što je priznao WHO, odnosno Svjetska zdravstvena organizacija (1999.) kao i za ono što su dokazala brojna znanstvena istraživanja i ono što je dokazano u medicini Istoka: razne kardio-vaskularne nedostatnosti, degenerativne demencije, vaskularne demencije, zaboravnost, poremećaji koncentracije, depresivna emocionalna stanja, vrtoglavica, zujanje u ušima, glavobolja, impotencija, oštećeno centralno uho, regulira očni tlak, krvni tlak, pomaže kod raznih upala, djeluje preventivno od raznih karcinoma i tumora, liječi plučne edeme, kao i one u trudnoći, astmu, migrene, alergije, poremečaje erekcije, hemeroide, bolove u želucu, čireve na želucu itd. Ginkov ekstrat je antiseptik, antidepresiv, antipiretik, antibiotik itd. U stvari – gotovo da i ne postoji ono što ginko ne liječi ili gdje ne služi kao preventiva.

Prema WHO studiji i preporukama (1999.) doziranje je slijedeće: sušeni standardni ekstrat (tzv. standardni GBE 761 gdje je obavezna baza 24% flavanoidglikozida i 6% terpenlaktona) - 120-240 mg dnevno u 2 ili 3 podijeljene doze • 40 mg ekstrata je ekvivalent za 1,4-2,7 g suhih listova.

Izrada i uporaba tinkture:
Koristi se 70% alkohol (prema kineskim i istočnjačkim iskustvima), a najbolji je škrobni alkohol. Na 1 litru alkohola dodaje se otprilike oko tri šake svježe ubranog lista ginka ubranog oko tjedan dana prije nego što je list počeo žutjeti, odnosno od oko kraja rujna do oko sredine listopada kada list ima najviše ljekovitih sastojaka – odnosno oko 50-70 listova srednje veličine. List se nasjecka na manje plohe poput crvenog luka i namoći u alkohol, te ostavi da odstoji oko 14 dana na sobnoj temperaturi. Svakih 3-4 dana pripravak promiješamo. Suhog lista je potrebno oko 40-50% manje na istu količinu alkohola budući da osušeni list ima puno manje vlage. Tada ga je dovoljno usitniti trganjem. Može se koristiti i nešto slabiji alkohol, no tada je potrebno na oko 10% manje vrijednosti alkohola dodati isto toliko više listova, kao i isto toliko vremena ostaviti da se otope vrijedni sastojci (ginkgolidi, bilobalidi i dr.). Nakon ovog procesa potrebno je pripravak procijediti i staviti u staklenku i dobro zatvoriti, a upotreba se vrši isključivo razrijeđena. Na dan je dovoljno oko 10 kapi 2-3 puta na dan. Ova vrsta ekstrata koristi se sa šećerom ili vodom, odnosno medom ili u čaju. Umjesto škrobnog industrijskog alkohola koji se proizvodi od žitarica, krumpira ili voća u Kini i na Istoku koriste se 40-70%-e razne rakije (koje se koriste i za piće jer imaju i ugodan/određeni okus) npr. od riže, grožđa ili drugog voća.

Više možete saznati na brojnim kineskim stranicama preko Googlovog pretraživača.

Valja napomenuti da se za upotrebljavanje tinkture valja posavjetovati u ljekarnama ili kod liječnika. Vidi ovdje mišljenje Svjetske zdravstvene organizacije od 1999. (origin. PDF)



by • Branko Begović - Bego •



Dynamic Glitter Text Generator at TextSpace.net

10. prosinca 2008.
by • Branko Begović - Bego •



Ginko kao ukras i lijek u vrtu i kući

Gotovo je nezamislivo da bi neka biljna vrsta današnjeg izgleda mogla izgledati isto tako i prije 100 milijuna i više godina. No to je slučaj upravo sa biljkom Ginkgo biloba (Ginkgoacea), jedinom od desetak (prema fosilima) poznatih vrsta koja se sačuvala do danas - u zabačenim dijelovima Kine.

Gotovo da nemamo slične biljke Ginkgu bilobi. On je listopadno drvo, postoje muške i ženske jedinke, razmnožava se poput četinjača gibljivom spermom, a izgled lista, koji sliči lepezi, nema niti približno niti jedna biljna vrsta.

Početkom proljeća na granama ginka počinju se otvarati veliki sivkasto-zelenkasti pupovi iz koji h će se pojaviti prvo sitno, zatim sve veće lišće svježe zelene boje. Ako već imamo stariju biljku tada će uskoro biljka procvjetati neuobičajenim cvjetovima (sad da li oni bili muški ili ženski) kakve nema niti jedna biljna vrsta na Zemlji. Tijekom ljeta ginko će pokazati svoju ljepotu prekrasnim buketama lišća na granama, a dolaskom jeseni list će od vrha prema dršci početi dobivati narančasto-žutu boju koja će se vrlo brzo pretvoriti u raskošne razigrane detalje izrazito žute ili zlatno žute boje, kakve se rijetko mogu vidjeti u prirodi.

Začudo! Neko vrijeme prekrasan žuti list će ostati na biljci, a zatim će postepeno padati i stvarati gotovo nezamisliv ugodan žuti lisnati tepih koji će, ako ga se ne pokupi, ostati u punom svom efektu danima i danima.

Možda imate ginko u nekom svojem lijepom cvjetnjaku na terasi ili u kući? Ako nemate onda ga svakako nabavite. Već star samo godinu dana ginko će vam pokazati sve svoje čari, a iz godine u godinu ta girlanda lišća biti će sve upečatljivija i sve zapaženija za svakog gosta koji će doći u vaš dom. U tom obliku, u kakvoj lijepoj ukrasnoj vazi, glinenom cvjetnjaku ginko može biti dugi niz godina i čak deset godina star neće biti viši od jednog do dva metra, tako da vam neće smetati poput benjamina ili pak nekih drugih kućnih ili ukrasnih terasnih biljaka - kao što su razni drugi ficusi ili tzv. adami. Za razliku od drugih biljaka oko ginka će vam trebati relativno malo vremena, a neće ga napasti niti najučestalije bolesti koje se mogu pojaviti i u vašem vrtu. Ginku je dovoljno pažnje u toj mjeri da mu dadete dosta svjetla, da ga previše ne zalijevate, previše ne prihranjujete, a kada jednom zaista naraste u toj mjeri da vam je prevelik za stambeni prostor presadite ga u vrt ili dvorište. Stavite ga na mjesto koje ima dosta slobodnog prostora i tu će vam sasvim sigurno ponovno biti eksponat kojega neće zasjeniti niti kakva profinjena skulptura načinjena ljudskom rukom.

Kada već imate ginka za ukras ili već (jednostavno) samo zato da ga imate, jer je rijetka i posebna biljka, priča o ginku ovdje ne završava. Njegov list sadrži nekoliko kemijskih spojeva koje ne proizvodi niti jedna druga biljka na Svijetu pa se u farmaceutskoj industriji od njega radi tzv. ginkov ekstrat (znanstveni naziv Gbe) koji je poznat po svojim vrlo ljekovitim svojstvima, a nadasve je poznat za pospješivanje cirkulacije krvi u mozag (i za još mnogo toga...). Dakle, ako imate ginko onda imate i priručnu apoteku. Ginkov list je najljekovitiji od kraja lipnja pa sve do rujna/listopada. Tada ga valja ubirati, sušiti i spremati u tamne i suhe posude kako biste ga imali u zimi. U vrijeme vegetacije dovoljno je otkinuti list dva sa biljke i staviti u čaj i to će sasvim sigurno pomoći ili biti preventiva protiv mnogih bolesti. Spomenut ću vam istinitu priču iz 2008. godine, kada je moja supruga negdje u ljetu prošetala perivojem oko Pejačevićevog dvorca u Virovitici i došla do starog stabla ginka iz sredine 19. stoljeća i tu zatekla starog gospodina koji je ubirao list sa te biljke koje grane često dopiru i do same zemlje. Na njezino pitanje, što to bere, zašto bere, kako se to zove, starac je odgovorio kratko «to je za čaj, za lijek. To lišće berem od mladosti, a kako se zove ne znam. Nekada su mi moji stari govorili da je to zdravo lišće i ja ga berem još i sada». «Djede, to vam se zove ginko!». – A tako dakle, to je ginko - odgovorio je stari gospodin.



GINKGO BILOBA - BILJKA JE KOJA JE USPJELA PREŽIVJETI STOTINE MILIJUNA GODINA!!!!!! TO SE NIJE DOGODILO BEZ RAZLOGA!!!!!!!!!
MNOGO VIŠE!!!!!!!!

NO NA OVOJ STRANICI SAZNAT ĆETE VRLO MNOGO O LJEKOVITIM SVOJSTVIMA GINKGA BILOBE


ZA POČETAK EVO PRVO RAZNIH KEMIJSKIH FORMULA KOJE ĆEMO POSTEPENO OBJASNITI. ČEKA NAS VELIKI POSAO PA VAS MOLIM ZA STRPLJENJE - TIJEKOM SLIJEDEĆIH NEKOLIKO DANA OBJAVIT ĆEMO VELIKI DIO ONOGA ŠTO TREBAMO ZNATI O GINKGU BILOBI! - jer ne želimo pogreške!!!!!!!!!!!!!!





WHO

monografija o

selekciji

medicinskih - ljekovitih biljaka

__________

VOLUMEN 1

World Health Organization

Geneva

1999


(Originalna verzija uvoda – prijevod osnovnih pojmova o biti ove monografije: B. Begović)


WHO Library Cataloguing in Publication Data

WHO monographs on selected medicinal plants.—Vol. 1.

1.Plants, Medicinal 2.Herbs 3.Traditional medicine

ISBN 92 4 154517 8

(NLM Classification: QV 766)


The World Health Organization welcomes requests for permission to reproduce or translate itspublications, in part or in full. Applications and enquiries should be addressed to the Office ofPublications, World Health Organization, Geneva, Switzerland, which will be glad to provide thelatest information on any changes made to the text, plans for new editions, and reprints andtranslations already available.


© World Health Organization 1999

Publications of the World Health Organization enjoy copyright protection in accordance with theprovisions of Protocol 2 of the Universal Copyright Convention. All rights reserved.

The designations employed and the presentation of the material in this publication do not imply theexpression of any opinion whatsoever on the part of the Secretariat of the World Health Organizationconcerning the legal status of any country, territory, city or area or of its authorities, orconcerning the delimitation of its frontiers or boundaries.

The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of asimilar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

Designed by WHO Graphics

Typeset in Hong Kong

Printed in Malta

97/11795-Best-set/Interprint-6500


Sadržaj (Izdvojeno - ginkgo – ostalo originalna opcija)

Navedena monografija obuhvaća slijedeće pojmove-biljke (original)

Monografska obrada (abecednim redom – u originalu)


Bulbus Allii Cepae

Bulbus Allii Sativi

Aloe

Aloe Vera Gel

Radix Astragali

Fructus Bruceae

Radix Bupleuri

Herba Centellae

Flos Chamomillae

Cortex Cinnamomi

Rhizoma Coptidis

Rhizoma Curcumae Longae

Radix Echinaceae

Herba Echinaceae Purpureae

Herba Ephedrae

Folium Ginkgo

Radix Ginseng

Radix Glycyrrhizae

Radix Paeoniae

Semen Plantaginis

Radix Platycodi

Radix Rauwolfiae

Rhizoma Rhei

Folium Sennae

Fructus Sennae

Herba Thymi

Radix Valerianae

Rhizoma Zingiberis


Annex


Participants in the WHO Consultation on Selected Medicinal


Plants


Prilog

Sudionici za odabrane WHO konzultante o lijekovima

(U nastavku plavom bojom je predstavljena originalna i potpuna varijanta monografije ili samo pojedini važni fragmenti monografije!)


Zahvala

Posebna zahvala, zbog značajnog doprinosa na ovom projektu, profesorima Normanu R. Farnsworth, Harryu Rs Fong, i Gailu B. Mahady za suradnju sa WHO - Centrom za Traditional Medicin, College of Pharmacy, University of Illinois u Chicagu, SAD, za izradu i reviziju monografije. Navedeni ju također odobravaju i zahvaljuju članovima savjetodavne grupe koja se sastala u Pekingu, Kina, 1994. i sastavila popis ljekovitih biljaka za ovu monografiju koju je pripremilo više od 100 stručnjaka koji su dali komentare i savjete o nacrtu tekstova, a koji su sudjelovali u WHO konzultacijama, koje su se održavale u Münchenu, Njemačka, 1996. - sve do konačne varijante monografije (vidi Prilog - Annex) - Finally, WHO would like to thank the Food and Agriculture Organization of the United Nations and the United Nations Indus-trial Development Organization for their contributions and all those who submitted comments through the World Self-Medication Industry, a nongov-ernmental organization in official relations with WHO.


Uvod

Tijekom proteklih desetljeća, tradicionalni sustavi medicine postali su tema od globalne važnosti. Trenutne procjene sugeriraju da se veliki dio svjetske populacije snažno oslanja na tradicionalnu tehniku liječenja i ljekovito bilje što bi trebalo zadovoljiti (dopuniti) i potrebe primarne zdravstvene zaštite. Iako moderna medicina ne može uvijek biti dostupna u tim zemljama koje preferiraju ovakvu vrstu medicine, LJEKOVITO BILJE (phytomedicines) je često vezano uz popularizaciju iz povijesnih i kulturnih razloga. Usporedno tome, mnogi ljudi u razvijenim zemljama počeli su se baviti alternativnim ili komplementarnim terapijama, uključujući i ljekovito bilje. Nekoliko biljnih vrsta ljekovitih biljaka su znanstveno ocijenjene za svoje moguće uspješne medicinske primjene. Podataka (o pripravcima) o sigurnoj ljekovitosti i djelotvornosti kao lijeka imamo podatke za malo biljaka – njihovih ekstrata i njihovih aktivnih sastojaka. Nadalje, u većini zemalja u biljnoj mediteranskoj skupini tržište je slabo regulirano, i biljni proizvodi su često vrlo loše ili nikako regulirani – što se tiće pravila WHO-a. Osiguranje sigurnosti, kvalitete i učinkovitosti medicinskog bilja i biljnih proizvoda je trenutno postao ključni problem u industrijaliziranim zemljama i zemljama u razvoju. Oba potrošaća trebaju od kompetentnih osoba (profesora i doktora medicine, botanike i dr. znanstvenika) dobiti mišljenja i studije, te autoritativne informacije o sigurnosti i učinkovitost ljekovitih biljaka. Tijekom četvrte Međunarodne konferencije o drogama-lijekovima (ICDRA) održane u Tokyu 1986., zatražen je popis ljekovitih biljaka te da se uspostavi međunarodna specifikacija za većinu naširoko koristećih ljekovitih biljaka koje se jednostavno pripremaju. Smjernice za uporabu ljekovitih biljaka za biljne lijekove je naknadno pripremila WHO i usvojila na šestom ICDRA u Ottawi, Kanada, 1991. (Guidelines for the assessment of herbal medicines. In: Quality assurance of pharmaceuticals: a compendium of guidelines and related materials. Volume 1. Geneva, World Health Organization, 1997:31–37.)


Kao rezultat ICDRA-ove preporuke i kao odgovor na zahtjeve iz država članica ove skupine - u pružanju pomoći za sigurne i učinkovite biljne lijekovite preparate za uporabu nacionalnih zdravstvenih sustava, u ovom (1) dijelu izdvojeno je i uvršteno 28 odabranih ljekovitih biljaka, a druge su u pripremi za isto.


Priprema za monografiju

Ljekovite biljke sadržane u ovoj monografiji su odabrane prema savjetodavnoj stručnoj skupini koja je radila protekle četiri godine – od 1994.

The medicinal plants featured in this volume were selected by an advisory group in Beijing in 1994. The plants selected are widely used and important in all WHO regions, and for each sufficient scientific information seemed available to substantiate safety and efficacy. The monographs were drafted by the WHO Collaborating Centre for Traditional Medicine at the University of Illinois at Chicago, United States of America. The content was obtained by a systematic review of scientific literature from 1975 until the end of 1995: review articles; bibliographies in review articles; many pharmacopoeias—the International, African, British, Chinese, Dutch, European, French, German, Hungarian, Indian, and Japanese; as well as many other reference books. Draft monographs were widely distributed, and some 100 experts in more than 40 countries commented on them. Experts included members of WHO's Expert Advisory Panels on Traditional Medicine, on the International Pharmacopoeia and Pharmaceutical Preparations, and on Drug Evaluation and National Drug Policies; and the drug regulatory authorities of 16 countries. A WHO Consultation on Selected Medicinal Plants was held in Munich, Germany, in 1996. Sixteen experts and drug regulatory authorities from Member States participated. Following extensive discussion, 28 of 31 draft monographs were approved. The monograph on one medicinal plant was re-jected because of the plant's potential toxicity. Two others will be reconsidered when more definitive data are available. At the subsequent eighth ICDRA in Bahrain later in 1996, the 28 model monographs were further reviewed and endorsed, and Member States requested WHO to prepare additional model monographs.


Svrha i sadržaj monografije

Svrha ove monografije je:

pružiti znanstvene informacije o sigurnosti, djelotvornosti i kontroli kvalitete / Osiguranje stupnja kvalitete ljekovitog bilja, kako bi se olakšala njihova odgovarajuća primjena u državama članicama; osigurati pomoć državama članicama u razvoju vlastitog odnosa prema biljnim lijekovima, i olakšati razmjenu informacija između država članica.

Readers will include members of regulatory authorities, practitioners of orthodox and of traditional medicine, pharmacists, other health professionals, manu-facturers of herbal products, and research scientists.

Each monograph contains two parts. The first part consists of pharmacopoeial summaries for quality assurance: botanical features, distribution, identity tests, purity requirements, chemical assays, and active or major chemical constituents. The second part summarizes clinical applications, pharmacology, contraindications, warnings, precautions, potential adverse reactions, andposology.

In each pharmacopoeial summary, the Definition section provides the Latin binomial pharmacopoeial name, the most important criterion in quality assurance. Latin pharmacopoeial synonyms and vernacular names, listed in the sections Synonyms and Selected vernacular names, are those names used in com-merce or by local consumers. The monographs place outdated botanical nomenclature in the synonyms category, based on the International Rules of Nomenclature.

For example, Aloe barbadensis Mill. is actually Aloe vera (L.) Burm. Cassia acutifolia Delile and Cassia angustifolia Vahl., often treated in separate monographs, are now believed to be the same species, Cassia senna L. Matricaria chamomilla L., M. recutita L., and M. suaveolens L. have been used for many years as the botanical name for camomile. However, it is now agreed that the name Chamomilla recutita (L.) Rauschert is the legitimate name.

The vernacular names listed are a selection of names from individual countries worldwide, in particular from areas where the medicinal plant is in common use. The lists are not complete, but reflect the names appearing in the official monographs and reference books consulted during preparation of the WHO monographs and in the Natural Products Alert (NAPRALERT) database (a database of literature from around the world on ethnomedical, biological and chemical information on medicinal plants, fungi and marine organisms, located at the WHO Collaborating Centre for Traditional Medicine at the University of Illinois at Chicago).

A detailed botanical description (under Description) is intended for quality assurance at the stages of production and collection, whereas the detailed description of the drug material (under Plant material of interest) is for the same purpose at the manufacturing and commerce stages. Geographical distribution is not normally found in official compendia, but it is included here to provide additional quality assurance information.

General identity tests, Purity tests, and Chemical assays are all normal compendial components included under those headings in these monographs. Where purity tests do not specify accepted limits, those limits should be set in accordance with national requirements by the appropriate Member State authorities.

Each medicinal plant and the specific plant part used (the drug) contain active or major chemical constituents with a characteristic profile that can be used for chemical quality control and quality assurance. These constituents are described in the section Major chemical constituents.

The second part of each monograph begins with a list of Dosage forms and of Medicinal uses categorized as those uses supported by clinical data, those uses described in pharmacopoeias and in traditional systems of medicine, and those uses described in folk medicine, not yet supported by experimental or clinical data.

The first category includes medical indications that are well established in some countries and that have been validated by clinical studies documented in the world's scientific literature. The clinical trials may have been controlled, randomized, double-blind studies, open trials, or well-documented observations of therapeutic applications. Experts at the Munich Consultation agreed to include Folium and Fructus Sennae, Aloe, Rhizoma Rhei, and Herba Ephedrae in this category because they are widely used and their efficacy is well documented in the standard medical literature.

The second category includes medicinal uses that are well established in many countries and are included in official pharmacopoeias or national monographs. Well-established uses having a plausible pharmacological basis and supported by older studies that clearly need to be repeated are also included. The references cited provide additional information useful in evaluating specific herbal preparations. The uses described should be reviewed by local experts and health workers for their applicability in the local situation.

The third category refers to indications described in unofficial pharma-copoeias and other literature, and to traditional uses. The appropriateness of these uses could not be assessed, owing to a lack of scientific data to support the claims. The possible use of these remedies must be carefully considered in the light of therapeutic alternatives.

The final sections of each monograph cover Pharmacology (both experimental and clinical); Contraindications such as sensitivity or allergy; Warnings; Precautions, including discussion of drug interactions, carcinogenicity, teratogenicity and special groups such as children and nursing mothers; Adverse reactions; and Posology.

Use of the monographs

WHO encourages countries to provide safe and effective traditional remedies and practices in public and private health services.

This publication is not intended to replace official compendia such as pharmacopoeias, formularies, or legislative documents. The monographs are intended primarily to promote harmonization in the use of herbal medicines with respect to levels of safety, efficacy, and quality control. These aspects of herbal medicines depend greatly on how the individual dosage form is pre-pared. For this reason, local regulatory authorities, experts, and health workers, as well as the scientific literature, should be consulted to determine whether a specific herbal preparation is appropriate for use in primary health care.

The monographs will be supplemented and updated periodically as new information appears in the literature, and additional monographs will be prepared. WHO would be pleased to receive comments and suggestions, to this end, from readers of the monographs.

Finally, I should like to express our appreciation of the support provided for the development of the monographs by Dr H. Nakajima and Dr F. S. Antezana during their time as Director-General and Assistant Director-General, respectively, of WHO.

Dr Xiaorui Zhang

Medical Officer

Traditional Medicine

World Health Organization

Svjetska zdravstvena organizacija (WHO)


List ginkgo Folium Ginkgo


Definicija

List ginkga se sastoji od osušenog cijelog lista ginkgo biloba L. (Ginkgoaceae).


Sinonimi

Pterophyllus salisburiensis Nelson, Salisburia adiantifolia Smith, Salisburia macrophylla C. Koch (1-4).


Odabrani kolokvijalni nazivi

Eun-haeng, gin-nan, ginkgo, ginkgo matičnjak, ginkyo, ginan, icho, ityo, kew drvo, stablo viline vlasi, pei-wen, hramsko stablo, yin guo, yinhsing (1-5).


Opis

Dvodomna biljka koja je jedini živi predstavnik porodice Ginkgoales. Kora stabla je siva, doseže visinu od 35 m, a promjera 3-4 m (ponekad i do 7 m), lišće otpada kao u bjelogorice, dvorežnjasto je, osnovni oblik lepezast, 6-9 cm širok (ponekad 15-20 cm), u jesen list žute boje. Žilice lista paralelno se granaju. Muški pokretljivi spermiji oplođuju ženska jaja. Rezultat: plod oštrog i jakog mirisa u kojem je jedna koštunica. Vanjski sloj mesnat. Zrelo sjemenje žućkaste boje, a suho sjeme vrlo tvrdo.

A monotypic dioecious plant that is the only living representative of the Ginkgoales. It has a grey bark, reaches a height of 35 m and a diameter of 3–4 m (sometimes up to 7 m), and has fan-like leaves that are deciduous, alternate, lengthily petiolate, bilobate, base wedge-shaped, 6–9 cm broad (sometimes up to 15–20 cm), turning yellow in autumn. Venation dichotomously branching, seemingly parallel. Staminate and ovulate strobili borne on separate trees; staminate strobili consisting of naked pairs of anthers in catkin-like clusters; ovulate strobili in the form of long, slender, fused stalks bearing a single naked ovule which is fertilized by motile sperm cells, developing into 2 seeds. Seeds yellow when mature, foul-smelling, drupe-like, the middle layer of integument becoming hard or stone-like, the outer layer fleshy (3, 4).


Važan biljni materijal: osušeni list

Koštica (kao orah - sjeme) koja se koristi u kineskoj medicini (6, 7).


Opći izgled

U vegetaciji list je zelen, zatim sivo-žut, te smeđi ili crnkast; gornja strana lista uglavnom je nešto tamnija nego donja. U biti na dužoj peteljci nalazi se list koji se sastoji od dva dijela sličnih lepezi (2, 4, 8).


Organoleptička svojstva

Ginkgo nema posebno karakterističan miris – list (2, 4, 8).


Mikroskopski karakteristike

Mladi listovi imaju izobilje krvotočnih žilica, dok lišće nema srednje rebro, a list ispunjavaju paralelne žilice koje nemaju bazu, međutim sve počinje od peteljke.

While the leaves have no midrib, dichotomous venation with regular, numerous branching parallel veins arises from two vascular strands within the petiole. Stomata occur almost exclusively on the lower surface of the leaf. The epidermis of the upper and underside of the leaf consists of undulated, irregular, mostly long extended cells. In the cross-section, the epidermal cells appear nearly isodiametric and from above appear to be slightly undulated, with the upper cells appearing larger. The outer walls of the epider-mal cells are covered with a more or less thin layer of cuticle. In the area of vascular bundles there are remarkable long extended narrow cells with slightly undulated walls. Numerous druses of calcium oxalate occur near the vascular bundles (2, 4).


Biljni materijal u prahu

Boja praha suhog lista identična je boji lišća.

The powder shows fragments of the epidermis with wavelike indentations irregular in form with generally elongated cells; large stomal openings of the anisocytic type; mark-edly elongated, narrow cells with only weakly undulated walls in the vascular areas and without marked indentations. The equifacial mesophyll comprises excretory vesicles, secretory cells, and idioblasts, as well as intermittent calcium oxalate druses, in the region of the vascular fascicles (2, 8).


Geografsko podrijetlo

Postojbina u Kini, ali raste kao ukrasno stablo u Australiji, jugoistočnoj Aziji, Europi, Japanu i Sjedinjenim Američkim Državama (1-3, 6). Komercijalno se najviše uzgaja u Francuskoj i Sjedinjenim Američkim Državama (2).

Identifikacijske testovne osnove

Opći i mikroskopski pregled (2, 8). Analizom potvrđena prisutnost: flavonoidi, ginkgolidi i bilobalidi (9), visoke performanse tekućina kromatografske analize za: flavonoidi (10), ginkgolidi i bilobalidi (2); i evaluacija od ginkgolida i bilobalida (11).


Testovi

Mikrobiologija

Test na salmonele spp. u listu ginkga je negativan. MAXI-mama je prihvatljivih granica kao i drugih mikroorganizama - kako slijedi (12-14). Za priprema esencije: aerobna bakterija - ne više od 107 / g, gljive - ne više od 105 / g, Escherichia coli - ne više od 102 / g. Pripreme za internu uporabu: aerobna bakterija - ne više od 105 / g ili ml; gljive-ne više od 104 / g ili ml; enterobakterije i neke gram - negativne bakterije - ne više od 103 / g ili ml; Escherichia coli-0 / g ili ml.


Strane organske tvari

Ne više od 5% neštetnih tvari i ne više od 2% drugih stranih tvari (15).


Ukupno pepeo

Ne više od 11% (15).


Pesticidi

Da bi bio u skladu s internacionalno prihvatljivim zahtjevima. Uobičajeno je maksimalno ograničenje ostataka aldrina i dieldrina u listu ginkga ne više od 0,05 mg / kg (14). Za druge pesticide, vidjeti upute za kontrolu kvalitete za ljekovito bilje (12), i smjernice za predviđanje unosa od ostataka pesticida (16).


Teški metali

Preporučena razina olova i kadmija ne smije biti veća od 10 i 0.3mg/kg, odnosno, doza u konačnom obliku je biljni materijal (12).

Recommended lead and cadmium levels are not more than 10 and 0.3mg/kg,

respectively, in the final dosage form of the plant material (12).


Radioaktivni ostaci

Za analizu – stroncija - 90, jod - 131, cezij - 134, cezija - 137 i plutonij - 239, kao kod opće kontrole kvalitete ljekovitog bilja (12).


Ostali testovi čistoće

Kiseline.........i dr. u skladu s nacionalnim zahtjevima.

Acid-insoluble ash, acid-insoluble extractive, chemical, and moisture tests to be established in accordance with national requirements.


Kemijski sastojci - mjere

Flavonoidi ne manje od 0,5% - obračunava se kao flavonol glikozida 0.2-0.4% - izračunava se kao aglycones (17), također sadrži ginkgolida (0.06-0.23%) i bilobalida (do 0,26%) (2, 17). Kvalitativna i kvantitativna određivanja flavonoidglikozida je provedena (nakon hidrolize) na glycones kemferovo ulje, kvercetin, a izoramnetin. Za kvalitetu određuje se prisutnost ili odsutnost biflavona (17); i kvalitativna i kvantitativna sadržajnost ginkgolida i sesquiterpen bilobalida (2, 18), ( 11).

Neki komercijalni proizvodi koriste se za kliničke i eksperimentalne biološke studije, npr. EGb LI 761 i 1370, koji ne sadrže biflavone.

Flavonoids not less than 0.5% calculated as flavonol glycosides or 0.2–0.4% calculated as aglycones (17); also contains ginkgolides (0.06–0.23%) and bilobalide (up to 0.26%) (2, 17).

Qualitative and quantitative determination of flavonoid glycosides is carried out after hydrolysis to the aglycones kaempferol, quercetin, and isorhamnetin. The qualitative presence or absence of biflavones (17) is determined by high-performance liquid chromatography; and qualitative and quantitative deter-mination of the diterpene ginkgolides and sesquiterpene bilobalide by high-performance liquid chromatography (2, 18) or gas–liquid chromatography (11).

Certain commercial products used for clinical and experimental biological studies, e.g. EGb 761 and LI 1370, do not contain biflavones.


Značajke kemijskih konstituenata

List ginkgo sadrži raznovrsnu fitokemiju. Tu su uključeni alkani, lipidi, steroli, benzenoidi, karotenoidi, fenilpropani, ugljikohidrati, flavonoidi i terpenoli (18, 19). U glavnini su flavonoidi. Karakteristični sastojak ovog biljnog materijala su jedinstveni ginkgolidi A, B, C, J i M i sesquiterpen lakton bilobalidi (17).

Folium Ginkgo contains a wide variety of phytochemicals, including alkanes, lipids, sterols, benzenoids, carotenoids, phenylpropanoids, carbohydrates, flavonoids, and terpenoids (18, 19). The major constituents are flavonoids of which mono-, di-, and tri-glycosides and coumaric acid esters that are based on the flavonols kaempferol and quercetin dominate. Lesser quantities of glyco-sides are derived from isorhamnetin, myricetin, and 3'-methylmyricetin. Non-glycosidic biflavonoids, catechins, and proanthocyanidins are also present (15).

Characteristic constituents of this plant material are the unique diterpene lactones ginkgolides A, B, C, J, and M and the sesquiterpene lactone bilobalide (17). Representative structures of the major and characteristic constituents are presented below.


Oblici doziranja

Standardizirani ekstrati (suhi ekstrati iz osušeni listovi, izdvojen sa acetonom i vodom, droga (lijek): ekstrat omjer 35-67: 1) sadrži 22-27% flavonglikozida i 5-7% terpenlactona, od kojih oko 2.8-3.4% čine ginkgolidi A, B i C i 2.6-3.2% bilobalidi. Razina ginkgolidne kiseline je ispod 5 mg / kg. Ovo je sadržaj ekstrata koji se unosi u organizam putem tableta (20, 21).


Ljekovitost

Ljekovitost je podržana od strane kliničkih podataka. Ekstrakt (doziranje) je kako je gore opisan (doziranje - oblici) su korišteni za simptomatično liječenje blage do umjerene cerebrovaskularne nedostatnosti (u osnovi degenerativne demencije, vaskularne demencije, i mješoviti oblici oba) sa sljedećim simptomima: manjak memorije, poremećaj u koncentraciji, depresivna emocionalna stanja, vrtoglavica, zujanje u ušima, glavobolja (1, 3, 20-22)...

Extracts as described above (Dosage forms) have been used for symptomatic treatment of mild to moderate cerebrovascular insufficiency (demential syn-dromes in primary degenerative dementia, vascular dementia, and mixed forms of both) with the following symptoms: memory deficit, disturbance in concen-tration, depressive emotional condition, dizziness, tinnitus, and headache (1, 3, 20–22). Such extracts are also used to improve pain-free walking distance in people with peripheral arterial occlusive disease such as intermittent claudication, Raynaud disease, acrocyanosis, and post-phlebitis syndrome, and to treat inner ear disorders such as tinnitus and vertigo of vascular and involutive origin (20, 23–27). Extracts and doses other than those described in Dosage forms and Posology are used for similar but milder indications (28, 29).


Opisanih koristi u farmaceutskim i tradicionalnim medicinskim sistemima

Nema.


Opisane koristi u narodnoj medicini - ne podržavaju eksperimentalne kliničke podatke

As a vermifuge, to induce labour, for the treatment of bronchitis, chronic rhinitis, chilblains, arthritis, and oedema (3, 5).


Farmakologija

Eksperimentalna farmakologija

Cerebrovaskularna oštećenja i periferne vaskularne bolesti

.......... In vitro istraživanja su pokazala da G. biloba ekstrat djeluje protiv aktivnih radikala (33-37). ......Miševi tretirani s standardiziranim ekstratom G. biloba (100 mg / kg, oralno za 4-8 tjedna) - pokazalo je poboljšanje memorije i brže učenje ..... (64).

In vitro studies. A standardized extract of Ginkgo biloba (100 µg/ml) did not produce isometrically recordable contractions in isolated rabbit aorta but did potentiate the contractile effect of norepinephrine (30). Higher concentrations (EC50 ? 1.0 mg/ml) produced a concentration-dependent contraction that could be antagonized by the α-adrenoceptor-blocking agent phentolamine (30). Both cocaine and desipramine, inhibitors of catecholamine reuptake, potentiated the contractile effect of norepinephrine but inhibited the contractile effects of a standardized extract of G. biloba and tyramine (30). The results of these experi-ments indicate that the contractile action of G. biloba may be due to the release of catecholamines from endogenous tissue reserves, and this activity may explain some of the therapeutic effects of the drug in humans (e.g. improve-ment in cerebrovascular and peripheral vascular insufficiency) (1, 30). On the basis of experiments comparing the effects of an extract of G. biloba, phentolamine, propranolol, gallopamil, theophylline, and papaverine on the biphasic contractile response of norepinephrine in isolated rat aorta, researchers concluded that G. biloba had musculotropic action similar to that of papaverine (31). This activity was previously reported for the flavonoids quercetin, kaempferol, and isorhamnetin, isolated from the leaves of G. biloba (32). The flavonoids and papaverine both inhibit 3',5' -cyclic-GMP phosphodiesterase, which in turn induces endothelium-dependent relaxation in isolated rabbit aorta by potentiating the effects of endothelium-derived relaxing factors (1).

In vitro studies have demonstrated that G. biloba extracts scavenge free radicals (33–37). Ginkgo biloba extracts have been reported to reduce free radical-lipid peroxidation induced by NADPH-Fe3+ systems in rat microsomes (33), and to protect human liver microsomes from lipid peroxidation caused by ciclosporin A (34). The extract also inhibits the generation of reactive oxygen radicals in human leukocytes treated with phorbol myristate acetate (35). The antioxidant action of G. biloba extract may prolong the half-life of endothelium-derived relaxing factor by scavenging superoxide anions (36, 37). Both the flavonoid and terpenoid constituents of G. biloba appear to aid the free-radical scavenging activity of the drug (37).

Ginkgo biloba extract protected against brain tissue hypoxic damage in vitro. The ginkgolides and bilobalide were responsible for the antihypoxic activity of the extract (38, 39). Ginkgolides A and B have been shown to protect rat hippocampal neurons against ischaemic damage, which may be due to their ability to act as antagonists to receptors for platelet-activating factor (PAF) (40–42).

In vivo studies. Oral administration of G. biloba extract protected rats against induced cerebral ischaemia (43–45). Intravenous perfusion of a G. biloba extract prevented the development of multiple cerebral infarction in dogs injected with fragments of an autologous clot into a common carotid artery (46). These data suggest that G. biloba extract, administered after clot formation, may have some beneficial effects on acute cerebral infarction or ischaemia caused by embolism (1). Other experiments demonstrated that animals treated with G. biloba extract survived under hypoxic conditions longer than did untreated controls (47, 48). Longer survival was due not only to significant improvements in cerebral blood flow, but also to an increase in the level of glucose and ATP (44, 48–50). Other studies have shown that a G. biloba extract devoid of ginkgolides but containing bilobalide had protective activity when administered intraperitoneally to mice with induced hypobaric hypoxia (51, 52). Intravenous infusion of G. Biloba extract significantly increased pial arteriolar diameter in cats (53) and improved cerebral blood flow in rats (53). The active constituents of G. biloba responsible for increasing cerebral blood flow appeared to be the non-flavonoid compounds (54); ginkgolide B may be responsible for this action owing to its PAF-antagonist activity (55, 56). Furthermore, intravenous administration of a standardized G. biloba extract and ginkgolide B to rats showed that the extract, but not ginkgolide B, decreased the brain's use of glucose (57).

The constituents of G. biloba responsible for its anti-ischaemic activity re-main undefined. The flavonoids, ginkgolides, and bilobalide have all been sug-gested, but it is possible that other constituents may be responsible. An extract of G. biloba was effective in the in vivo treatment of cerebral oedema, a condition of excessive hydration of neural tissues owing to damage by neurotoxic agents (such as triethyltin) or trauma (58–60). Bilobalide appeared to play a significant role in the antioedema effect (61, 62). Oral or subcutaneous administration of an extract of G. biloba to rats with acute and chronic phases of adriamycin-induced paw inflammation partially reversed the increase in brain water, sodium, and calcium and the decrease in brain potassium associated with sodium arachidonate-induced cerebral infarction (63).

Mice treated with a standardized extract of G. biloba (100 mg/kg, orally for 4–8 weeks) showed improved memory and learning during appetitive operant conditioning (64).


Vestibularni i slušni efekti - djelovanje Gbe

Ginkgo biloba ekstrat pozitivno je djelovao na vestibularni i slušni sustav nakon eksperimentiranja na miševima, štakorima i mačkama.......

Ginkgo biloba extract improved the sum of action potentials in the cochlea and acoustic nerve in cases of acoustically produced sound trauma in guinea-pigs (1, 65). The mechanism reduced the metabolic damage to the cochlea. Oral or parenteral administration of a standardized G. biloba extract to mice (2 mg/kg) improved the ultrastructure qualities of vestibular sensory epithelia when the tissue was fixed by vascular perfusion (66). Improvement was due to the effects of the drug on capillary permeability and general microcirculation (1, 66).

Positive effects on vestibular compensation were observed after administration of G. biloba extract (50 mg/kg intraperitoneally) to rats and cats that had undergone unilateral vestibular neurectomy (67, 68).


Antagonizam trombocita-aktivirajući faktor (PAF)

Ginkgolidi, a posebice ginkgolid B, poznat je kao pokretać trombocita...

The ginkgolides, and in particular ginkgolide B, are known antagonists of PAF (69–73). PAF is a potent inducer of platelet aggregation, neutrophil degranu-lation, and oxygen radical production leading to increased microvascular per-meability and bronchoconstriction. Intravenous injections of PAF induced transient thrombocytopenia in guinea-pigs, which was accompanied by non-histamine-dependent bronchospasm (69, 70). Ginkgolide B has been shown to be a potent inhibitor of PAF-induced thrombocytopenia and bronchocon-striction (71, 72). PAF or ovalbumin-induced bronchoconstriction in sensitized guinea-pigs was inhibited by an intravenous injection of ginkgolide B (1–3mg/kg) 5 minutes prior to challenge (73).


Klinička farmakologija

Cerebralne nedostatnosti

Cerebralna nedostatnost nije potpuno egzaktan pojam za opisivanje prikupljenih simptoma povezanih s demencijom – padom intelektualnih sposobnosti, no pokazalo se da Gbe pozitivno djeluje na tu vrstu oboljenja tj: poteškoće u koncentraciji i pamćenju, odsutnosti duha, konfuziju, nedostatak energije, umor, smanjene fizičke performanse, depresivna raspoloženja, anksioznost, vrtoglavicu, zujanje u ušima, glavobolju....

Cerebral insufficiency is an inexact term to describe a collection of symptoms associated with dementia (21, 22). In dementia owing to degeneration with neuronal loss and impaired neurotransmission, decline of intellectual function is associated with disturbances in the supply of oxygen and glucose. In clinical studies G. biloba effectively managed symptoms of cerebral insufficiency including difficulty in concentration and memory, absent-mindedness, confusion, lack of energy, tiredness, decreased physical performance, depressive mood, anxiety, dizziness, tinnitus, and headache (20–22). Several mechanisms of action of G. biloba have been described: effects on blood circulation such as the vasoregulating activity of arteries, capillaries, veins (increased blood flow); rheological effects (decreased viscosity, by PAF-receptor antagonism); metabolic changes such as increased tolerance to anoxia; beneficial influence on neurotransmitter disturbances; and prevention of damage to membranes by free radicals (22). Treatment of humans with G. biloba extract has been shown to improve global and local cerebral blood flow and microcirculation (74–76), to protect against hypoxia (77), to improve blood rheology, including inhibition of platelet aggregation (74, 78–81), to improve tissue metabolism (82), and to reduce capillary permeability (83).

A critical review of 40 published clinical trials (up to the end of 1990) using an orally administered G. biloba extract in the treatment of cerebral insufficiency concluded that only eight of the studies were well performed (21, 22). Almost all trials reported at least a partially positive response at dosages of 120–160mg a day (standardized extract) and treatment for at least 4–6 weeks (21, 22). In a comparison of G. biloba with published trials using co-dergocrine

(dihydroergotoxine), a mixture of ergoloid mesilates used for the same purpose, both G. biloba extract and co-dergocrine showed similar efficacy. A direct comparison of 120mg of G. biloba standardized extract and 4.5 mg co-dergocrine showed similar improvements in both groups after 6 weeks (84).

A meta-analysis of 11 placebo-controlled, randomized double-blind studies in elderly patients given G. biloba extract (150 mg orally per day) for cerebral insufficiency concluded that eight studies were well performed (85). Significant differences were found for all analysed single symptoms, indicating the superiority of the drug in comparison with the placebo. Analysis of the total score of clinical symptoms indicated that seven studies confirmed the effectiveness of G. biloba extract, while one study was inconclusive (85).


Periferne arterijske bolesti

Nakon kontroliranih pokusa sa bolesnicima s perifernim arterijskim bolestima 1990. godine g. biloba ekstrat kod tih bolesnika djelovao je vrlo pozitivno i ostvaren je značajan pozitivan terapijski učinak.

The effectiveness of G. biloba extract in the treatment of intermittent claudication (peripheral arterial occlusive disease Fontaine stage II), as com-pared with a placebo, was demonstrated in placebo-controlled, double-blind clinical trials by a statistically significant increase in walking distance (1, 23, 24).

Sixty patients with peripheral arterial occlusive disease in Fontaine stage Iib who were treated with the drug (120–160mg for 24 weeks) and underwent physical training also clearly increased their walking distance (25).

Out of 15 controlled trials (up to the end of 1990) only two (23, 24) were of acceptable quality (22–24). The results of both studies were positive and showed an increase in walking distance in patients with intermittent claudication after 6 months (23), and an improvement of pain at rest in patients treated with 200 mg of G. biloba extract for 8 weeks (24).

After meta-analysis of five placebo-controlled clinical trials (up to the end of 1991) of G. biloba extract in patients with peripheral arterial disease, investigators concluded that the extract exerted a highly significant therapeutic effect (26).


Vrtoglavica i zujanje u ušima

Ginkgo biloba ekstrati su korišteni su u liječenju centralnog uha, tj. bolesti kao što su nagluhost, vrtoglavica i zujanje u ušima. Primjenom GBe na stotinjak pacijenata javilo se znatno poboljšanje.

Ginkgo biloba extracts have been used clinically in the treatment of inner ear disorders such as hearing loss, vertigo, and tinnitus. In a placebo-controlled, double-blind study of 68 patients with vertiginous syndrome of recent onset, treatment with G. biloba extract (120–160mg daily, for 4–12 weeks) produced a statistically significant improvement as compared with the placebo group

(27).

The results of clinical studies on the treatment of tinnitus have been contradictory. At least six clinical studies have assessed the effectiveness of G. Biloba extract for the treatment of tinnitus. Three studies reported positive results (86, 87, 88). One multicentre, randomized, double-blind, 13-month study of 103 patients with tinnitus showed that all patients improved, irrespective of the prognostic factor, when treated with G. biloba extract (160 mg/day for 3 months) (86). Three other clinical trials reported negative outcomes (89–91).

Statistical analysis of an open study (80 patients) without placebo, coupled with a double-blind, placebo-controlled part (21 patients), demonstrated that a con-centrated G. biloba extract (29.2 mg/day for 2 weeks) had no effect on tinnitus (91).


Kontraindikacije

Hipersenzitivnost G. biloba praparata (20).

Hypersensitivity to G. biloba preparations (20).


Upozorenja

Nema dostupnih informacija.


Mjere opreza

Karcinogeneza, mutageneza, smanjenje plodnosti.

Carcinogenesis, mutagenesis, impairment of fertility

Investigations with G. biloba extracts have shown no effects that were mu-tagenic, carcinogenic, or toxic to reproduction (20).


Trudnoća: nisu značajno proučavani i dokazani popratni efekti

The safety of Folium Ginkgo for use during pregnancy has not been established.


Majka-dojilja

Izlučivanje iz lista ginkga u mlijeko i utjecaj na novorođenče – nema podataka o popratnim efektima, nije ustanovljeno.

Excretion of Folium Ginkgo into breast milk and its effects on the newborn have not been established.


Ostale mjere opreza

Nema posebnih informacija.

No information is available concerning general precautions or drug interactions, drug and laboratory test interactions, teratogenic effects on pregnancy, or paediatric use.


Nepovoljne reakcije

Glavobolje, gastrointestinalni poremećaji, moguće su alergijske reakcije na koži.

Headaches, gastrointestinal disturbances, and allergic skin reactions are possible adverse effects (20).


Doziranje-omjeri

Osušeni ekstrat (kao što je opisano u doziranju), 120-240 mg dnevno u 2 ili 3 podijeljene doze (2), 40 mg ekstrata je ekvivalent za 1,4-2,7 g listova (20). Fluid ekstrat (1:1), 0,5 ml 3 puta dnevno (1, 2).


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_____

Annex


Participants in the WHO Consultation on Selected

Medicinal Plants

Munich, Germany, 8–10 July 1996

Dr Keita Arouna, National Institute for Research in Public Health, Bamako, Mali

Professor Elaine Elisabetsky, Department of Pharmacology, Federal University of Rio

Grande do Sul, Porto Alegre, Brazil

Professor Norman Farnsworth, University of Illinois at Chicago, College of Pharmacy,

Chicago, IL, USA

Professor Harry Fong, University of Illinois at Chicago, College of Pharmacy, Chicago, IL, USA

Dr Abdel-Azim M. Habib, Professor of Pharmacognosy, Faculty of Pharmacy, University

of Alexandria, Alexandria, Egypt

Dr Djoko Hargono, Former Head, Directorate General of Drugs and Food Control,

Ministry of Health, Jakarta, Indonesia

Dr Konstantin Keller, Director, Federal Institute of Drug and Medicinal Products, Berlin,

Germany

Professor Fritz H. Kemper, Umweltprobenbanken für Human-Organproben, University

of Münster, Münster, Germany

Mr Eftychios Kkolos, Director, Pharmaceutical Services, Ministry of Health, Nicosia, Cyprus

Dr Mamadou Koumaré, School of Medicine and Pharmacy, Bamako, Mali

Dr Gail Mahady, University of Illinois at Chicago, College of Pharmacy, Chicago, IL, USA

Dr Satish Mallya, Representative, Bureau of Pharmaceutical Assessment, Health Protection Branch, Drugs Directorate, Ottawa, Ontario, Canada

Professor Tamas Paal, National Institute of Pharmacy, Budapest, Hungary

Dr Tharnkamol Reancharoen, Food and Drug Administration, Ministry of Public Health,

Bangkok, Thailand

Dr Gillian Scott, National Botanical Institute, Conservation Biology Research Unit, Cape

Town, South Africa

Dr Geoffrey N. Vaughan, National Manager, Therapeutic Goods Administration, Com- monwealth Department of Health, Housing and Community Service, Woden, Australian Capital Territory, Australia

Mr Tuley De Silva, Special Technical Adviser, United Nations Industrial Development

Organization, Vienna, Austria

WHO Secretariat

Dr Mary Couper, Medical Officer, Division of Drug Management and Policies, World

Health Organization, Geneva, Switzerland

Dr Martijn ten Ham, Chief, Drug Safety, Division of Drug Management and Policies,

World Health Organization, Geneva, Switzerland

Dr Jutta Schill, Technical Officer, Traditional Medicine Programme, Action Programme

on Essential Drugs, World Health Organization, Geneva, Switzerland

Dr Xiaorui Zhang, Medical Officer, Traditional Medicine Programme, Action

Programme on Essential Drugs, World Health Organization, Geneva, Switzerland.





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