Encyclopedia/Botanical/TCM/encyclopedia-ginkgo-biloba

Ginkgo Biloba

Ginkgo biloba L.

Sources

6 listed

Best forAdults considering a standardised ginkgo leaf extract for medically assessed cognitive complaints. Medical advice is needed with medicines affecting clotting and before procedures.

Clinical evidence

Emerging

Real World Significance

32Regional historical significance

Breadth 33 Depth 13 Density 53 Convergence 25 Continuity 45

SafetyUse with cautionCaution is warranted particularly because of possible interactions and bleeding events. Use with medicines affecting clotting and before surgery should be discussed with a doctor. Pregnancy is a contraindication for the defined leaf extract. Seeds have a separate poisoning risk that cooking does not completely remove.

Tradition

TCM

Common preparations

CapsuleTabletStandardised extract

In short

Summary of findings for quick reference

Ginkgo is the last living representative of a very ancient plant lineage. Its recorded medicinal history is much younger. Chinese texts particularly describe the seeds, Bai Guo, including their use for cough, wheezing and urinary complaints in the Bencao Gangmu. Today’s standardised leaf extracts are a twentieth-century pharmaceutical development. The history of the seeds therefore does not establish centuries of treatment of cognitive complaints with these extracts.

The EMA monograph distinguishes two preparations. For a defined leaf extract it lists well-established use for age-associated cognitive impairment and improved quality of life in mild dementia. Powdered leaf instead has traditional use for heavy legs and cold hands and feet due to minor circulatory disorders, after serious causes have been excluded by a doctor. Findings for a specific extract cannot be transferred to arbitrary capsules or homemade tea.

Possible benefits for dementia symptoms remain uncertain. For mild cognitive impairment without dementia, the current Cochrane review finds probably little or no benefit; the large GEM trial found no protection against dementia. A clinically significant walking-distance benefit in peripheral arterial disease is also unproven. Discuss ginkgo with your care team if you take medicines affecting clotting or have a procedure planned. Seeds and foraged leaves are not substitutes for a quality-controlled medicine.

Clinical evidence ↔ Historical significance

We display two separate evidence categories: clinical evidence from modern trials and historical significance from documented healing tradition. Both are valuable, but they answer different questions.

In every encyclopedia entry we evaluate two distinct categories of evidence. Clinical evidence as used in trials meets a narrower but scientifically essential bar. At the same time, the hundreds of thousands of plant species worldwide have only partially been captured and tested in modern studies.

Alongside the trial picture our researchers compile a comprehensive overview of where and since when a plant has been used across different traditions of natural medicine. When a plant has been used as a medicinal plant in many cultures across many generations, that historical significance deserves to be visible too.

Our position: a truly informative overview emerges only when both categories sit side by side. We communicate transparently what counts as what.

Overview

Ginkgo (Ginkgo biloba) is the only living representative of an ancient plant lineage. Its fan-shaped leaves are used in modern phytotherapy. Standardised leaf extracts have been studied clinically for decades, especially for cognitive complaints in older people and circulatory disorders. Ginkgo is also grown as an ornamental tree in Vienna and many other European cities. Its leaves cannot be used to make an equivalent medicine at home.

The EMA Committee on Herbal Medicinal Products lists a well-established use for a precisely defined dry extract to improve age-associated cognitive impairment and quality of life in mild dementia. The monograph specifies extract quality and is not a general recommendation for food supplements. A separate traditional use concerns powdered leaf for heavy legs and cold hands and feet associated with minor circulatory disorders after serious causes have been excluded by a doctor. Studies of cognitive complaints remain inconsistent.

History

Ginkgo biloba is often called a living fossil: the plant lineage of which it is the last representative dates back to the time of the dinosaurs. Ginkgo trees were cultivated in temple gardens in China and Japan; seeds reached Europe in the eighteenth century. The seeds have a particularly long history in Chinese medicine. Older uses of the leaves are also described, but they are distinct from the modern treatment of cognitive complaints with standardised extracts.

Modern research on ginkgo leaf extracts was developed substantially in Germany. Schwabe marketed the ginkgo medicine Tebonin in 1965; the special extract EGb 761 was subsequently investigated in numerous clinical trials. This development is distinct from the older use of the seeds as Bai Guo. Li Shizhen’s sixteenth-century Bencao Gangmu describes them for cough, wheezing and urinary complaints, among other uses. Such historical records document past use, not present-day efficacy or safety.

Mechanism

Characteristic constituents of ginkgo leaf extracts include flavone glycosides, such as derivatives of kaempferol, quercetin and isorhamnetin, and terpene lactones including ginkgolides and bilobalide. EGb 761 is commonly described as containing about 24% flavone glycosides and 6% terpene lactones. Pharmacopoeial quality also requires a specified manufacturing process and a ginkgolic-acid limit of 5 ppm. Two percentages on a label are therefore not enough to establish equivalence between extracts.

Proposed mechanisms include changes in blood flow, antioxidant effects and antagonism of platelet-activating factor, particularly by ginkgolide B. Many findings come from cell or animal experiments. The exact mechanism in humans is not established. Such laboratory findings do not establish a particular clinical benefit or quantify bleeding risk.

The 2026 Cochrane review by Wieland and colleagues includes 82 studies of cognitive complaints and dementia. In mild cognitive impairment without dementia, ginkgo probably offered little or no benefit for cognition or activities of daily living after six months. In dementia, improvements in cognition, overall status and some daily activities may occur. Certainty in these findings is low, however, and results vary substantially between studies. These patient groups should therefore be assessed separately.

The GEM study by DeKosky and colleagues (2008) tested dementia prevention in 3,069 people aged 75 or older with normal cognition or mild cognitive impairment. Ginkgo extract at 120 mg twice daily did not reduce dementia risk over a median follow-up of 6.1 years. This is distinct from symptomatic treatment of established dementia. For walking distance in peripheral arterial disease, a separate 2013 Cochrane review of 14 trials found no convincing clinically significant benefit.

Evidence

4 Outcomes evaluated. Sorted by grade.

Outcome	Class	Grade	Effect	Studies	Refs
Cognitive function in dementiaAdults with dementia; mild cognitive impairment without dementia requires separate assessment.	Emerging	C	Mixed Effect		[1]
Peripheral arterial disease, walking distanceAdults with intermittent claudication	Insufficient	C	No convincing benefit established	14 studies	[3]
Dementia prevention in older adults without dementiaPeople aged 75 or older with normal cognition or mild cognitive impairment	Insufficient	I	No preventive benefit established	1 study	[2]
Bleeding events with anticoagulants or antiplateletsAdults on warfarin, aspirin, clopidogrel, or chronic NSAIDs	Traditional	D	Possible bleeding risk		[4][5][6]

Usage

Forms and preparation

For cognitive complaints, the research and EMA monograph concern specific leaf extracts. The monograph specifies a refined and quantified dry extract with a drug-to-extract ratio of 35 to 67:1 and 60% acetone (m/m) as extraction solvent. EGb 761 is a frequently studied special extract; LI 1370 has also been studied but is a distinct preparation. Check the exact extract identity and product leaflet. A claim of “24% flavone glycosides, 6% terpene lactones” alone does not guarantee equivalence. Foraged ginkgo leaves and homemade tea are not comparable to a refined medicinal extract. The German Federal Institute for Risk Assessment could not conclusively assess ginkgo-leaf teas because of insufficient data; tested tea mixtures contained concerning amounts of ginkgolic acids. Do not collect street-tree leaves to make a health tea. Ask a pharmacist for advice on choosing a medicine.

Dosage

For the dry extract specified in the EMA monograph, the adult daily dose is 240 mg, taken once or as 120 mg twice daily. Treatment should last at least eight weeks. Without improvement after three months, or if symptoms worsen, a doctor should review whether treatment remains appropriate. The separate traditional use concerns powdered leaf at 750 mg daily; symptoms lasting longer than two weeks require medical advice. Extract and powdered-leaf doses are not interchangeable. Follow the leaflet for the specific medicine. Before use, discuss all medicines and supplements with your clinician or pharmacist, particularly products that affect blood clotting. These combinations require medical advice. Increasing the dose is not a solution if there is no improvement.

Safety

Safety profile

If you take anticoagulants such as phenprocoumon, warfarin or dabigatran, antiplatelets such as aspirin or clopidogrel, or regular nonsteroidal anti-inflammatory medicines, use ginkgo only after medical advice. Bleeding has been reported. The additional risk is not established for every combination. Inform the care team before surgery, dental extractions or other procedures. For the extract, the EMA advises stopping three to four days before surgery as a precaution. Your team should determine your individual interval. Other medicines may also interact, particularly efavirenz, which the EMA does not recommend taking concurrently. People with a pathologically increased tendency to bleed should also seek medical advice before using ginkgo. With warfarin, appropriate monitoring is advised when starting ginkgo, changing its dose, stopping it or changing products. Ginkgo may also increase blood concentrations of nifedipine, requiring caution. Do not eat raw ginkgo seeds. Ginkgotoxin can cause seizures, particularly in children. Cooked seeds can also cause poisoning. People with epilepsy should seek medical advice before any ginkgo use because further seizures cannot be excluded. The leaf extract described in the EMA monograph must not be used during pregnancy and is not recommended during breastfeeding. Powdered ginkgo leaf is not recommended during either pregnancy or breastfeeding. There is no corresponding recommendation for children or adolescents. Do not take a preparation if you are allergic to ginkgo. Headache, dizziness and gastrointestinal complaints are possible adverse effects. Stop the preparation and seek medical advice if unusual bruising, nosebleeds or other bleeding occurs.

Look-alikes

Botany

Family

Ginkgoaceae

Native regions

China, Japan, Korea, cultivated worldwide

Harvest window

Leaves harvested green in late summer for extraction

Habitat

Ginkgo is native to China; Kew lists Zhejiang as its native range. Whether the old populations there are entirely wild or partly descended from historical plantings is not fully resolved. The tree is now cultivated throughout temperate regions, including as an ornamental in European cities. Leaves for medicinal extracts are obtained from controlled cultivation.

Identification & foraging

Ginkgo is a tall deciduous tree with fan-shaped leaves, often divided into two or more lobes. They turn bright yellow in autumn. Male and female reproductive organs generally occur on separate trees. Female trees form seeds with a fleshy outer coat that smells unpleasant when ripe. Botanically, these are not fruits. The distinctive leaves assist recognition but are not suitable for preparing a homemade medicine.

FAQs

Is a generic Ginkgo supplement the same as EGb 761?

No, not automatically. EGb 761 is a specific special extract. Its manufacturing process, constituent profile and ginkgolic-acid limit together define its quality. Even matching percentages on another package do not establish equivalence. LI 1370 is also a separate preparation. Ask a pharmacist which extract is present and which indication and dose its leaflet specifies.

Can I take Ginkgo together with low dose aspirin?

Only after discussing it with your doctor. An increased bleeding risk cannot be excluded with ginkgo and aspirin. Case reports warrant caution but do not establish the exact risk or an equally strong interaction in everyone. This also applies to low-dose aspirin for cardiovascular prevention. Do not stop a prescribed medicine on your own to take ginkgo.

I have surgery scheduled. When should I stop Ginkgo?

Tell the surgical or anaesthesia team in advance which ginkgo preparation you take. The EMA monograph advises stopping the leaf extract three to four days before surgery as a precaution. Your team may specify a different interval depending on the procedure, preparation and other medicines. Also inform your clinician before dental extractions or other invasive procedures. If the procedure is imminent, report your use promptly so the team can plan accordingly.

Can I make tea from fresh Ginkgo leaves in autumn?

This is not advisable. Neither equivalent efficacy nor a safe dose has been established for foraged ginkgo leaves and homemade tea. Ginkgolic acids are an additional concern; the German Federal Institute for Risk Assessment could not conclusively establish the safety of ginkgo-leaf teas because of insufficient data. Cognitive trials used specific extracts. The EMA traditional indication for powdered leaf is not a recommendation for homemade tea.

References

6 sources.

Wieland LS; Ludeman E; Chi Y; Feinberg TM; Chen I-H; Chen K-H; Zhu Y; Wolverson E; Amri H. Ginkgo biloba for cognitive impairment and dementia. 2026. doi:10.1002/14651858.CD013661.pub2
DeKosky ST; Williamson JD; Fitzpatrick AL; Kronmal RA; Ives DG; Saxton JA; et al.; Ginkgo Evaluation of Memory Study Investigators. Ginkgo biloba for prevention of dementia: a randomized controlled trial. 2008. doi:10.1001/jama.2008.683
Nicolaï SPA; Kruidenier LM; Bendermacher BLW; Prins MH; Stokmans RA; Broos PPHL; Teijink JAW. Ginkgo biloba for intermittent claudication. 2013. doi:10.1002/14651858.CD006888.pub3
Bent S; Goldberg H; Padula A; Avins AL. Spontaneous bleeding associated with ginkgo biloba: a case report and systematic review of the literature. 2005. doi:10.1007/s11606-005-0114-4
Kellermann AJ; Kloft C. Is there a risk of bleeding associated with standardized Ginkgo biloba extract therapy? A systematic review and meta-analysis. 2011. doi:10.1592/phco.31.5.490
European Medicines Agency, Committee on Herbal Medicinal Products (HMPC). European Union herbal monograph on Ginkgo biloba L., folium. 2015. Source

Legal notice: The depiction of historical significance and traditional use is context within our encyclopedia and not a health claim for any product, not a treatment promise, and not a substitute for medical advice. What may be stated on product labels, product pages, or in advertising is governed by the applicable legal requirements.