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Baikal Skullcap

Scientific Name(s): Scutellaria baicalensis Georgi.
Common Name(s): Baical skullcap, Chinese skullcap, Golden root, Huang chin, Huang lien, Huang-qin, Hwang-keum, Hwanggum, Koganebana, Senohgon, Whang-geum, Wogon

Medically reviewed by Drugs.com. Last updated on Nov 21, 2023.

Clinical Overview

Use

Baikal skullcap has been used traditionally in Chinese medicine for various conditions. Baikal skullcap has been investigated for its anti-inflammatory, immunoprotective, antimicrobial, antipsoriatic, and neuroprotective effects; however, limited quality clinical trials support these uses.

Dosing

Clinical trials are lacking to provide dosing recommendations for Baikal skullcap.

Contraindications

Contraindications have not been identified.

Pregnancy/Lactation

Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Few adverse reactions have been reported.

Toxicology

In a phase 1 study of healthy volunteers, baicalein 100 mg to 2.8 g was not associated with hepatic or kidney toxicity.

Scientific Family

Botany

Baikal skullcap is an herbaceous perennial with fleshy roots that grows to 0.3 to 1.2 m in height. It has lancet-shaped leaves, purple-blue flowers, and black-brown, egg-shaped nutlets. The plant is found in Japan, China, Korea, Mongolia, and Russia,Gaire 2014 and thrives on sunny, grassy slopes and in dry, sandy soils. The dried root has been used in traditional Chinese medicine. Baikal skullcap is related to skullcap (Scutellaria laterifolia), a North American species (see Scullcap monograph).Chevalier 1996

History

Baikal skullcap is a Chinese medicinal herb that has been used for more than 2,000 years to treat fever, hypertension, coughing, and other ailments, and is used today as a traditional remedy for dysentery and diarrhea. Baikal skullcap was an ingredient in several pharmaceutical combination preparations found in a second-century AD tomb in northwestern China.Chevalier 1996

Baikal skullcap is prescribed in China for fever, cough, and GI and urinary conditions. Baikal skullcap is also used in Chinese herbal medicine for inflammation, allergies, dermatitis, hyperlipidemia, and atherosclerosis.Chevalier 1996, Newell 1996

Chemistry

Major phytochemicals found in S. baicalensis include flavonoids, glycosides, and their glucuronides.Gaire 2014 Flavonoids present in S. baicalensis include baicalin, baicalein, wogonin, and wogonoside.Chevalier 1996, Gao 2000 Reversed-phase high-performance liquid chromatography determination of flavonoids from S. baicalensis root has been reported.Stojakowska 1998 Flavone synthases Ι and ΙΙ, chrysin, wogonin, apigenin, salvigenin, scutellarein, and isoscutellarein were among flavonoid constituents found in S. baicalensis leaf parts.Miyaichi 1988 The flavones baicalein, oroxylin, and skullcapflavone ΙΙ were also identified.Liao 1998 Other reports have confirmed similar flavonoid content.Morimoto 1998, Tomimori 1985 One report described melatonin in certain plant samples.Murch 1997 Other compounds include sterols and benzoic acid.Chevalier 1996 The North American species S. laterifolia differs regarding chemical constituents.

Uses and Pharmacology

Alpha-glucosidase inhibitory activity

In vitro data

Five flavonoids derived from S. baicalensis inhibited alpha-glucosidase activity in vitro. The strongest inhibitor was baicalein, followed by wogonin, baicalin, chrysin, and oroxylin A.Yang 2015 Additionally, baicalein inhibited the activity of rat intestinal sucrose as well as human intestinal sucrose expression in Caco-2 cells. Results suggest the compound might be useful in lowering postprandial blood glucose levels.Nishioka 1998

Anti-inflammatory effects

Anti-inflammatory effects of Baikal skullcap are well documented. Baicalein may yield anti-inflammatory effects through inhibition of cyclooxygenase (COX), ultimately reducing the formation of prostaglandins.Huang 2005

Animal and in vitro data

One study evaluating effects of a methanolic extract of 3 flavonoids (wogonin, baicalein, and baicalin) on gingival fibroblasts reported an effect similar to that of prednisolone.Chung 1995 Another study reported that chloroform extract of Saxifraga rivularis exhibited greater inhibition than indomethacin against carrageenan-induced rat paw edema. Baicalin also demonstrated the most effective inhibitory activity when compared with baicalein and wogonin.Lin 1996 Wogonin, baicalein, and baicalin all influenced some anti-inflammatory pathways via certain proteins, antigens, and enzymes.Chang 2001, Krakauer 2001, Wakabayashi 1999

A standardized and purified extract of S. baicalensis containing baicalein, oroxylin A, and wogonin exerted anti-inflammatory effects in both in vitro and in vivo models of colitis. Specifically, the extract reduced tumor necrosis factor (TNF)-alpha–induced COX-2 expression by reducing the histopathological severity as well as the expression of COX-2, TNF-alpha, and interleukin (IL)-1beta.Jiang 2015 In a murine model of induced colitis, a Chinese formula containing S. baicalensis, Paeonia lactiflora, Glycyrrhiza uralensis, and Ziziphus jujube showed effectiveness similar to salicylazosulfapyridine, resulting in improved colonic swelling and redness, as well as recovered body weight.Chen 2015

In a study of 2,4-dinitrochlorobenzene–induced contact dermatitis in BALB/c mice, topical application of an aqueous extract of S. baicalensis suppressed dermatitis by reducing the production of inflammatory cytokines (ie, IL-4, IFN-gamma, TNF-alpha). Infiltration of leukocytes into the dermis and epidermal thickness were also reduced with S. baicalensis.Kim 2016

Antimicrobial effects

In vitro data

Several studies have evaluated the antimicrobial effects of Baikal skullcap. In vitro testing of an S. baicalensis preparation on select oral bacteria demonstrated bacteriostatic and bactericidal effects at specified concentrations.Lee 2000 In another study, the flavone isolate baicalin was synergistic with beta-lactam antibiotics against methicillin-resistant Staphylococcus aureus (MRSA) and other beta-lactam–resistant strains of S. aureus.Tsao 1982 One study found that baicalein was effective against penicillinase-producing S. aureus and MRSA by inhibiting penicillinase in a dose-dependent manner.Liu 2000 In an herbal screening study, S. baicalensis demonstrated high antifungal activity against Candida albicans.Wong 2009 Antifungal effects were attributed to baicalein in another report, in which S. baicalensis was active against Cryptococcus neoformans and Pityrosporum.Blaszczyk 2000

In another in vitro study, baicalein exerted antimicrobial effects against 11 different oral bacterial species. Baicalein also exerted synergistic and sometimes additive effects when administered in combination with ampicillin and/or gentamicin in these bacterial strains.Jang 2014 A literature review of the effects of baicalin in treating periodontal disease reported on multiple potential mechanisms, including direct antibacterial effects, and anti-inflammatory and immunomodulatory effects.Ming 2018

Clinical data

One study compared a Scutelleria compound injection with intravenous (IV) piperacillin in 60 patients with pulmonary infection. Results were comparable regarding certain parameters, such as efficacy rates, leucocyte count, and low adverse reaction incidence. However, 4 of the 30 patients in the piperacillin group had subsequent fungal infections, whereas no fungal infections occurred in the Scutelleria group after treatment.Lu 1990

Antioxidant effects

Flavonoids from S. baicalensis have been studied for antioxidant effects. Four major flavonoids (baicalein, baicalin, wogonin, and wogonoside) have been studied in various systems, confirming antioxidant activity.Gao 1999

Animal and in vitro data

One in vitro study showed that baicalein exhibited the most consistent antioxidant effects, with baicalin and wogonin also displaying antioxidant effects; wogonoside was found to be inactive.Wozniak 2015 An extract of S. baicalensis also demonstrated protective action against oxidation induced by ultraviolet light, suggesting potential use against certain skin diseases.Gabrielska 1997 Another study found that the flavonoid baicalein inhibited lipid peroxidation in rat liver microsomes.Gao 1995 Studies also found that baicalein and baicalin scavenged hydroxyl radical, superoxide anion, and other free radicals in a dose-dependent manner,Gao 2000 and that baicalein directly scavenged superoxide, hydrogen peroxide, and hydroxyl radicals in cardiomyocytes.Shao 1999 The flavonoids wogonin and wogonoside demonstrated subtle effects on these radicals but did inhibit nitric oxide production, as did a water extract of S. baicalensis.Gao 2000, Kim 2001, Tezuka 2001 Results also showed that ganhuangenin isolated from S. baicalensis had greater antioxidant potency than alpha-tocopherol.Lim 1999

Antiviral activity

In vitro data

A flavonoid compound from S. baicalensis inhibited T-cell leukemia virus type Ι (HTLV-Ι). The constituent baicalin inhibited reverse transcriptase activity in HTLV-Ι–infected cells, as well as the activity of purified reverse transcriptase from Moloney murine leukemia virus and Rous-associated virus type 2.Qian 2015 Other flavones, such as isoscutellarein from S. baicalensis leaves, also showed anti–influenza virus activity in vitro.Baylor 1992 Isoscutellarein-8-methylether from S. baicalensis roots demonstrated effects against influenza A and B viruses; results suggested inhibition of the replication of A/Guizhou and B/Ibaraki viruses via inhibition of the fusion of viral envelopes with the endosome/lysosome membrane that occurs early in the virus infection cycle.Nagai 1992

Cancer

Because of its potential effects as an antioxidant, Baikal skullcap has been studied for effects in cancer.

Animal and in vitro data

In rats with Pliss lymphosarcoma associated with disorders in platelet-mediated hemostasis, S. baicalensis administration resulted in a normalizing effect, suggesting adaptogenic activity, which may be responsible for S. baicalensis Georgi's antitumor and metastasis-preventing effects.Razina 1989 In other reports, a 14-flavone combination from S. baicalensis had marked inhibitory effects on mouse skin tumor promotionKonoshima 1992 and demonstrated anticancer activity in laboratory mice with head and neck squamous cell carcinoma.Zhang 2003

In a murine model of adenocarcinoma, baicalin ameliorated anorexia by reducing cytokine (ie, TNF-alpha, IL-6) levels and preventing muscle atrophy. Food intake was greater in mice receiving baicalin compared with those receiving placebo.Li 2014

Baicalein inhibited migration, adhesion, and invasion caused by 17-beta-estradiol in a line of breast cancer cells by interfering with activation of the GPR30 signaling pathway.Shang 2015

Wogonin inhibited cell viability in both a time- and dose-dependent manner in HL-60 leukemia cells; it also increased the activation of caspases 3, 8, and 9.Hu 2015

In human colorectal cancer HCT116 cells, baicalein reduced cell viability in a concentration-dependent manner. After 24 hours of treatment with baicalein, the cells were more rounded and dispersed with aggregation. Baicalein induced apoptosis of the colorectal cancer cells. Suppression of HCT116 cell migration with baicalein treatment was suggested to be associated with inhibition of matrix metalloproteinases 2 and 9 activities. Baicalein also reduced the formation of tumors associated with inflammation.Kim 2013

Cell viability of peripheral blood leukocytes obtained from children with acute lymphocytic leukemia was reduced with the use of an S. baicalensis extract.Orzechowska 2014

Baicalin and baicalein inhibited cell proliferation in certain cell lines,Wang 2015 induced quinone reductase,Hsu 2001 and induced apoptosis in prostate cancer cells.Park 1998 Other in vitro effects included antigenotoxic actions of baicalein.Chan 2000

Clinical data

A review of the biomedical and clinical studies of S. baicalensis in the treatment of cancer reported favorably on the potential of the extract and individual chemical constituents. However, limitations were noted in the trials, especially regarding quality control of the interventions.Cheng 2018

S. baicalensis extract administered to lung cancer patients improved certain immunoglobulins.Smol'ianinov 1997 Dry extract of Baikal skullcap given to 88 lung cancer patients increased hematopoiesis stimulation and improved other anticancer parameters.Gol'dberg 1997

Cardiovascular effects

Baikal skullcap has been used to alleviate circulatory problems (eg, high blood pressure, arteriosclerosis, varicose veins, bruising).Chevalier 1996

Animal and in vitro data

The flavone baicalein inhibited thrombin and thrombin-induced calcium and plasminogen activators in cultured human umbilical vein endothelial cells, suggesting potential benefits in arteriosclerosis and thrombosis.Yang 1995

S. baicalensis roots have been suggested to reduce blood pressure, particularly in renin-dependent hypertension; however, in a murine model, baicalein increased sensitivity to vasoconstriction. Inhibition of lipoxygenase may also explain baicalein's hypotensive effects.Huang 2005

Baicalein reduced thrombin-mediated fibrin polymerization, prolonged activated partial thromboplastin time and prothrombin time, reduced platelet aggregation, decreased ferric chloride–induced thrombus formation, and inhibited activated factor X and thrombin activity. Additionally, bleeding time in mice tails was prolonged. However, baicalein exerted weaker anticoagulant activities when compared with warfarin and heparin.Lee 2015

Cholesterol-lowering effects

Animal data

In rats, radix of S. baicalensis was synergetic with metformin in lowering cholesterol levels.Han 2017

Estrogenic activity

In vitro data

An in vitro study reported weak estrogenic activity associated with S. baicalensis.Zhang 2005

Food allergy

Animal data

In a study of mice sensitized with ovalbumin to induce a food allergy response, administration of Baikal skullcap 25 mg/kg orally once daily was associated with reduced anaphylactic response and reduction in cytokine production, suggesting Baikal skullcap may be a preventive moiety for food allergies.Shin 2014

Hepatoprotective effects

Animal data

Baicalin exhibited hepatoprotective activity in rats.Kyo 1998

Neuroprotective effects

Baikal skullcap may exert a protective effect in neurodegenerative diseases due to anti-inflammatory, antioxidant, and antiapoptotic effects.Gaire 2014

Animal and in vitro data

One study suggests Baikal skullcap may be useful for the treatment of Alzheimer disease. Flavonoids from Baikal skullcap exerted a protective effect on hippocampal neurons by reducing lipid peroxidation buildup and glial cell proliferation.Gao 2013 In a murine model of okadaic acid–induced neuronal damage, S. baicalensis reduced neuronal injuries in the hippocampus and cerebral cortex. Additionally, S. baicalensis reversed the reduction in neuron count.Zhang 2015

In a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)–induced murine model of Parkinson disease, baicalein 140 mg/kg or 280 mg/kg improved behavioral deficits caused by the MPTP in a manner similar to the positive control, madopar. Baicalein was also associated with improvements in neurogenesis, neuroblast proliferation, neurotrophin signaling pathway, walking and locomotor behaviors, and regulation of gene expression.Gao 2015

In vitro studies and modelling have reported effects for S. baicalensis and the constituents baicalin and baicalein, including increased monoamine and dopamine neurotransmission, as well as influences on gamma-aminobutyric-A receptor signaling. Anxiolytic and antidepressant effects of S. baicalensis have been demonstrated in rodent studies.Limanaqi 2020

Clinical data

In one study evaluating the effects of herbal compounds on cognitive function, 300 mg of an extract of S. baicalensis reportedly resulted in improved speed and accuracy in processing complex information in computer tasks.Limanaqi 2020

A protocol has been published for a clinical trial evaluating an extract of S. baicalensis and Pueraria lobate in improving neurologic status (particularly motor function) in acute ischemic stroke patients; the protocol was designed to investigate the efficacy and safety of the combination preparation.Heo 2019

The pharmacokinetics, safety, and tolerability of baicalein have been investigated in a study of 33 healthy Chinese volunteers, with a secondary objective of characterizing the safety and tolerability of multiple-dose baicalein to support subsequent clinical trials in Parkinson disease.Pang 2016

Psoriasis

Animal data

In a murine model, topical application of baicalin cream inhibited a 2,4-dinitrofluorobenzene–induced contact hypersensitivity reaction. The anti-inflammatory effect was not of the same magnitude as with tacrolimus. The effects were stronger at higher concentrations as well as at 48 versus 24 hours. Additionally, baicalin cream produced differentiation in the epidermis of mouse tails with psoriasis, with the 5% cream having the greatest effect compared with baicalin 1% and 3% creams.Wu 2015

Clinical data

A case report described the successful treatment of psoriasis with a topical ointment containing S. baicalensis, Indigo naturalis, and Cortex phellodendri. An 8-year-old boy with a 2-year history of psoriasis was originally responsive to conventional antipsoriatic therapies; however, his symptoms worsened with continued therapy. After receiving the S. baicalensis combination ointment twice daily for 2 months, the patient's previous body surface coverage of 80% improved to 0%. He remained in remission for more than 2 years, with reapplication of the ointment for occasional small flare-ups proving beneficial.Lin 2006 No clinical trial evidence supporting these findings exists.

Other uses

Other potential uses of Baikal skullcap preparations include for the treatment of neonatal jaundiceHo 1996; sores, swelling, boils, and diabetic problemsChevalier 1996; and ulcer.Amosova 1998

Dosing

Clinical trials are lacking to provide dosing recommendations for Baikal skullcap. A pharmacokinetic study reported that multiple-dose oral baicalein administration, with dosing regimens of 200 mg, 400 mg, or 800 mg once daily on days 1 and 10, twice daily on days 3 to 9, was safe and well tolerated.Pang 2016

Pregnancy / Lactation

Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking. In a study of mice, administration of an aqueous extract of S. baicalensis root up to 32 g/kg/day did not result in fetal malformations. However, the maximum dosage of 32 g/kg/day resulted in elevations in maternal liver and kidney weights.Tian 2009, Yimam 2015, Yimam 2015, Yimam 2015

Interactions

Alpha-glucosidase inhibitors: Because baicalein may have a mechanism of action similar to that of alpha-glucosidase inhibitors,Nishioka 1998 use caution in patients receiving alpha-glucosidase inhibitors. If alpha-glucosidase inhibitors are taken with baicalein, patients should be monitored for hypoglycemia.

Antiplatelets/Anticoagulants: Due to its potential antiplatelet, anticoagulant, and profibrinolytic effects,Lee 2015 baicalein should be used with caution in patients taking any medications or supplements that can prolong bleeding time.

Garlic supplementation: In a murine model, the addition of garlic to S. baicalensis was associated with reduced area under the curve and time to maximum plasma concentration.Zhou 2008

Adverse Reactions

Few adverse reactions have been reported. Because flavones of Baikal skullcap have been shown to interact with the benzodiazepine site of the gamma-aminobutyric acid A receptor, sedation may occur with coadministration.Hui 2000 Isoscutellarein isolated from S. baicalensis leaves produced negligible toxic effects in mice.Tsao 1982

No adverse reactions were reported in liver, kidney, or medulla regions in a 60-patient study of IV Scutellaria compound.Jang 2014 In a phase 1 study, hyperactive bowel sounds, abdominal distention, constipation, dizziness, somnolence, blurred vision, reduction in plasma fibrinogen, and reduction in blood leukocytes were reported in healthy volunteers taking baicalein 100 mg to 2.8 g.Li 2014

Baikal skullcap or baicalin has been a component of several combination products associated with severe hepatic injury. Identifying the component responsible for these adverse effects may not be possible, but caution may be warranted.Braude 2019, Chalasani 2012

Toxicology

In a phase 1 study of healthy volunteers, baicalein 100 mg to 2.8 g was not associated with hepatic or kidney toxicity.Li 2014

Index Terms

References

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

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