A centuries-old tree offers a modern solution to one of medicine's most persistent challenges.
Imagine a natural remedy that has weathered millions of years of evolution, now being refined in high-tech laboratories to address one of humanity's most formidable health threats: cerebral infarction, commonly known as ischemic stroke. This article explores the fascinating journey of ginkgo biloba from ancient traditional medicine to modern intravenous injections, examining the scientific evidence behind its potential to protect and heal the brain when every minute counts.
Cerebral infarction occurs when a blood clot blocks an artery supplying blood to the brain, depriving brain cells of oxygen and nutrients. Within minutes, these cells begin to die, potentially leading to permanent disability or death. It represents approximately 70% of all stroke cases in China 9 , and is a leading cause of disability and mortality worldwide 1 8 .
The standard treatments—thrombolytic therapy to dissolve clots and antiplatelet drugs to prevent new ones—face significant limitations. Thrombolytics have a strict time window for administration and carry bleeding risks 1 , while antiplatelet drugs like aspirin may encounter resistance issues in some patients and provide limited long-term prognosis improvement 1 8 . This treatment gap has driven researchers to explore complementary therapies, particularly neuroprotective agents that can shield vulnerable brain cells from damage .
Contains ginkgolide A, B, and K 1
Contains bilobalide, ginkgolide A, B, and C 1
Combines ginkgo extract with the antiplatelet drug dipyridamole 9
Ginkgo biloba, often called a "living fossil," has been used in traditional Chinese medicine for centuries. Modern science has isolated its active components, primarily flavonoid glycosides and terpenoid lactones (ginkgolides and bilobalide) 8 , which are formulated into medical injections.
These aren't simple leaf extracts—they're sophisticated pharmaceutical preparations with specific compositions. When administered intravenously, these compounds bypass the digestive system, achieving rapid bioavailability crucial during the critical hours after a stroke.
Recent comprehensive analyses have synthesized data from numerous clinical trials to evaluate ginkgo injections' effectiveness and safety.
A 2025 meta-analysis of 27 randomized controlled trials (3,336 patients) revealed that ginkgo terpene lactone preparations combined with antiplatelet drugs significantly improved several key outcomes compared to antiplatelet therapy alone 1 :
Another 2021 meta-analysis of 13 clinical trials similarly found that ginkgo biloba leaf preparations significantly improved NIHSS scores and patients' ability to live independently 4 .
The data suggests these benefits may stem from multiple mechanisms working together, which we'll explore next.
Ginkgo injections don't work through a single pathway but rather offer multiple neuroprotective effects that address the complex cascade of damage following cerebral infarction:
They inhibit cerebral ischemia/reperfusion-induced inflammatory response in astrocytes via the TLR4/NF-κB pathway 8 .
The components help reduce oxidative stress by scavenging free radicals 9 .
The preparations inhibit the apoptosis (programmed cell death) of hippocampal neurons in post-stroke mice 8 .
As natural platelet-activating factor receptor antagonists, ginkgolides may synergize with conventional antiplatelet regimens by inhibiting platelet aggregation 1 .
Ginkgolide B disrupts the NCOA4-FTH1 interaction, inhibiting autophagic degradation of FTH1 and reducing ferroptosis 6 .
This multi-target approach represents a significant advantage over single-mechanism drugs, potentially addressing the complex pathophysiology of cerebral infarction more comprehensively.
Recent research has uncovered an exciting new mechanism through which ginkgo components may protect the brain. A 2023 study investigated Ginkgolide B's effects on cerebral ischemia-reperfusion injury, focusing on a recently discovered form of cell death called ferroptosis 6 .
Researchers established transient middle cerebral artery occlusion (tMCAO) in rats to simulate human ischemic stroke followed by reperfusion.
Rats were divided into multiple groups receiving different GB doses (5, 10, and 20 mg/kg) or edaravone (positive control).
After 24 hours of tMCAO, researchers documented neurological scores and used TTC staining to quantify brain infarct volume.
PC12 cells (a neuron-like cell line) underwent oxygen glucose deprivation/reperfusion (OGD/R) to mimic stroke conditions in vitro.
Using techniques including Western blot, immunofluorescence, and co-immunoprecipitation, the team examined GB's effect on ferroptosis markers and related pathways.
The study demonstrated that medium and high doses of GB significantly reduced infarct volume and improved neurological scores in a dose-dependent manner 6 . GB treatment restored levels of key ferroptosis markers (GPX4, FTH1) and reduced iron content in the cerebral cortex during I/R injury 6 .
Most importantly, researchers discovered that GB disrupts the NCOA4-FTH1 interaction, thereby inhibiting autophagic degradation of FTH1 (ferritin heavy chain) and reducing ferroptosis 6 . This represents a previously unknown mechanism for GB's neuroprotective effects and suggests potential for combination therapies targeting multiple cell death pathways simultaneously.
| GB Dose (mg/kg) | Infarct Volume Reduction | Neurological Score Improvement | Iron Content Normalization |
|---|---|---|---|
| 5 (Low) | Mild | Mild | Partial |
| 10 (Medium) | Significant | Significant | Significant |
| 20 (High) | Most Significant | Most Significant | Most Significant |
For any stroke treatment, safety is as important as efficacy. The 2025 meta-analysis of 27 trials reported a total of 419 adverse reactions across all studies, with 206 occurring in the ginkgo combination treatment group 1 . Reassuringly, there was no significant difference in adverse event incidence between the ginkgo combination group and the antiplatelet therapy alone group 1 .
However, a 2025 mechanistic study offered a more nuanced safety perspective, specifically examining Ginkgo biloba extract's impact on platelet activity and coagulation when combined with low-dose aspirin . The research found that while GBE specifically inhibited arachidonic acid-induced platelet aggregation and enhanced aspirin's antiplatelet effects, the combination was associated with an increased risk of minor bleeding events .
| Safety Aspect | Finding | Source |
|---|---|---|
| Overall Adverse Events | No significant difference from antiplatelet therapy alone | 1 |
| Minor Bleeding Risk | Increased when combined with low-dose aspirin | |
| Platelet Function | Specifically inhibits AA-induced platelet aggregation | |
| Coagulation Parameters | Mild prolongation of APTT |
| Research Tool | Function in Experimental Studies | Example Use Cases |
|---|---|---|
| tMCAO Rat Model | Reproduces human ischemic stroke conditions by blocking middle cerebral artery | Evaluating infarct volume, neurological deficits |
| OGD/R-induced PC12 Cells | Mimics cerebral ischemia-reperfusion injury in vitro | Studying cellular mechanisms, drug screening |
| GBE (Ginkgo Biloba Extract) | Standardized extract containing active ingredients (flavonoids, terpenoid lactones) | Investigating neuroprotective mechanisms |
| Light Transmission Aggregometry | Measures platelet aggregation in response to agonists (AA, ADP) | Assessing effects on platelet function |
| TTC Staining | Distinguishes between metabolically active (red) and infarcted (white) brain tissue | Quantifying cerebral infarct volume |
The evidence supporting ginkgo injections in cerebral infarction treatment is promising but requires further validation through larger, more rigorous clinical trials. Future research should focus on:
While current systematic reviews note that many existing trials have methodological limitations 8 , the consistent positive findings across multiple studies and meta-analyses suggest ginkgo injections represent a valuable complementary approach to conventional stroke treatment.
Ginkgo injections represent a fascinating convergence of traditional medicine and modern science in the battle against cerebral infarction. The current evidence suggests that when used alongside conventional antiplatelet therapy, these preparations can significantly enhance clinical efficacy, improving neurological function and daily living capabilities with a favorable safety profile.
As research continues to unravel the sophisticated mechanisms behind ginkgo's neuroprotective effects—from anti-inflammatory and antioxidant properties to the newly discovered inhibition of ferroptosis—these ancient compounds may find their place as standard adjuvants in stroke treatment protocols, offering new hope for recovery in the critical hours after a cerebral infarction.