Zhi Zi (梔子 – Gardeniae Fructus): An Anti



Zhi Zi (梔子 – Gardeniae Fructus): An Anti
Zhi Zi (梔子 – Gardeniae Fructus): An Anti-inflammatory Herb
Journal of Chinese Medicine • Number 108 • June 2015
Zhi Zi (梔子 – Gardeniae Fructus):
An Anti-inflammatory Herb
By: Sabine
Zhi Zi, Gardeniae
Chinese medicine
The objective of this article is to investigate the commonly-used Chinese herb Zhi Zi (Gardeniae Fructus), and ask
whether it is effective and safe in the treatment of inflammatory diseases. The potential clinical uses of Zhi Zi are
analysed according to the latest biochemical and pharmacological research. Commonly used Western drugs are not
always convenient or effective for the treatment of inflammation due to their adverse side-effects. Thus, safe and
effective treatment options from natural sources with fewer side-effects are needed. Chinese herbal treatment, as a
supplement to conventional treatment or as a stand-alone therapy, can be effective in the treatment of inflammatory
diseases. By knowing the advantages and disadvantages of Western and Chinese treatment options, the most
beneficial treatment can be given to patients.
Figure 1: Zhi Zi (Gardeniae Fructus)
This article investigates the commonly-used Chinese
herb Zhi Zi (梔子, Gardeniae Fructus), asking whether
it is an effective and safe medicinal in the treatment
inflammatory diseases. Inflammation manifests
as increased local temperature, redness, pain and
swelling. Symptoms of inflammatory diseases are
often alleviated by conventional medical treatment
for only a short time, while the underlying cause
of the disease remains unchanged (seen when the
symptoms of the disease reoccur after drug cessation).
Most conventional drugs such as corticosteroids
(eg. prednisone or deltasone1) and non-steroidal
anti-inflammatory drugs (NSAIDS, e.g. ibuprofen,
aspirin or diclofenac2) have severe side-effects, and
immunosuppressive drugs such as methotrexate and
cyclosporine that are often used to treat inflammatory
diseases interfere with the immunological processes
of the human organism and thus cause unwanted
reactions.3,4 Patients taking such drugs need regular
medical supervision and it is the responsibility of
the prescribing doctor to weigh up the use of such
drugs against their inherent risks in order to give
the patients the best possible treatment and quality
of life. In addition, the costs of conventional medical
drugs are relatively high and patients frequently
feel uncomfortable about taking them. According
to the author’s clinical experience, Chinese herbal
medicine is affordable and easy in preparation and
application. Moreover, while a single approach as
seen in Western medicine will not fit every patient,
Chinese herbal medicine offers an approach that can
be adapted to an individual’s particular needs and
clinical presentation.
This article presents a detailed investigation of
traditional (TCM) and modern perspectives on the
Journal of Chinese Medicine • Number 108 • June 2015
Chinese herb Zhi Zi, with a particular focus on the treatment
of inflammatory diseases. Modern pharmacological
research of Chinese herbs has been intensive over the past
two decades, leading to a tremendous increase in the use
and knowledge of Chinese herbal medicine. The author
hopes that this information will help readers in their
clinical practice.
Zhi Zi (梔子 – Gardeniae Fructus): An Anti-inflammatory Herb
According to traditional Chinese medicine (TCM) theory,
inflammation commonly manifests as internal heat (re)
or fire (huo). Heat and fire lie along a continuum and
differ only in their severity, with heat at the milder end
and fire at the more extreme end.5 Because they are yang
pathogens, diseases in which they are involved tend to
be characterised by acute onset and rapid transmission.
Excess yang within the body often leads to symptoms
such as a red complexion, fever, thirst, irritability, a red
tongue and a rapid and full pulse. Since heat tends to flame
upward, it predominantly attacks the upper part of the
body, resulting in symptoms like red eyes, tongue sores,
gum inflammation and tooth-ache. As heat (fire) pertains
to yang, it tends to consume yin fluids (body fluids) and
exhaust qi. Abundant heat drives yin fluids out of the
body, resulting in sweating. Thus, heat manifestations are
often accompanied by thirst (with a preference for cold
water), a dry throat and tongue, dark and scanty urine
and constipation. When extreme heat or fire enters the
blood vessels it sears them, causing an abnormal flow
of blood, manifesting as conditions involving bleeding
such as haemoptysis, epistaxis, haematuria, ecchymosis
or excessive menstruation. The Chinese herbal treatment
of inflammatory disease usually requires herbs that clear
heat and drain fire (qing re xie huo). The Chinese herbal
medicinal Zhi Zi is one such herb.
bleeding and break up toxic accumulations.10 Moreover,
Zhi Zi has a light character and thus particularly affects
the Heart and the Lungs in the upper jiao. According to
TCM theory, its shining red colour confirms its close
relationship to the Heart, which is why it is particularly
effective in treating irritability. However, because of its
bitter and cold nature, Zhi Zi can easily harm the Spleen
and Stomach and should be therefore used with caution
in patients with Spleen deficiency or deficiency-cold. For
patients with a weak digestive system, chao (dry-fried)
Zhi Zi can be used. This preparation reduces its cold
properties and makes it more tolerable for the digestive
Zhi Zi has been used for centuries in TCM formulas.
For example, it is one of the components of Dan Zhi Xiao
Yao San (Augmented Rambling Powder, also known as Jia
Wei Xiao Yao San), which first appeared in the text Nei Ke
Zhai Yao (Summary of Internal Medicine) written by Xue
Ji11 in the Ming Dynasty.12 Dan Zhi Xiao Yao San is based
upon Xiao Yao San (Rambling Powder), a commonly used
formula to treat Liver qi stagnation. By adding Mu Dan Pi
(Moutan Cortex) and Zhi Zi to the original formula, this
prescription becomes able to effectively clear heat. Mu Dan
Pi and Zhi Zi are often used in combination to resolve qi
level constraint heat as well as heat in the blood.13 Another
commonly used formula that includes Zhi Zi is Long Dan
Xie Gan Tang (Gentian Decoction to Drain the Liver), first
recorded in the Qing dynasty14 text Yi Fang Ji Jie (Medical
Formulas Collected and Analysed) written by Wang Ang
in 1682. The author states that the formula can clear heat
from the organs, and in particular treat the patterns of
excess heat or damp-heat in the Liver and Gallbladder. In
this prescription Zhi Zi, along with the two other deputy
herbs Huang Qin and Chai Hu, assist the chief herb Long
Dan Cao in draining fire and expelling dampness. Zhi Zi and TCM theory
Modern pharmacological research
Zhi Zi has been used as a medicine in China as well as
in other Asian countries for centuries. It has a bitter, cold
and downward-directing nature, and is one of the most
commonly used herbs to clear heat and drain fire from all
of the three jiao.6 As it can drain fire, it has a therapeutic
effect in treating febrile conditions.7 It is traditionally
said to enter the Liver, Heart, Lung, Stomach and San
Jiao channels It is an effective herb for draining Liver
fire manifesting with symptoms such as irritability,
short temper, pre-menstrual syndrome (PMS) and early
menstruation. Zhi Zi also resolves constrained heat and
directs damp-heat downward, guiding it out through the
urine. As it can channel damp-heat through the urine, it
is often used to treat jaundice and urinary difficulty.8 Zhu
Danxi observed that Zhi Zi has ‘a tremendous ability to
drain fire downward and out through the urine, as by
nature it winds its way downward.’9 Besides clearing fire at
the qi level, Zhi Zi is also able to treat heat in the blood, stop
Time does not stand still and Chinese medicine is
evolving. Modern scientific insights can help practitioners
to understand the mechanisms and actions of herbs and
formulas. This dynamic process may help to improve the
knowledge base of Chinese medicine and its application
in treating ‘modern’ diseases.
The gardenia family of plants contains about 630
genera and 10,200 species.15 Zhi Zi is the dried ripe
fruit of Gardenia jasminoides and is the most commonly
used species for medicinal purposes.16 The major active
constituents of Zhi Zi have been identified in laboratory
tests, and various clinical studies have documented their
therapeutic effects and applications. Zhi Zi contains a
large amount of iridoid glycosides, which are involved
in its anti-inflammatory effects.17,18 Iridoids are secondary
metabolites of terrestrial and marine flora and fauna,
and are found in more than 50 medicinal plant families
(usually as glycosides). They are characterised by their
Inflammation and Chinese medicine
Journal of Chinese Medicine • Number 108 • June 2015
Zhi Zi (梔子 – Gardeniae Fructus): An Anti-inflammatory Herb
extremely bitter taste. Studies have revealed that iridoids
have a wide range of pharmacological activities, including
anti-inflammatory, cardiovascular, hepatoprotective,
hypoglycaemic, anti-mutagenic, anti-spasmodic, antitumour, anti-viral, immunomodulating and purgative
effects.19 Geniposide is one of the major iridoid glycosides
found in the fruit of dried Zhi Zi. Other constituents, such
as crocins, caffeoylquinic acids and dicaffeoylquinic acids,
also contribute to its bioactive activity.20,21 Numerous
studies have confirmed that these substances have
antioxidant, anti-inflammatory, anti-atherosclerotic, antiischaemic, anti-hyperglycaemic, anti-hyperlipidemic
and anti-hypertensive effects, as well as helping to
prevent platelet aggregation.22 The caffeoylquinic and
dicaffeoylquinic acids in Zhi Zi are powerful free radical
scavengers, inhibiting the oxidation of cells and tissues
and preventing cell-damage that contributes to ageing
and disease.23
It is known that extracts of Zhi Zi markedly prolong
bleeding time and inhibit platelet aggregation and
thrombosis,24 which supports the TCM perspective
that Zhi Zi most probably has blood-moving actions
(although traditional indications relate this specifically
to external usage for trauma25). It also has a significant
anti-proliferation effect on both endothelial cells and
endothelial progenitor cells.26 In this context, Zhi Zi can
be an effective medicinal in the treatment of the chronic
inflammatory skin disease psoriasis. It has also been
shown that geniposide - one of the main ingredients of
Zhi Zi - exhibits anti-tumour effects,27 and that genipin, a
metabolic product of geniposide, appears to be a potent
anti-inflammatory and anti-angiogenic agent.28,29
and drain the fire involved in inflammation. Scientific
research is leading to the modernisation of TCM, and
doctors should use the latest research to inform their
clinical practice. The bioactive ingredients in Zhi Zi have
been shown to have the capacity to treat inflammation.
Sabine Schmitz practises acupuncture and Chinese herbal medicine
in Cologne. Her particular interest and focus is on Chinese medicine
gynaecology and dermatology. Find out more about Sabine at www.
Logged in journal subscribers can comment on this article
at www.jcm.co.uk
Picture references
Figure 1: Sabine Schmitz
Figure 2: Koo, H.J., Song, Y.S., Kim, H.J., et al. (2004). “Antiinflammatory
effects of genipin, an active principle of gardenia”. Eur J Pharmacol,
495, 201–208
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Figure 2: The chemical structures of genipin and geniposide
Chinese herbal medicine can offer effective, safe and
affordable treatment for patients with inflammatory
diseases. Bitter-cold herbs such as Zhi Zi can clear the heat
8 Bensky, D., Clavey, S. & Stöger,
E. (2004). Materia Medica,. 3rd
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14 Qing Dynasty (1616-1840 AD)
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Zhi Zi (梔子 – Gardeniae Fructus): An Anti-inflammatory Herb