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treated group were considerably reduced. The glutathione peroxidase and
superoxide dismutase levels of the ginger-treated group were considerably
conserved in the NEC þginger group. The tissue xanthine oxidase, mal-
ondialdehyde (MDA) and myeloperoxidase levels of the NEC þginger group
were considerably lower than those in the NEC group. Ginger treatment
efficiently ameliorated the severity of intestinal damage in NEC and may be a
hopeful management choice.
87
3.8.5 Protective Effect on Ulcerative Colitis
Colitis is the typical pathological lesion of inflammatory bowel diseases.
Ginger was more effective as a healing than a prophylactic agent in acetic
acid-induced colitis. Ginger ameliorated acetic acid-induced colitis not only
through its anti-inflammatory and antioxidant properties but also via a de-
crease in serotonin, which may contribute to the downregulation of NF-kB-
dependent TNF-a expression and a decrease in the lipid peroxidation and
tissue damage.
88
Pretreatment with ginger essential oil ameliorated the in-
dications of acetic acid-induced colitis in rats because of its antioxidant and
antilipoperoxidative actions, which illustrated that ginger may be advan-
tageous in the treatment of colon mucosal injury caused either experi-
mentally or through IBD.
89
Ginger extract and its compound zingerone
improved 2,4,6-trinitrobenzene sulfonic acid-induced colitis in mice through
modulation of NF-kB activity and the IL-1b signaling pathway.
90
3.8.6 Pain Relief Effect
Eleven successive days of nutritional supplementation with 2 g of raw and
heat-treated ginger reduced muscle pain produced by eccentric exercise, and
raw ginger is as effective as heat-treated ginger in attaining this outcome.
91
The effect of ginger powder supplementation on some inflammatory mark-
ers was investigated in patients suffering from knee osteoarthritis in a
double-blind randomized, placebo-controlled clinical trial with a follow-up
period of 3 months that was conducted in 120 outpatients with moderately
painful knee osteoarthritis. After 3 months of supplementation, the serum
concentration of nitric oxide and hs-C reactive protein decreased in the
ginger group. Ginger powder supplementation at a dose of 1 g per day can
attenuate inflammatory markers in patients with knee osteoarthritis, and it
thus can be suggested as an appropriate supplement for knee osteoarthritis
patients.
92
3.8.7 Anticancer Effect
Cancer-related mortality and morbidity are a major healthcare concern.
Developing effective anticancer remedies which are sustainable, afford able
and nontoxic is possible with alternative medicine. An aqueous natural ex-
tract mixture was prepared from common spices, including turmeric, ginger
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and garlic, and its apoptotic and anti-proliferative properties examined
against both ER-positive and ER-negative breast cancer cell lines (MCF 7,
ZR-75 and MDA-MB 231) with or without tamoxifen, which is a selective
estrogen receptor modulator utilized in the management of breast cancers.
Enhanced effects of tamoxifen when mixed with the natural extracts
indicated that the ginger-containing natural extract could be a potential
substitute healing tactic in some kinds of cancer.
93
3.8.8 Management of Chronic Diseases
A large cross-sectional study was conducted to investigate the occurrence of
chronic diseases such as hypertension, diabetes, hyperlipidemia, coronary
heart disease, fatty liver, cerebrovascular disease, tumor and anemia, along
with daily ginger intake. The outcomes indicated that ginger had a poten-
tially protective effect against some chronic diseases, particularly coronary
heart disease and hypertension, in addition to its capability to decrease the
possibility of sickness by enhancing 1 g per day ginger consumption on the
basis of the prior diet. It was advised as a wise dietary decision to suitably
boost daily ginger consumption as it was a heart-healthy alternative.
94
3.8.9 Management of Nausea and Vomiting
One of the most common postoperative complications is nausea and vo-
miting. Due to numerous morbidities linked with postoperative nausea and
vomiting, its inhibition and management have been a matter of urgency for
physicians, and so various medications have been suggested for this pur-
pose. In one study, 100 patients with cholelithiasis who has laparoscopic
cholecystectomy were the subjects. The patients were separated into two
groups: group A included 50 patients who received 500 mg oral ginger 1 h
before surgery, and group B comprised 50 patients who received 4 mg
intravenous ondansetron before completion of surgery. The nausea severity
was considerably lower in the ginger group, which suggested an intake of
500 mg oral ginger 1 h before laparoscopic cholecystectomy, which is tol-
erable and safe.
95
A randomized controlled trial was conducted to examine
the effect of ginger essence on post-nephrectomy nausea and vomiting with
120 nephrectomy patients and they were randomly allotted to either the
treatment or control group. Inhaling ginger essence has a positive outcome
on postoperative nausea and vomiting. Consequently, ginger essence can be
utilized as an active antiemetic agent for treating postoperative nausea and
vomiting.
96
3.8.10 Antidiabetic Effect
The daily intake of 1000 mg ginger decreased the serum fasting glucose,
which is a cause of dyslipidemia, peritoneal membrane fibrosis, hyper-
insulinemia and cardiovascular disease, in peritoneal dialysis patients.
97
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Daily intake of 3 g of ginger in capsules for 8 weeks by patients with type 2
diabetes leads to depressed fasting blood sugar and hemoglobin A1c
(HbA1c), in addition to differences in insulin resistance, fasting insulin,
increasing of sensitivity to insulin and quantitative insulin sensitivity check
index (QUICKI). Consequently, intake of ginger powder supplements is
suitable for diabetic patien ts.
98
3.8.11 Neuroprotective and Memory-enhancing Effect
The influence of ginger has been examined on oxidative stress markers in
the mitochondrial segments of the cerebellum, cerebral cortex, hypo-
thalamus and hippocampus of diabetic rats. Diabetes exacerbates neuronal
damage induced by hyperglycemia-mediated oxidative damage. Decreased
activities of antioxidant enzymes in diabetic rats were improved on oral in-
take of ginger and ginger management exhausted the MDA level, which was
improved in the diabetic rats, which recommended that ginger displays a
neuroprotective effect by accelerating brain antioxidant defense mech-
anisms and downregulating the MDA levels to the usual levels in diabetic
rats. Accordingly, ginger may be utilized as a healing agent in inhibiting
difficulties in diabetic patients.
99
The memory-enhancing effects of dried
ginger extract were assessed in a model of scopolamine-induced memory
deficits and in normal animals through a novel object recognition test.
Ginger extract induced the upregulation of nerve growth factor and
enhanced the levels of rabbit monoclonal antiphosphorylated extracellular-
signal-regulated kinase (pERK) antibody and rabbit polyclonal antipho-
sphorylated cyclic adenosine monophosphate response element-binging
protein (pCREB) antibody in the hippocampus. Through nerve growth
factor-induced activation of extracellular-signal-regulated kinase (ERK)/cyc-
lic adenosine monophosphate response element-binding protein (CREB)
signaling, ginger extract may improve synaptogenesis and memory. Taken
together, the cognitive improvement of ginger might, in part, be linked with
stimulation of nerve growth factor expression and ERK/CREB-mediated
synapse development in the hippocampus. Ginger extract could be a
promising drug candidate for memory disorders and neurodegenerative
diseases.
100
3.8.12 Protective Effect on Respiratory Disorders
The effect of ginger extract on delayed gastric emptying, developing
ventilator-associated pneumonia and clinical outcomes in adult respiratory
distress syndrome were evaluated with 32 adult respiratory distress syn-
drome patients who were in need of mechanical ventilation and fed via a
nasogastric tube. Gastric feed supplementation with ginger extract reduced
and delayed gastric emptying and maintained a reduced incidence of
ventilator-associated pneumonia in adult respiratory distress syndrome.
101
The effect of hot water extracts of fresh and dried gingers on human
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respiratory syncyt ial virus was verified by plaque reduction assay in both
human upper (HEp-2) and lower (A549) respiratory tract cell lines. The
capacity of ginger to stimulate antiviral cytokines was assessed by enzyme-
linked immunosorbent assay (ELISA). Fresh ginger prevented human re-
spiratory syncytial virus-induced plaque formation in both HEp-2 and A549
cell lines and could motivate mucosal cells to secrete IFN-b that probably
participated in countering viral infection. Therefore, fresh ginger is active
against human respiratory syncytial virus-induced plaque development on
the airway epithelium by hindering viral attachment and internalization.
102
Shariatpanahi et al.
103
assessed the impacts of an enteral diet improved with
ginger extract on inflammatory factors and respiratory profile, and the
results in patients with acute respiratory distress syndrome. Patients fed an
enteral diet improved with ginger had considerably lower serum levels of
IL-1, IL-6 and TNF-a and higher levels of red blood cell glutathione with
considerable enhancement in oxygenation being detected as compared with
the control group. The enteral diet supplemented with ginger in patients
with acute respiratory distress syndrome may be favorable for gas exchange
and could reduce the period of mechanical ventilation and length of stay
in the intensive care unit.
103
One study provided an indication that
ginger prevents allergen-induced lung inflammation by decreasing airway
eosinophilia, T helper type 2 cytokines and allergen-specific antibodies,
consequently assisting its anti-inflammatory role during the allergic
response in the lung. Ginger is consequently a hopeful novel protective agent
to combat allergies.
104
3.8.13 Effect on Oxidative Stress and Hypertension
Oxidative stress has a signi ficant role in the progression and development of
diabetic nephropathy. Ginger extract considerably decreased oxidative
stress, apoptosis and inflammation, and improved antioxidant defenses in
the diabetic kidney, which highly recommends ginger rhizome extract for
use in a defensive role against diabetes-induced renal damage by amelior-
ating oxidative stress, apoptosis and inflammation.
105
Dietary supplemen-
tation of ginger and turmeric rhizomes prevented angiotensin-1 converting
enzyme and arginase activities in addition to enhan cing nitric oxide pro-
duction in
L-NAME-induced hypertensive rats due to their antihypertensive
benefits in traditional medicine.
106
Hydroethanolic extract of ginger has
anticonvulsant effects in a model of clonic seizures induced with pentyle-
netetrazole in male mice, probably via an interaction through inhibitory and
excitatory systems, oxidative stress, calcium channel inhibition and anti-
oxidant mechanisms.
107
3.8.14 Antiobesity Effect
Mitochondrial dysfunction and dyslipidemia are related to obesity-
associated metabolic disorders. The effect of ginger extract was
Ginger in Ayurvedic Preparations and Its Applications 65
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investigated on muscle mitochondrial biogenesis and high-density lipo-
protein-cholesterol (HDL-C) metabolism in rats fed a high-fat diet. Sup-
plementation with ginger extract decreased the final body weight and
epididymal adipose tissue mass without disturbing energy ingestion. Ginger
extract improved mitochondrial size and mitochondrial DNA content in
addition to the expression of important genes linked to mitochondrial bio-
genesis, comprising peroxisome proliferator-activated receptor g coactivator-
1a, nuclear respiratory factor-1 and transcription factor A in skeletal muscle.
Furthermore, ginger extract raised serum HDL-C along with upregulating
adenosine triphosphate binding cassette transporter A1, apolipoprotein A-1
and lecithincholesterol acyltransferase mRNA in liver. These outcomes rec-
ommend that ginger extract may have an advantageous effect against
obesity-related metabolic disorders by elevating muscle mitochondrial bio-
genesis and serum HDL-C levels.
108
A study has demonstrated that dietary
ginger extract reduced diet-induced obesity and enhanced endura nce cap-
acity by stimulating fat usage through improved peroxisome proliferator-
activated receptor d (PPARd) signaling. 6-Shogaol and 6-gingerol in the
ginger extract may serve as PPARd agonists with consequent effects on en-
ergy homeostasis, which may be significant for the additional development
of PPARd-based remedies for obesity treatment.
109
3.9 Conclusion
Traditional Indian medicine (Siddha and Ayurveda) is a holistic method-
ology for health and personalized medicine based on a knowledge of life.
Plant species described in the ancient scripts of Siddha and Ayurveda and
other Indian medicine structures could be explored with the current scien-
tific methods for improved healthcare roles. Several drugs have arrived in
the global market through the exploration of traditional medicine and eth-
nopharmacology. Ginger is used globally as a culinary spice, condiment and
herbal remedy, and has been as a significant herb in traditional Indian
medicine for centuries. More than 400 active ingredients have been identi-
fied ginger, among them gingerols, shogaols, paradols and zingerone are the
most important bioactiv e components, which have been shown to have
various biological activities in areas such as antioxidant, anti-inflammatory,
gastrointestinal health, hepatoprotectivity, anticancer, antiarthritis and pain
relief effects, antidiabetic, neuroprotective and memory-enhancing effects,
cholesterol and pressure-lowering effects, obesity, etc. This chapter has
concentrated on the overall application of ginger in Ayurvedic preparations
and phytochemical evaluations utilized in the Ayurvedic drug scenario and
its upcoming possibilities for advanced scientific exploration. Significant
research in chemistry, pharmacology, pharmacognosy and clinical ther-
apeutics has been carried out on ginger-based Ayurvedic formulations,
functional foods and various nutraceuticals. Several preclinical and clinical
studies have investigated the immunomodulatory, immunoadjuvant and
cytoprotective potential of ginger-based Ayurvedic and nutraceutical
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formulations. The expansion of ginger-based traditional systems of medi-
cines through the perspectives of safety, efficacy and quality will assist not
only to preserve this traditional custom but also improve the utilization of
natural products in health care. Ayurvedic-based herbal remedies and other
nutraceuticals are progressively and comprehensively utilized by a large part
of the global population. Collectively, treatment with natural herbal medi-
cines, particularly ginger-based nutraceuticals, functional foods and dietary
supplements, is highly recommended.
Acknowledgements
The authors gratefully thank the management of Plant Lipids Private Lim-
ited, Cochin, India, for their support and encouragement. They also wish to
express their appreciation to their laboratory members for their active help
and cooperation.
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