Herbal Monograph
Ginger
Zingiber officinale Roscoe
Zingiberaceae
Premier warming digestive aid and antiemetic remedy with robust evidence for nausea, vomiting, and inflammatory pain
Overview
Plant Description
Perennial herbaceous plant, 60-120 cm tall, arising from a thick, aromatic, branched rhizome. Rhizome is laterally compressed, irregularly branched (palmate), 5-15 cm long, 1.5-6 cm wide, pale yellow to buff externally with rings of leaf scars, bright yellow internally with a pungent aromatic odor and characteristic hot taste. Pseudostems (formed by sheathing leaf bases) erect, reed-like, unbranched. Leaves alternate, distichous, sessile, linear-lanceolate, 15-30 cm long, 2-2.5 cm wide, glabrous, with prominent midrib and parallel venation, aromatic when crushed. Inflorescence a dense, ovoid-cylindrical spike, 4-7 cm long, borne on a separate leafless peduncle arising directly from the rhizome. Flowers yellowish-green with a purple lip marked with cream-colored spots; three-lobed labellum (lip petal). Flowering is rare in cultivation. Fruit a three-valved capsule, seldom produced. The plant is known only in cultivation and does not exist in a confirmed wild state; it is a sterile cultigen propagated vegetatively from rhizome divisions.
Habitat
Tropical and subtropical regions. Requires warm, humid climate with temperatures of 25-30C, well-drained loamy soil rich in organic matter, partial shade, and annual rainfall of 1500-3000 mm. Does not tolerate frost or waterlogging. Grows from sea level to approximately 1500 m altitude.
Distribution
Believed to have originated in the tropical rainforests of the Indian subcontinent or Southeast Asia (exact wild origin unknown as it has never been found in a truly wild state). Now cultivated pantropically. Major producers: India (largest global producer, particularly Cochin and Calicut types), China, Nigeria, Nepal, Indonesia, Thailand, and Australia (Queensland). Jamaica produces high-quality ginger prized for its aroma and mild flavor.
Parts Used
Fresh rhizome (Rhizoma Zingiberis Recens; Sheng Jiang in TCM)
Preferred: Fresh juice, fresh slices for decoction, grated fresh rhizome
Primary medicinal and culinary form. Rich in gingerols (particularly 6-gingerol), volatile oils, and water content. In TCM, fresh ginger (sheng jiang) is classified as warm (not hot) and is used for exterior wind-cold conditions, nausea, and to harmonize the stomach. Fresh ginger is preferred for nausea, vomiting, and as a diaphoretic. Most clinical trials on nausea and vomiting used dried ginger powder, but fresh ginger juice and fresh preparations are traditional.
Dried rhizome (Rhizoma Zingiberis; Gan Jiang in TCM)
Preferred: Powdered dried rhizome (capsule or loose powder), dried slices for decoction, tincture
Dried ginger has a different chemical profile from fresh: gingerols are partially converted to shogaols during drying, making the product more pungent and hotter in energetic terms. In TCM, dried ginger (gan jiang) is classified as hot and targets the spleen, stomach, heart, and lung channels. Used to warm the interior, rescue devastated yang, and warm the lungs to transform phlegm. Commission E and WHO monographs cover the dried rhizome. Most commercially available capsule products use dried powdered ginger.
Key Constituents
Gingerols (pungent phenolic compounds)
Gingerols are the principal bioactive pungent compounds in fresh ginger. The homologous series (6-, 8-, 10-gingerol) differs by two methylene units in the alkyl chain. Anti-inflammatory mechanism includes inhibition of prostaglandin and leukotriene biosynthesis via dual COX-2/5-LOX inhibition. 6-Gingerol is the most studied and considered the primary active marker compound for fresh ginger preparations. See Semwal et al. 2015 for comprehensive phytochemistry review of gingerols and shogaols.
Shogaols (dehydration products of gingerols)
Shogaols are formed from gingerols during drying, cooking, or prolonged storage. They are more pungent and in some pharmacological models more potent than their parent gingerols, particularly for anti-inflammatory and anticancer activities. The gingerol-to-shogaol ratio is a key quality indicator distinguishing fresh from dried ginger products. This chemical transformation underlies the traditional distinction between fresh ginger (warming) and dried ginger (hot).
Zingerone and related compounds
Zingerone and paradols represent further metabolic/thermal breakdown products of the gingerol-shogaol pathway. They are milder in pungency but retain anti-inflammatory and antioxidant activity. Zingerone's antidiarrheal activity adds to ginger's gastrointestinal therapeutic profile.
Volatile oil (essential oil)
Essential oil comprises 1-3% of fresh rhizome weight. Over 50 components identified. Responsible for aroma and flavor; contributes to carminative and spasmolytic activity. Essential oil alone does not account for ginger's antiemetic or major anti-inflammatory effects (these require gingerols/shogaols). Oil composition varies significantly by cultivar and geographic origin, which affects aroma and flavor profiles -- for example, Australian ginger oil is high in citral (lemony), while Indian and Chinese varieties differ in zingiberene:sesquiphellandrene ratios.
Other constituents
Minor constituents providing nutritional matrix. Starch is the major component by weight in dried ginger but is not considered therapeutically active. Diarylheptanoids contribute to antioxidant effects.
Herbal Actions
Relieves intestinal gas and bloating
One of ginger's most well-established traditional and pharmacologically supported actions. Relieves intestinal gas, bloating, and associated discomfort. Promotes gastric motility and gastric emptying. Enhances gastrointestinal transit. Also encompasses ginger's powerful antiemetic effects (nausea/vomiting from motion sickness, pregnancy, chemotherapy, and post-operative states) as ginger modulates gastric motility and serotonin (5-HT3) receptor signaling. Commission E approved for dyspepsia and prevention of motion sickness. WHO monograph lists prophylaxis of nausea/vomiting.
[1, 2, 6]Reduces inflammation
Gingerols and shogaols inhibit prostaglandin and leukotriene biosynthesis via dual COX-2 and 5-LOX inhibition. Suppresses NF-kB activation and pro-inflammatory cytokine production (TNF-alpha, IL-1beta, IL-6). Bartels et al. 2015 meta-analysis found significant pain reduction in osteoarthritis. Terry et al. 2011 review documented anti-inflammatory effects across multiple pathways. Clinical evidence supports use in osteoarthritis and exercise-induced muscle pain.
[9, 10, 21]Promotes perspiration
Promotes perspiration, particularly when taken as a hot infusion. Traditionally used at the onset of colds and flu to 'break a fever' and promote sweating. Fresh ginger is a mild diaphoretic; dried ginger is more strongly warming and diaphoretic. Central to its traditional use in TCM for exterior wind-cold patterns and in Ayurveda for colds.
[2, 20]Relieves smooth muscle spasm
Relaxes smooth muscle of the gastrointestinal tract. Demonstrated spasmolytic activity on isolated guinea pig ileum and other smooth muscle preparations. Contributes to relief of intestinal cramping and colic. Mechanism involves calcium channel antagonism and modulation of serotonin receptors.
[2, 20]Prevents or slows oxidative damage to cells
Gingerols and shogaols demonstrate significant free radical scavenging activity. 6-Gingerol inhibits nitric oxide production and reduces lipid peroxidation. Protective against oxidative stress-induced tissue damage in animal models. Supplementary to primary actions.
[10, 21]Kills or inhibits the growth of microorganisms
In vitro antibacterial activity against various Gram-positive and Gram-negative bacteria including H. pylori (Park et al. 2005). Antifungal activity against Candida species. Clinical significance of antimicrobial action at normal dietary or therapeutic doses is not well-established.
[21]Therapeutic Indications
Digestive System
Nausea and vomiting of pregnancy (morning sickness)
Viljoen et al. 2014 Cochrane review of 12 RCTs (n=1278) found ginger significantly improved nausea symptoms compared to placebo (RR for improvement 1.55). Daily dose 1000-1500 mg dried ginger powder in divided doses. Comparable efficacy to vitamin B6 (pyridoxine) in several trials. No significant adverse effects on pregnancy outcomes. Multiple systematic reviews support efficacy and safety for this indication.
[7, 8, 17]Postoperative nausea and vomiting (PONV)
Ernst & Pittler 2000 systematic review of 6 RCTs found ginger superior to placebo for PONV prevention. Chaiyakunapruk et al. 2006 meta-analysis of 5 RCTs (n=363): ginger significantly reduced nausea incidence at 24 hours (RR 0.69). Some trials show equivalence to metoclopramide. Dose typically 1 g powdered ginger pre-operatively. Results have been mixed, with some later trials showing no benefit. The variability may relate to anesthetic protocols and concurrent antiemetic use.
[6, 11]Motion sickness prevention
Commission E approved indication. One of the earliest studied applications. Mowrey & Clayson 1982 original trial demonstrated superiority over dimenhydrinate. Mechanism may involve both gastric and central effects -- ginger appears to modulate gastric motility and may act on 5-HT3 receptors in the GI tract rather than solely through central antiemetic pathways. Dose: 1-2 g dried ginger powder taken 30 minutes before travel.
[1, 2, 6]Chemotherapy-induced nausea and vomiting (CINV)
Marx et al. 2017 systematic review of 18 RCTs (n=1874) found ginger reduced acute CINV severity when used as adjunct to standard antiemetics. Ryan et al. 2012 large multi-center RCT (n=576): 0.5 g and 1.0 g ginger doses significantly reduced acute nausea on day 1 when added to 5-HT3 receptor antagonist. Results are most consistent for acute (not delayed) nausea. Ginger is used as an adjunct to, not replacement for, standard antiemetic protocols.
[8, 12]Functional dyspepsia
Commission E approved for dyspeptic complaints. Ginger accelerates gastric emptying in functional dyspepsia. Hu et al. 2011 RCT (n=11): ginger (1200 mg) significantly accelerated gastric emptying of a solid meal compared to placebo (13.1 vs 26.7 min half-emptying time, P=0.02). Wu et al. 2008: ginger enhanced antral contractions and gastroduodenal motility. Traditional carminative use across all major herbal traditions.
[1, 2, 16]Musculoskeletal System
Osteoarthritis (pain and stiffness)
Bartels et al. 2015 meta-analysis of 5 RCTs (n=593): ginger showed a statistically significant effect on reducing pain (SMD -0.30, 95% CI -0.50 to -0.09) and disability in OA compared to placebo. Most trials studied knee OA. Altman & Marcussen 2001 RCT (n=261): ginger extract (255 mg bid) significantly reduced knee pain on standing and after walking compared to placebo (P=0.048). Mechanism via COX-2 and 5-LOX inhibition. Effect size is modest; ginger is an adjunctive rather than primary treatment.
[9, 13]Exercise-induced muscle pain and soreness
Black et al. 2010 RCT (n=74): daily consumption of 2 g raw ginger for 11 days reduced exercise-induced muscle pain by 25% (P=0.041). Wilson 2015 meta-analysis supported modest analgesic effect for delayed-onset muscle soreness. Anti-inflammatory mechanism (COX-2 and 5-LOX inhibition) underlies activity.
[10, 14]Cardiovascular System
Hyperlipidemia / cardiovascular risk factors
Animal studies demonstrate lipid-lowering and anti-atherosclerotic effects. Some small human trials suggest modest reductions in total cholesterol, LDL, and triglycerides. A 2018 meta-analysis of 12 RCTs found significant reductions in triglycerides and LDL with ginger supplementation. Evidence is still preliminary; larger well-designed trials are needed. Not a substitute for established lipid-lowering therapies.
[21]Peripheral circulation enhancement
Traditional use as a circulatory stimulant in Western herbalism. Ginger promotes peripheral blood flow and has a warming effect on the extremities. Used traditionally for Raynaud's-type symptoms and cold extremities. Limited modern clinical evidence specifically for this application.
[20]Respiratory System
Common cold with chills (early-stage wind-cold pattern)
Cornerstone traditional use across TCM, Ayurveda, and European herbalism. Fresh ginger decoction promotes diaphoresis and is used at the onset of colds characterized by chills, clear nasal discharge, and absence of sore throat. Often combined with honey, lemon, or other herbs (e.g., cinnamon, scallion white in TCM). The diaphoretic and warming properties are well-accepted in traditional practice though not evaluated in rigorous clinical trials for this specific indication.
[2, 19, 20]Cough with clear/white phlegm
Dried ginger (gan jiang) used in TCM to warm the lungs and transform cold-phlegm. Component of classical formulas such as Xiao Qing Long Tang (Minor Blue Dragon Decoction) for cold-phlegm conditions. Fresh ginger used similarly in Ayurveda for kapha-type cough.
[19]Reproductive System
Primary dysmenorrhea
Daily et al. 2015 systematic review of 7 RCTs found ginger powder (750-2000 mg/day during first 3-4 days of menstruation) significantly reduced menstrual pain compared to placebo. In some trials, efficacy was comparable to ibuprofen and mefenamic acid. Anti-inflammatory mechanism (prostaglandin synthesis inhibition) is consistent with this action.
[15]Energetics
Temperature
hot
Moisture
dry
Taste
Tissue States
cold/depression, damp/stagnation
Ginger is considered hot and dry across virtually all traditional systems. In TCM, FRESH ginger (sheng jiang) is classified as warm (not hot), acrid, and targeting the lung, spleen, and stomach channels, used for dispersing exterior cold and warming the middle. DRIED ginger (gan jiang) is classified as hot, acrid, targeting spleen, stomach, heart, lung, and kidney channels, used for warming the interior and rescuing devastated yang. This fresh/dried distinction is therapeutically significant. In Ayurveda, dried ginger (sunthi/shunti) is one of the three ingredients in trikatu ('three pungents') and is considered the 'universal remedy' (vishwabheshaja). It reduces vata and kapha while mildly increasing pitta. The sweet post-digestive taste (vipaka) in Ayurveda distinguishes it from other hot spices. Western energetics: hot, dry, stimulating, dispersing. Indicated for cold, stagnant, and damp tissue states.
Traditional Uses
Traditional Chinese Medicine (TCM)
- Sheng jiang (fresh ginger): Release the exterior in wind-cold patterns (colds with chills, no sweating, clear nasal discharge)
- Sheng jiang: Warm the middle jiao to stop vomiting and nausea
- Sheng jiang: Warm the lung to stop cough
- Sheng jiang: Reduce toxicity of other herbs (Pinellia/ban xia, Arisaema/tian nan xing)
- Gan jiang (dried ginger): Warm the interior, rescue devastated yang (collapse with cold extremities)
- Gan jiang: Warm the spleen and stomach for cold-type diarrhea and abdominal pain
- Gan jiang: Warm the lungs to transform cold-phlegm (thin, white, watery sputum)
- Pao jiang (blast-fried ginger): Warm the channels and stop bleeding (for cold-type hemorrhage)
"Fresh ginger (sheng jiang) first recorded in Shen Nong Ben Cao Jing (Divine Husbandman's Classic of the Materia Medica, c. 200 CE). Dried ginger (gan jiang) described in the same text. The distinction between fresh and dried ginger as separate medicinal substances with different properties and indications is fundamental to TCM practice and has been maintained for over 2000 years. Sheng jiang enters the lung, spleen, and stomach channels; gan jiang enters the spleen, stomach, kidney, heart, and lung channels."
[19]
Ayurveda
- Vishwabheshaja ('universal medicine') -- ginger is one of the most broadly used herbs in Ayurvedic practice
- Sunthi/shunti (dried ginger): Component of Trikatu ('three pungents') with black pepper and long pepper -- used to stimulate agni (digestive fire) and enhance bioavailability of other herbs
- Fresh ginger (adrak): Stimulate appetite before meals (thin slice with salt and lime juice)
- Digestive aid for ama (metabolic toxin) accumulation
- Colds, cough, and respiratory congestion (especially kapha-type with white phlegm)
- Reduce vata and kapha dosha imbalances
- Joint pain and rheumatic conditions
- Nausea and vomiting
- External paste applied to headaches and joint pain
"Described in the Charaka Samhita and Sushruta Samhita (c. 600-200 BCE). Called 'maha-aushadhi' (great medicine) in Ayurvedic texts. Dried ginger (sunthi/shunti) is pungent (katu rasa), has hot potency (ushna virya), and sweet post-digestive effect (madhura vipaka). This unusual combination of hot virya and sweet vipaka makes it unique among pungent herbs -- it provides warmth and stimulation without excessive aggravation of pitta over time."
European/Western Herbalism
- Digestive tonic and carminative for bloating, gas, and indigestion
- Warming circulatory stimulant for cold extremities and poor peripheral circulation
- Diaphoretic in early-stage colds and flu (hot ginger tea)
- Anti-nausea remedy (motion sickness, morning sickness)
- Anti-inflammatory for joint pain and arthritis
- Carrier/bioavailability enhancer for other herbs in formulations
- External: ginger compress or poultice for muscle and joint pain
"Ginger was known in ancient Greece and Rome, imported via the spice trade from India. Dioscorides (De Materia Medica, c. 70 CE) recommended it for warming the stomach and aiding digestion. Widely used in medieval European medicine. Gerard's Herball (1597) described its digestive and warming properties. In the 19th century, Eclectic physicians used ginger as a stimulant, carminative, and to 'correct' nauseating properties of other remedies."
[20]
Unani (Greco-Islamic) medicine
- Digestive stimulant and carminative
- Treatment of colic and flatulence
- Aphrodisiac
- Memory enhancer
- Treatment of paralysis and rheumatic conditions
"Known as 'zanjabil' in Unani medicine (from Arabic). Mentioned in the Quran (76:17) as a flavoring of drinks in paradise. Classified as hot and dry in the second degree in Unani humoral theory. Avicenna (Ibn Sina) described it in the Canon of Medicine for digestive and respiratory complaints."
[2]
Modern Research
Systematic review of ginger for nausea and vomiting (multiple etiologies)
Systematic review of 6 randomized clinical trials evaluating ginger for prevention of nausea and vomiting from various causes including seasickness, morning sickness, and postoperative nausea.
Findings: 5 of 6 studies favored ginger over placebo. Ginger was superior to placebo for prevention of postoperative nausea and vomiting, seasickness, and morning sickness. One study found ginger equivalent to metoclopramide for PONV prevention. Effective doses ranged from 1-2 g powdered ginger root.
Limitations: Small trial sizes, heterogeneous etiologies grouped together, variable preparations and doses. The review acknowledged that the mechanism of action (peripheral gastrokinetic vs. central antiemetic) was not fully elucidated.
[6]
Cochrane review of ginger for nausea and vomiting in pregnancy
Cochrane systematic review of 12 randomized controlled trials (1278 pregnant women) evaluating oral ginger for nausea and vomiting in early pregnancy.
Findings: Ginger significantly improved nausea symptoms compared to placebo (4 trials, RR 1.55, 95% CI 1.28-1.86 for symptom improvement). No statistically significant difference between ginger and vitamin B6 for nausea. No significant difference in risk of spontaneous abortion or other adverse pregnancy outcomes between ginger and control groups. Typical dose: 1000-1500 mg/day dried ginger in divided doses.
Limitations: Methodological quality was variable. Different ginger preparations and doses used across trials. Short treatment durations (4-21 days). Some trials had high risk of bias. Evidence quality rated as low to moderate.
[7]
Systematic review of ginger for chemotherapy-induced nausea and vomiting
Systematic review of 18 randomized controlled trials (1874 participants) assessing ginger supplementation for CINV as an adjunct to standard antiemetic therapy.
Findings: Ginger supplementation reduced acute CINV severity (within first 24 hours) when used alongside standard antiemetics. Less consistent evidence for delayed CINV (after 24 hours). Subgroup analysis suggested greater benefit when ginger was started before chemotherapy. Doses of 0.5-1.5 g/day most commonly studied.
Limitations: Significant heterogeneity in chemotherapy regimens, ginger doses, preparation types, and outcome measures. Several trials had small sample sizes. Inconsistent results across studies.
[8]
Meta-analysis of ginger for osteoarthritis pain
Meta-analysis of 5 randomized controlled trials (593 patients) evaluating oral ginger supplementation for osteoarthritis symptoms.
Findings: Ginger showed a statistically significant effect on reducing pain (SMD -0.30, 95% CI -0.50 to -0.09, P=0.005) and disability in OA compared to placebo. Effect size was modest. Ginger was well-tolerated with mostly mild gastrointestinal side effects. Treatment durations ranged from 3-12 weeks with doses of 500-1000 mg/day.
Limitations: Moderate heterogeneity (I2=66%). Small number of included trials. Variable ginger preparations (whole extracts vs. standardized extracts). Short study durations insufficient to assess long-term efficacy. Effect size is clinically modest.
[9]
Anti-inflammatory mechanisms of ginger: comprehensive review
Narrative review of the anti-inflammatory and antioxidative properties of ginger and its molecular mechanisms.
Findings: Ginger constituents (primarily 6-gingerol and 6-shogaol) inhibit multiple targets: COX-2, 5-LOX, iNOS, TNF-alpha, IL-1beta, and NF-kB signaling pathways. Dual COX-2/5-LOX inhibition is pharmacologically significant as it suppresses both prostaglandin and leukotriene synthesis. Gingerols also modulate TRP channels (TRPV1) and serotonin receptors (5-HT3), which may contribute to analgesic and antiemetic effects.
Limitations: Much of the mechanistic data derives from in vitro and animal studies. Bioavailability and in vivo concentrations of gingerols/shogaols at target tissues in humans need further characterization.
Ginger for primary dysmenorrhea
Systematic review and meta-analysis of 7 RCTs evaluating ginger for primary dysmenorrhea pain.
Findings: Ginger powder (750-2000 mg/day for the first 3-4 days of menstruation) was significantly more effective than placebo for reducing menstrual pain. In some trials, ginger was comparable in efficacy to NSAIDs (ibuprofen 400 mg, mefenamic acid 250 mg). The anti-prostaglandin mechanism is consistent with both the effect and the timing of efficacy (prostaglandin-mediated pain peaks in the first 48 hours of menstruation).
Limitations: Small sample sizes across trials. Variable doses and ginger preparations. Most trials conducted in Iran. Comparison with NSAIDs based on limited head-to-head data. Pain assessment tools varied between studies.
[15]
Ginger extract for knee osteoarthritis: multicenter RCT
Multicenter, double-blind, placebo-controlled, parallel-group RCT of 261 patients with moderate-to-severe knee OA. Patients received either a standardized ginger extract (EV.EXT 77, 255 mg bid) or placebo for 6 weeks.
Findings: Ginger extract significantly reduced knee pain on standing (P=0.048) and after walking (P=0.049) compared to placebo. A higher proportion of ginger patients were classified as responders (63% vs 50%, P=0.048). Mild GI adverse events were more common in the ginger group (59 events vs 21 in placebo).
Limitations: Short treatment duration (6 weeks). Higher dropout rate in ginger group. Gastrointestinal adverse effects, though mild, were more frequent than placebo. Effect sizes were modest. Industry-funded study.
[13]
Ginger accelerates gastric emptying in functional dyspepsia
Double-blind, placebo-controlled, crossover RCT in 24 healthy volunteers evaluating the effect of ginger (1200 mg capsules) on gastric emptying rate.
Findings: Ginger significantly accelerated gastric emptying of a low-nutrient meal compared to placebo. Gastric half-emptying time was 12.3 min with ginger vs 16.1 min with placebo (P<0.02). Antral area was significantly smaller at 60 and 90 minutes post-meal in the ginger group. Gastric fundus dimensions did not differ, suggesting ginger acts primarily on antral motility.
Limitations: Small sample size (n=24 healthy volunteers). Used a low-nutrient soup meal rather than a standard solid meal. Relevance to patients with gastroparesis or functional dyspepsia needs confirmation in patient populations. Single-dose study.
[16]
Preparations & Dosage
Infusion (Tea)
Strength: 2-4 g fresh ginger per 240 mL water
Steep 1-2 teaspoons (approximately 2-4 g) of freshly grated or thinly sliced ginger root in 240 mL (8 oz) of just-boiled water for 10-15 minutes, covered. Strain and drink. Fresh ginger is preferred for this preparation. May add honey and lemon for palatability.
1-2 cups (240-480 mL) up to 3 times daily
2-3 times daily as digestive aid; up to 4 times daily at onset of cold symptoms
As needed for acute conditions (nausea, colds). May be used long-term as daily digestive tonic.
Children over 6: half adult dose (consult practitioner). Not established for children under 6.
The most common traditional preparation worldwide. Hot infusion maximizes diaphoretic effect. For nausea, sipping slowly may be more effective than drinking quickly. Ginger infusion is milder than dried powder preparations.
Decoction
Strength: 3-6 g dried ginger or 6-10 g fresh ginger per 360-480 mL water
Simmer 3-6 g of dried ginger slices or 6-10 g of fresh ginger slices in 360-480 mL of water for 15-20 minutes. Strain. In TCM practice, fresh ginger is typically added in the last 5-10 minutes of a multi-herb decoction to preserve volatile oils.
180-240 mL (6-8 oz), 2-3 times daily
2-3 times daily
Short-term for acute conditions; may be used regularly as digestive tonic
Not well-established. Consult practitioner.
Decoction extracts both water-soluble and some heat-stable pungent compounds. Standard TCM preparation method. Dried ginger decoction is stronger and hotter than fresh ginger infusion.
Tincture
Strength: Dried: 1:5, 90% ethanol. Fresh: 1:2, 95% ethanol.
Macerate dried ginger root in 90% ethanol (or fresh ginger in 95% ethanol) at a ratio of 1:5 for dried (or 1:2 for fresh) for 2-4 weeks. Shake daily. Press and filter.
1-3 mL (approximately 20-60 drops), 3 times daily
3 times daily, taken with or before meals for digestive indications
As needed for acute nausea; may be used regularly as digestive support
Not established. Alcohol-based preparations generally not recommended for children.
Tincture effectively extracts both gingerols/shogaols and volatile oils. The high alcohol percentage is necessary for adequate extraction of the pungent oleoresin compounds. Can be diluted in warm water before taking. Some practitioners add ginger tincture to formulas as a stimulant and bioavailability enhancer.
[20]
capsule-powder
Strength: 250 mg-1 g powdered dried ginger root per capsule
Fill capsules with finely powdered dried ginger root. This is the most commonly used form in clinical trials for nausea and vomiting.
250 mg to 1 g, 2-4 times daily (total daily dose 1-4 g). For motion sickness: 1-2 g taken 30 minutes before travel. For morning sickness: 250 mg four times daily (1 g/day total). For OA: 250-500 mg two to three times daily.
2-4 times daily depending on indication
Motion sickness: single or repeated dosing as needed. Morning sickness: up to 4 days studied in most trials. OA: 3-12 weeks in clinical trials. Long-term safety data available for culinary use but less established for high-dose supplementation.
Not well-established. Some studies in children over 6 years used 250 mg for postoperative nausea.
Most clinically studied preparation form. Commission E approved dose: 2-4 g dried rhizome daily for dyspepsia; 2 g for motion sickness prophylaxis. Capsule standardization is recommended: look for products standardized to gingerol and/or shogaol content. Dried powder contains shogaols due to processing (gingerol-to-shogaol conversion during drying).
Standardized Extract
Strength: Variable. Products may be standardized to 5% gingerols, or to a specified ratio of gingerols:shogaols, or to total pungent compounds.
Commercially prepared standardized extracts with defined levels of gingerols, shogaols, or combined pungent compounds.
Product-specific. EV.EXT 77 (Altman 2001): 255 mg bid. Other standardized products: 100-250 mg 2-3 times daily. Follow manufacturer's recommendations based on standardization level.
Typically 2-3 times daily
3-12 weeks studied in OA trials. Follow practitioner guidance for longer-term use.
Not established for most standardized products
Standardized extracts provide more consistent dosing of active compounds. Particularly relevant for anti-inflammatory indications (OA, dysmenorrhea) where consistent dosing matters. Not all standardized ginger extracts are equivalent; different extraction processes yield different constituent profiles.
Syrup
Strength: Concentrated ginger decoction with 1:1 honey or sugar
Prepare a strong decoction (approximately 30-50 g fresh ginger per 240 mL water, simmered 20-30 minutes). Strain and add equal weight of honey or sugar. Simmer gently until syrupy consistency. Store refrigerated.
1-2 teaspoons (5-10 mL) as needed, up to 4 times daily
As needed for nausea or cough, up to 4 times daily
As needed
Children over 2 years: 1/2-1 teaspoon as needed. Do not give honey-based syrups to children under 1 year (botulism risk).
Palatable form particularly useful for nausea and sore throat. Honey adds demulcent and antimicrobial properties. The high sugar content acts as a preservative (refrigerated shelf life approximately 2-3 weeks). Popular in folk medicine across many cultures.
[20]
Fresh Juice / Expressed Juice
Strength: Undiluted fresh pressed juice of rhizome
Juice fresh ginger root using a juicer, or grate finely and squeeze through cheesecloth. Yields a concentrated, highly pungent juice.
1-2 teaspoons (5-10 mL) diluted in warm water or added to other juices, 1-3 times daily
1-3 times daily
As needed
Not recommended for young children due to intense pungency. Older children: very small amounts (1/4-1/2 teaspoon diluted) if tolerated.
Highly concentrated form with maximum gingerol content. Very pungent; always dilute before consuming. Used in traditional Ayurvedic practice (fresh ginger juice with honey). Can cause oral and esophageal irritation if taken undiluted in large amounts.
[20]
Essential Oil
Strength: Pure steam-distilled essential oil
Steam-distilled essential oil of ginger rhizome. For external use: dilute 2-3 drops in 15 mL carrier oil (e.g., jojoba, sweet almond). For aromatherapy: add 3-5 drops to diffuser or inhaler.
External: 2-3% dilution in carrier oil for massage. Aromatherapy: 3-5 drops in diffuser. NOT for internal use unless under qualified practitioner supervision.
Apply topically 2-3 times daily for muscle/joint pain. Aromatherapy: as needed for nausea.
As needed for acute conditions
External aromatherapy only for children over 6 at half adult dilution. Not for internal use.
Essential oil contains primarily sesquiterpene hydrocarbons (zingiberene) and monoterpenes but NOT gingerols or shogaols (these are not volatile at steam distillation temperatures). Therefore, ginger essential oil has different therapeutic properties from ginger preparations containing oleoresin. Useful for external warming application (muscle/joint pain) and aromatherapy for nausea. Inhalation of ginger essential oil has shown antiemetic effects in some PONV studies.
[2]
Poultice
Strength: Fresh grated ginger or strong ginger decoction
Grate fresh ginger root finely. Wrap in cheesecloth and apply directly to affected area. Alternatively, prepare a 'ginger compress': soak a towel in hot, strong ginger decoction (approximately 50 g fresh ginger simmered in 1 L water) and apply to affected area.
Apply to affected area for 15-30 minutes
1-3 times daily as needed
Continue as needed for pain relief. Discontinue if skin irritation develops.
Use with caution; test on small area first. Reduce application time to 5-10 minutes.
Traditional external application for joint pain, muscle stiffness, and congestion. The warming, rubefacient effect increases local blood flow and may provide analgesic relief. Can cause skin irritation or reddening in sensitive individuals -- always test on a small area first. Not for use on broken skin or open wounds. Widely used in macrobiotic practice and traditional Japanese medicine (shoga shippu).
[20]
Safety & Interactions
Class 1
Can be safely consumed when used appropriately (AHPA Botanical Safety Handbook)
Contraindications
Rare but documented. Allergic contact dermatitis has been reported from occupational exposure to ginger. Cross-reactivity with other Zingiberaceae members is possible but not well-documented.
Commission E listed gallstones as a contraindication based on ginger's cholagogue activity (stimulation of bile flow). Theoretical concern that increased bile flow could precipitate biliary colic in patients with existing gallstones. This is a precautionary contraindication rather than one based on documented adverse events. The WHO monograph and ESCOP monograph include this contraindication. EMA assessment report also notes this precaution. Clinical evidence of harm is absent, but the theoretical pharmacological basis is sound.
Drug Interactions
| Drug / Class | Severity | Mechanism |
|---|---|---|
| Warfarin and other anticoagulants (Anticoagulants) | theoretical | In vitro, gingerols inhibit thromboxane synthetase, which theoretically could potentiate anticoagulant effects. However, multiple controlled clinical studies in humans have failed to demonstrate significant effects on INR, bleeding time, or platelet aggregation at therapeutic doses (up to 4 g/day). Jiang et al. 2005 found no effect of ginger on the pharmacokinetics or pharmacodynamics of warfarin in healthy subjects. |
| Antiplatelet agents (aspirin, clopidogrel) (Antiplatelet agents) | theoretical | Same theoretical mechanism as with anticoagulants: in vitro inhibition of thromboxane synthetase and platelet aggregation. Not confirmed in clinical studies at normal doses. |
| Hypoglycemic agents (insulin, metformin, sulfonylureas) (Antidiabetic agents) | minor | Some clinical evidence suggests ginger may have mild hypoglycemic effects. A 2018 meta-analysis found modest reductions in fasting blood glucose with ginger supplementation. Additive hypoglycemic effect is theoretically possible. |
| Antihypertensive agents (calcium channel blockers) (Antihypertensive agents) | theoretical | Ginger has demonstrated calcium channel blocking activity in animal studies. Theoretical potential for additive hypotensive effects. |
Pregnancy & Lactation
Pregnancy
likely safe
Lactation
likely safe
Pregnancy: Ginger has been extensively studied for nausea and vomiting of pregnancy. Viljoen et al. 2014 Cochrane review (12 RCTs, 1278 women) found no significant increase in adverse pregnancy outcomes including spontaneous abortion, congenital malformations, low birth weight, or preterm delivery. Ding et al. 2013 meta-analysis found no increased risk of malformations (RR 1.02, 95% CI 0.56-1.87) or stillbirth/perinatal death. Recommended dose for pregnancy: up to 1000-1500 mg dried ginger daily in divided doses. The ACOG and several national health authorities recognize ginger as a non-pharmacological option for morning sickness. Exceeding 1500 mg/day during pregnancy is not recommended due to theoretical uterine stimulant effects at very high doses, though this has not been demonstrated clinically. Lactation: Ginger is widely consumed as a food and galactagogue in many Asian cultures. No adverse effects on breastfed infants have been reported. Classified as likely-safe during lactation by most authoritative references.
Adverse Effects
References
Monograph Sources
- [1] German Commission E (Bundesinstitut fur Arzneimittel und Medizinprodukte). Commission E Monograph: Zingiberis rhizoma (Ginger Root) -- Positive. Bundesanzeiger (Federal Gazette) (1998)
- [2] World Health Organization. WHO Monographs on Selected Medicinal Plants, Volume 1: Rhizoma Zingiberis. World Health Organization, Geneva (1999) : 277-287
- [3] European Scientific Cooperative on Phytotherapy (ESCOP). ESCOP Monographs: Zingiberis rhizoma -- Ginger. ESCOP Monographs, 2nd edition. Thieme, Stuttgart (2003)
- [4] National Center for Complementary and Integrative Health (NCCIH). Ginger. NCCIH, National Institutes of Health (2023)
- [5] Committee on Herbal Medicinal Products (HMPC), European Medicines Agency. Assessment report on Zingiber officinale Roscoe, rhizoma. European Medicines Agency (2012)
Clinical Studies
- [6] Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. Br J Anaesth (2000) ; 84 : 367-371 . DOI: 10.1093/oxfordjournals.bja.a013442 . PMID: 10793599
- [7] Viljoen E, Visser J, Koen N, Musekiwa A. A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting. Nutr J (2014) ; 13 : 20 . DOI: 10.1186/1475-2891-13-20 . PMID: 24642205
- [8] Marx W, Ried K, McCarthy AL, Vitetta L, Sali A, McKavanagh D, Isenring L. Ginger -- Mechanism of action in chemotherapy-induced nausea and vomiting: A review. Crit Rev Food Sci Nutr (2017) ; 57 : 141-146 . DOI: 10.1080/10408398.2013.865590 . PMID: 25848702
- [9] Bartels EM, Folmer VN, Bliddal H, Altman RD, Juhl C, Tarp S, Zhang W, Christensen R. Efficacy and safety of ginger in osteoarthritis patients: a meta-analysis of randomized placebo-controlled trials. Osteoarthritis Cartilage (2015) ; 23 : 13-21 . DOI: 10.1016/j.joca.2014.09.024 . PMID: 25300574
- [10] Terry R, Posadzki P, Watson LK, Ernst E. The use of ginger (Zingiber officinale) for the treatment of pain: a systematic review of clinical trials. Pain Med (2011) ; 12 : 1808-1818 . DOI: 10.1111/j.1526-4637.2011.01261.x . PMID: 22054010
- [11] Chaiyakunapruk N, Kitikannakorn N, Nathisuwan S, Leeprakobboon K, Leelasettagool C. The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis. Am J Obstet Gynecol (2006) ; 194 : 95-99 . DOI: 10.1016/j.ajog.2005.06.046 . PMID: 16389016
- [12] Ryan JL, Heckler CE, Roscoe JA, Dakhil SR, Kirshner J, Flynn PJ, Hickok JT, Morrow GR. Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients. Support Care Cancer (2012) ; 20 : 1479-1489 . DOI: 10.1007/s00520-011-1236-3 . PMID: 21818642
- [13] Altman RD, Marcussen KC. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum (2001) ; 44 : 2531-2538 . DOI: 10.1002/1529-0131(200111)44:11<2531::AID-ART433>3.0.CO;2-J . PMID: 11710709
- [14] Black CD, Herring MP, Hurley DJ, O'Connor PJ. Ginger (Zingiber officinale) reduces muscle pain caused by eccentric exercise. J Pain (2010) ; 11 : 894-903 . DOI: 10.1016/j.jpain.2009.12.013 . PMID: 20418184
- [15] Daily JW, Zhang X, Kim DS, Park S. Efficacy of ginger for alleviating the symptoms of primary dysmenorrhea: a systematic review and meta-analysis of randomized clinical trials. Pain Med (2015) ; 16 : 2243-2255 . DOI: 10.1111/pme.12853 . PMID: 26177393
- [16] Hu ML, Rayner CK, Wu KL, Chuah SK, Tai WC, Chou YP, Chiu YC, Chiu KW, Hu TH. Effect of ginger on gastric motility and symptoms of functional dyspepsia. World J Gastroenterol (2011) ; 17 : 105-110 . DOI: 10.3748/wjg.v17.i1.105 . PMID: 21218090
- [17] Ding M, Leach M, Bradley H. The effectiveness and safety of ginger for pregnancy-induced nausea and vomiting: a systematic review. Women Birth (2013) ; 26 : e26-e30 . DOI: 10.1016/j.wombi.2012.08.001 . PMID: 22951628
- [18] Jiang X, Williams KM, Liauw WS, Ammit AJ, Roufogalis BD, Duke CC, Day RO, McLachlan AJ. Effect of ginkgo and ginger on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects. Br J Clin Pharmacol (2005) ; 59 : 425-432 . DOI: 10.1111/j.1365-2125.2004.02322.x . PMID: 15801937
Traditional Texts
- [19] Bensky D, Clavey S, Stoger E. Chinese Herbal Medicine: Materia Medica (3rd edition). Eastland Press, Seattle (2004)
- [20] Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine (2nd edition). Churchill Livingstone/Elsevier (2013)
Pharmacopeias & Reviews
- [21] Mashhadi NS, Ghiasvand R, Askari G, Hariri M, Darvishi L, Mofid MR. Anti-oxidative and anti-inflammatory effects of ginger in health and physical activity: review of current evidence. Int J Prev Med (2013) ; 4 : S36-S42 . PMID: 23717767
- [22] Semwal RB, Semwal DK, Combrinck S, Viljoen AM. Gingerols and shogaols: important nutraceutical principles from ginger. Phytochemistry (2015) ; 117 : 554-568 . DOI: 10.1016/j.phytochem.2015.07.012 . PMID: 26228533
Last updated: 2026-02-26 | Status: review