Health Care Professional Information

Scientific Name
Radix isatidis baphicacanthi, Isatis tinctoria, Isatis indigotica
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Common Name

Ban Lan Gen, Indigo wood

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Brand Name

Ban Lan Gen Chong Ji

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Clinical Summary

Derived from the root of the isatis plant, a source of indigo dye. This botanical has been used for thousands of years in traditional Chinese medicine and Ayurvedic medicine. It is used in combination with other herbs to treat common cold, sore throat, mumps, respiratory aliments, other febrile diseases and malignant tumors (1) (2). The leaves of this plant are one of the eight ingredients used in PC-SPES, an herbal formula used to treat prostate cancer. Isatis root is also used in Danggui Longhui Wan, a formula used to treat chronic myelocytic leukemia (CML) in China (3). 

Isatis root exhibited antimicrobial (4), antiviral (1) (5) immunostimulatory effects (3) (6), and radioprotective effects (8)in vitro and in animal studies.  Anecdotal reports show that isatis root can be used to ward off severe acute respiratory syndrome (SARS) (9).

Isatis root eyedrops were shown effective in the treatment of bacterial conjunctivitis (4)and a small randomized clinical study demonstrated its utility in reducing the severity of radiation mucositis (7).

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Purported Uses
  • Bronchitis
  • Cancer treatment
  • Chest congestion
  • Common cold
  • Fever
  • Infections
  • Severe acute respiratory syndrome (SARS)
  • Viral infections
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Constituents
  • Indirubin
  • Indoxyl-beta-glucoside
  • Beta-sitosterol
  • Isatin
  • Amino acids: Arginine, glutamine, proline, tyrosine.
    (1) (2)
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Mechanism of Action

Isatis root extract has anti-inflammatory, antipyretic and antinociceptive effects on animals (8) (10). Extracts obtained from the dried leaves of isatis have cyclooxygenase-2 (COX-2) inhibitory effects (11). Isatis root also has immunostimulatory effects by enhancing reticuloendothelial system function. One animal study found that indigo root extract reduced tissue injury, enhanced hematopoietic system recovery, modulated serum inflammatory cytokines, and improved severe enteropathy in whole body irradiated mice (8). An in vitro study also found that an ethanol extract of isatis root had a dose-dependent cytotoxic effect against human leukemia HL-60 cells (12). Indirubin, an active component of isatis, is a potent inhibitor of cyclin-dependent kinases (CDKs). It inhibits the proliferation of cells by arresting the cells in the G2/M phase (3). Other alkaloids isolated from isatis can inhibit leukocyte function and reduce inflammatory response (13). Some studies show that isatis also has antiviral activities (5) (12).

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Warnings

The effect of isatis or Ban Lan Gen on severe acute respiratory syndrome (SARS) is not known. Patients are warned that reliance on herbal supplements as prevention or treatment may induce a false sense of security from this deadly disease. Patients with suspected SARS should limit interactions outside the home. The Centers for Disease Control (CDC) recommend that proper hygiene such as frequent hand washing and wearing a surgical mask can help prevent the spread of SARS (14).

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Adverse Reactions

None reported.

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Literature Summary and Critique

You WC, et al. Effect of extracts from indigowood root (Isatis indigotica Fort.) on immune responses in radiation-induced mucositis. J Altern Complement Med. 2009 Jul;15(7):771-8.
This study investigated the effect of indirubin (taken as isatis root powder) on acute radiation-induced mucositis. Twenty patients who were receiving radiation therapy for head and neck cancer were enrolled and randomized into a control or treatment group. The treatment group gargled with a solution made from indigowood root powder dissolved in double-distilled water for three minutes, and then swallowed it, before meals daily for seven weeks. The results of the clinical trial indicated that indigowood root significantly reduced the severity of radiation mucositis (p=0.01), anorexia (p=0.002), and swallowing difficulty (p=0.002) in treated patients compared to the control group. The authors concluded that indirubin may play a therapeutic role in improving radiation-induced mucositis, anorexia, and difficulty swallowing, but that the exact mechanism and pathways should be further studied.

Qi CX, Wu XM, Wang XL. Clinical research of isatis root eyedrops on the acute bacterial conjunctivitis. Zhong Yao Cai. 2007 Jan;30(1):120-2
This randomized, double-blind, parallel study evaluated the efficacy and safety of isatis root eyedrops on 200 cases of acute bacterial conjunctivitis. Patients received either isatis root or levofloxacin eyedrops (as a test and control agent, respectively), six times a day for 7 days. The efficacy rate in the isatis root and levofloxacin groups was observed to be 90% and 93%, respectively, a difference which was not statistically significant (p>0.05). Two patients experienced side effects. The investigators concluded that isatis root eyedrops exhibited an excellent efficacy and safety profile in the treatment of acute bacterial conjunctivitis.

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Dosage (Inside MSKCC Only)
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References
  1. Bensky D, Gamble A. Chinese Herbal Medicine: Materia Medica. Revised Ed. Seattle: Eastland Press; 1993.
  2. Hocking G. A Dictionary of Natural Products. Medford (NJ): Plexus Publishing Inc; 1997.
  3. Hoessel R, et al. Indirubin, the active constituent of a Chinese antileukaemia medicine, inhibits cyclin-dependent kinases. Nat Cell Biol. 1999;1:60-7.
  4. Qi CX, Wu XM, Wang XL. Clinical research of isatis root eyedrops on acute bacterial conjunctivitis. Zhong Yao Cai. 2007;30(1):120-2.
  5. Wang T, et al. Evaluation on antiendotoxic action and antiviral action in vitro of tetraploid Isatis indigotica. Zhongguo Zhong Yao Za Zhi. 2000;25:327-9.
  6. Xu YM, Lu PC. Experimental studies on immunostimulatory effects of the Isatis indigotica polysaccharide. Zhong Xi Yi Jie He Za Zhi. 1991;11:357-9, 325-6.
  7. You WC, Hsieh CC, Huang JT. Effect of extracts from indigowood root (Isatis indigotica Fort.) on immune responses in radiation-induced mucositis. J Altern Complement Med. 2009;15(7):771-8.
  8. You WC, Lin WC, Huang JT, Hsieh CC. Indigowood root extract protects hematopoietic cells, reduces tissue damage and modulates inflammatory cytokines after total-body irradiation: does Indirubin play a role in radioprotection? Phytomedicine. 2009;16(12):1105-11.
  9. Saulny S. In Chinatown, An Outbreak of Fear. The New York Times 2003;April 4:D1
  10. Ho Y, Chang Y. Studies on the antinociceptive, anti-inflammatory and anti pyretic effects of Isatis indigotica root. Phytomedicine. 2002;9:419-24.
  11. Danz H, et al. Identification and isolation of the cyclooxygenase-2 inhibitory principle in Isatis tinctoria. Planta Med. 2001;67:411-6.
  12. 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. 2009 May 4;123(1):61-7.
  13. Molina P, et al. Inhibition of leukocyte functions by the alkaloid isaindigotone from Isatis indigotica and some new synthetic derivatives. J Nat Prod. 2001;64:1297-300.
  14. Centers for Disease Control (CDC) Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2. http://www.cdc.gov/ncidod/sars/guidance/I/index.htm [Accessed April 5, 2011]
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Consumer Information

How It Works

Bottom Line: Isatis root has not been extensively studied in clinical trials, so it is not known if it works in humans.
Isatis root 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 and Ayurvedic medicine for thousands of years. In animal tests, this root extract reduced inflammation, fever, and perception of pain. Isatis root also was able to stimulate the immune system of laboratory mice by enhancing the activity of the reticuloendothelial system (the stationary immune cells in the liver, spleen, and other tissues that swallow and destroy foreign particles as they pass in the bloodstream). Laboratory studies have also suggested that indirubin, an active component of isatis root, inhibits the replication of dividing cells and therefore may be useful in cancer treatment. In the laboratory setting, isatis extracts are able to kill certain viruses and counteract the effects of endotoxin, which causes some of the symptoms and tissue damage of 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.

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Purported Uses
  • To treat bronchitis and relieve chest congestion
    Laboratory research suggests that isatis root has anti-inflammatory and immune-stimulating activity, but there is no proof from clinical trials that it can relieve bronchitis and chest congestion.
  • To treat the common cold
    Laboratory research suggests that isatis root has anti-viral and immune-stimulating activity, but there is no proof from clinical trials that it can effectively treat the common cold.
  • To prevent and treat cancer
    Laboratory studies show that an active compound in isatis root, indirubin, inhibits the replication of dividing cells. This herb is used in China in combination with other botanicals to treat chronic myelogenous leukemia (CML). There is no evidence from clinical trials that isatis root can prevent or treat cancer.
  • To reduce fever
    Animal studies show that isatis root can reduce fever, but no clinical trials have been performed to test this use in humans.
  • To fight viral infections
    Laboratory research shows that isatis root has anti-viral activity, but there is no proof from clinical trials that it can effectively treat viral infections.
  • To treat bacterial conjunctivitis
    One clinical study suggested that isatis root eyedrops may be effective for the treatment of bacterial conjunctivitis. However, further study is needed to confirm this effect.
  • To prevent and treat severe acute respiratory syndrome (SARS)
    Although laboratory research shows that isatis root has anti-viral activity, is has not been established whether this effect occurs in the human body. No studies in humans have been performed to verify the anecdotal reports that isatis might be helpful in warding off SARS.
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Research Evidence

Radiation-induced Mucositis
Twenty patients who were receiving radiation therapy for head and neck cancer were randomized into control or treatment groups. The treatment group gargled with a solution made from indigowood root powder dissolved in double-distilled water for three minutes, and then swallowed it, before meals daily for seven weeks. Indigowood root significantly reduced the severity of radiation mucositis, anorexia, and difficulty in swallowing in treated patients compared to the control group.

Acute Bacterial Conjunctivitis
Two hundred patients with Acute Bacterial Conjunctivitis received either isatis root or levofloxacin eyedrops, six times a day for 7 days. The efficacy rate in the isatis root and levofloxacin groups was observed to be 90% and 93%, respectively, a difference which was not statistically significant. Two patients experienced side effects. Investigators concluded that isatis root eyedrops may be useful in the treatment of acute bacterial conjunctivitis.

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Patient Warnings
  • The effect of isatis root on severe acute respiratory syndrome (SARS) is not known. It should be noted that reliance solely on herbal supplements as prevention or treatment may induce a false sense of security from this deadly disease. Patients with suspected SARS should limit interactions outside the home. The Centers for Disease Control (CDC) recommend that proper hygiene such as frequent hand washing and wearing a surgical mask should be used to prevent the spread of SARS.
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Side Effects

None known

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Last updated: April 26, 2012
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