Health Care Professional Information

Scientific Name
Isatidis baphicacanthi, Isatis tinctoria, Isatis indigotica, Folium isatidis
Common Name

Dyer’s woad leaf, Indigo, Da Qing Ye, Daqingye

Clinical Summary

Isatis leaf is derived from the isatis plant and is a source of indigo dye. In both traditional Chinese medicine (TCM) and Ayurveda, it is used in combination with isatis root and other herbs to treat the common cold, sore throat, mumps, respiratory ailments, other febrile diseases, hepatitis, and malignant tumors (1) (2). The pulverized form, known as Qing Dai, has been used to treat ulcerative colitis (3), and topically to treat oral sores and sore throat. Isatis leaf is one of the ingredients used in PC-SPES, an herbal formula used to treat prostate cancer. It is also used in Danggui Longhui Wan, a formula used to treat chronic myelocytic leukemia (CML) in China (4).

In vitro and in vivo studies indicate that isatis has antimicrobial, antiendotoxic (5), antiviral (6) (7) (8), immunostimulatory (9), anti-inflammatory (10) (11), and chemotherapeutic (12) properties. In several instances, the pharmacologic effects of isatis leaves were found to be greater than that of the roots (5) (8). A small preliminary study in healthy volunteers has also indicated anti-inflammatory (13) properties with topical isatis leaf.

Isatis root has both overlapping and different properties from isatis leaf.

Purported Uses
  • Cancer treatment
  • Diarrhea
  • GI disorders
  • Hepatitis
  • HIV and AIDS
  • Respiratory infections
Constituents
  • Indirubin, indican, isatin, indirubin, indigo, and indigotin
  • Indolic alkaloid, isatisine A, isaindigotone, tryptanthrin, and other alkaloids
  • Flavonoids, flavone C-glucosides
  • Glucosinolates, glucobrassicin
  • Isothiocyanates
  • Fatty acids, porphyrins, lignans, carotenoids, and cyclohexanones
    (1) (7) (11) (13) (14) (15) (16) (17)
Mechanism of Action

In vitro, isatis leaf inhibits cyclooxygenase-2 (COX-2) with preferential effects on COX-2–catalysed prostaglandin synthesis (10). The alkaloid tryptanthrin has been identified as the inhibitor of COX-2 (10) and 5-lipoxygenase (5-LOX) (13) (18). Indirubin, another active component, inhibits cyclin-dependent kinases (CDKs) and prevents proliferation by arresting cells in the G2/M phase (4). Other alkaloids isolated from isatis can inhibit leukocyte function and attenuate the production of mediators related to inflammatory responses (11). A compound isolated from isatisine A showed moderate anti-HIV-1 activity (7). One laboratory study found better virucidal activity for leaf than root extracts when tested for swine pseudorabies virus (8). Animal models suggest that isatis leaf can reduce allergic airway inflammation and hyperresponsiveness by inhibiting production of Th2 cytokines IL-4 and IL-5, and RANTES (9). Another model suggests that when used as postexposure prophylaxis, isatis leaf can attenuate lung tissue damage and reduce lung virus titers (6). In vitro and animal studies demonstrated the induction of hepatocellular cancer cell death by isatis through a distinguished caspase-independent apoptotic pathway (12).

Adverse Reactions

Common: Nausea and vomiting (19)
Reported: Hematuria following intramuscular injection (19)

Dosage (Inside MSKCC Only)
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References
  1. Zou P, Koh HL. Determination of indican, isatin, indirubin and indigotin in Isatis indigotica by liquid chromatography/electrospray ionization tandem mass spectrometry. Rapid Commun Mass Spectrom. 2007;21(7):1239-1246.
  2. Bensky D, Gamble A. Chinese Herbal Medicine: Materia Medica Revised ed. Seattle, WA: Eastland Press; 1993.
  3. Suzuki H, Kaneko T, Mizokami Y, et al. Therapeutic efficacy of the Qing Dai in patients with intractable ulcerative colitis. World J Gastroenterol. May 7 2013;19(17):2718-2722.
  4. Hoessel R, Leclerc S, Endicott JA, et al. Indirubin, the active constituent of a Chinese antileukaemia medicine, inhibits cyclin-dependent kinases. Nat Cell Biol. May 1999;1(1):60-67.
  5. Wang Y, Qiao CZ, Liu S, et al. [Evaluation on antiendotoxic action and antiviral action in vitro of tetraploid Isatis indigotica]. Zhongguo Zhong Yao Za Zhi. Jun 2000;25(6):327-329.
  6. Deng YP, Liu YY, Liu Z, et al. Antiviral activity of Folium isatidis derived extracts in vitro and in vivo. Am J Chin Med. 2013;41(4):957-969.
  7. Liu JF, Jiang ZY, Wang RR, et al. Isatisine A, a novel alkaloid with an unprecedented skeleton from leaves of Isatis indigotica. Org Lett. Oct 11 2007;9(21):4127-4129.
  8. Hsuan SL, Chang SC, Wang SY, et al. The cytotoxicity to leukemia cells and antiviral effects of Isatis indigotica extracts on pseudorabies virus. J Ethnopharmacol. May 4 2009;123(1):61-67.
  9. Brattstrom A, Schapowal A, Kamal MA, et al. The plant extract Isatis tinctoria L. extract (ITE) inhibits allergen-induced airway inflammation and hyperreactivity in mice. Phytomedicine. Jul 2010;17(8-9):551-556.
  10. Danz H, Stoyanova S, Wippich P, et al. Identification and isolation of the cyclooxygenase-2 inhibitory principle in Isatis tinctoria. Planta Med. Jul 2001;67(5):411-416.
  11. Molina P, Tarraga A, Gonzalez-Tejero A, et al. Inhibition of leukocyte functions by the alkaloid isaindigotone from Isatis indigotica and some new synthetic derivatives. J Nat Prod. Oct 2001;64(10):1297-1300.
  12. Chung YC, Tang FY, Liao JW, et al. Isatis indigotica induces hepatocellular cancer cell death via caspase-independent apoptosis-inducing factor translocation apoptotic pathway in vitro and in vivo. Integr Cancer Ther. Jun 2011;10(2):201-214.
  13. Heinemann C, Schliemann-Willers S, Oberthur C, et al. Prevention of experimentally induced irritant contact dermatitis by extracts of Isatis tinctoria compared to pure tryptanthrin and its impact on UVB-induced erythema. Planta Med. May 2004;70(5):385-390.
  14. Zhang Q, Hong B, Zheng L, et al. Matrix solid-phase dispersion extraction followed by HPLC-diode array detection method for the determination of major constituents in a traditional Chinese medicine Folium isatidis (Da-qing-ye). J Sep Sci. Sep 2012;35(18):2453-2459.
  15. Mohn T, Plitzko I, Hamburger M. A comprehensive metabolite profiling of Isatis tinctoria leaf extracts. Phytochemistry. May 2009;70(7):924-934.
  16. Deng X, Gao G, Zheng S, et al. Qualitative and quantitative analysis of flavonoids in the leaves of Isatis indigatica Fort. by ultra-performance liquid chromatography with PDA and electrospray ionization tandem mass spectrometry detection. J Pharm Biomed Anal. Nov 4 2008;48(3):562-567.
  17. Condurso C, Verzera A, Romeo V, et al. The leaf volatile constituents of Isatis tinctoria by Solid-Phase Microextraction and Gas chromatography/Mass Spectrometry. Planta Med. Aug 2006;72(10):924-928.
  18. Danz H, Stoyanova S, Thomet OA, et al. Inhibitory activity of tryptanthrin on prostaglandin and leukotriene synthesis. Planta Med. Oct 2002;68(10):875-880.
  19. Huang KC. The Pharmacology of Chinese Herbs. Second ed. Boca Raton, FL: CRC Press, Taylor & Francis Group; 1998.

Consumer Information

How It Works

Bottom Line: Isatis leaf has not been tested in clinical trials, so it is not known if it works in humans. It should not be used to treat SARS, HIV, or other serious diseases.

Isatis leaf extract is derived from the same plant from which indigo dye is made. It has been used in combination with other botanicals in traditional Chinese medicine and Ayurveda for thousands of years. Isatis leaf has anti-inflammatory properties. Laboratory studies suggest that indirubin, an active compound in isatis, stops cell duplication and therefore may be useful in cancer treatment. Other lab experiments show that isatis extract can kill certain viruses and counteract some symptoms and tissue damage from bacterial infections. However, this botanical has not yet been evaluated in clinical trials and therefore it remains uncertain whether these effects occur in the human body.

Isatis root has both similar and different properties from isatis leaf.

Purported Uses
  • To prevent and treat cancer
    Lab studies show that an active compound in isatis stops cell duplication, but there is no evidence from clinical trials that it can prevent or treat cancer. In China, isatis is used in combination with other botanicals to treat chronic myelogenous leukemia.
  • To treat diarrhea or gastrointestinal disorders
    Isatis extracts have anti-inflammatory activity in the laboratory setting. A pulverized version of the extract is used in China to treat ulcerative colitis.
  • To treat hepatitis
    Isatis extracts have anti-inflammatory effects.
  • To treat HIV and AIDS
    No scientific evidence supports this use.
  • To treat respiratory infections
    Although isatis has antiviral activity, there is no evidence from clinical trials that it can effectively treat infections.
Side Effects
  • Nausea, vomiting
  • Blood in the urine, reported after intramuscular injection
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