Health Care Professional Information
Common Name
Huang Qin, baikal skullcap, Chinese skullcap
Clinical Summary
Scutellaria baicalensis is an herb used in traditional Chinese medicine to treat a variety of conditions including epilepsy, hepatitis, infections, and cancer. It often is used in combination with other botanicals (e.g. PC-SPES and Sho-saiko-to).
In vitro and animal data suggest that its components cause apoptosis in various cancer cells (2) (3) (14), demonstrate neuroprotective (4) (5)and anti-inflammatory (17) effects, and protect against doxorubicin-induced cardiotoxicity (15). In addition, sedative and anticonvulsant effects have also been reported (6).
Although clinical trials have been conducted with formulas containing skullcap, it is not known if the herb would exert similar effects by itself.
Purported Uses
- Atherosclerosis
- Cancer treatment
- Epilepsy
- Hepatitis
- Infections
- Inflammation
- Insomnia
Constituents
- Flavonoids: Baicalin, baicalein, scutellarein, wogonin, apigenin, hispidulin, luteolin, scutellarein
- Iridoids: Catalpol
- Volatile oils: Limonene, terpineol, beta-humulene, caryophyllene
- Others: Lignin, resin, tannin
(1) (2)
Mechanism of Action
Baicalin exhibits anti-inflammatory, antioxidant, and gram-positive antibacterial activity in vitro (3). The neuroprotective effects of flavonoids were ameliorated by diazepam, a GABA receptor agonist, suggesting that the components influence GABA receptor activity (5). The flavonoids also prevent ethanol-induced hyperlipidemia, histamine release from mast cells, and catecholamine-induced lipolysis in animal models (8).
In vitro studies suggest that flavonoid components of S.baicalensis have anticancer activity. Induction of apoptosis in hepatoma G2, 3B, and SK-Hep1 cell lines occurs following 48 hours of exposure to baicalein, baicalin, and wogonin at concentrations of 25-100 mcg/ml. Wogonin causes arrest at G1 phase while baicalin and baicalein cause G2/M accumulation (2). Additional studies show that baicalin, at concentrations of 50-200 mcg/ml, activates caspase-3, resulting in apoptosis of Jurkat cells (leukemia-derived T cells).
Pharmacokinetics
Urinary pharmacokinetic analysis of baicalein, wogonin, and their glycosides in humans indicated that excretion of conjugated metabolites of wogonin was greater than those of baicalein (11.6 versus 7.2% of the dose) (10). The low recovery of both compounds may be due to bile excretion or metabolism by enteric bacteria. In addition, in vitro studies revealed that baicalein is capable of crossing the gut epithelium as well as the blood-brain barrier (11).
Warnings
Products containing S. baicalensis were found to be contaminated with a similar looking plant known as germander (Teucrium chamaedrys) that can cause hepatitis (8).
Adverse Reactions
Reported: Hepatotoxicity, pneumonitis (7)
Case Report: Acute liver injury has been reported in patients following consumption of a formula containing baicalin derived from S. baicalensis for osteoarthritis (18).
Herb-Drug Interactions
- Anticoagulants / Antiplatelets: May cause additive effects (12).
- Statins: Baicalin, an active constituent, can decrease the blood level of statin drugs used to lower cholesterol (13).
- Cytochrome P450 substrates: Wogonin inhibits CYP1A2 and CYP2C19, and can affect the intracellular concentration of drugs metabolized by these enzymes (16).
Literature Summary and Critique
Scutellaria baicalensis has been studied in combination with other botanicals in formulations such as PC-SPES and sho-saiko-to.
Dosage (Inside MSKCC Only)
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References
- Bonham M, Posakony J, Coleman I, Montgomery B, Simon J, Nelson PS. Characterization of chemical constituents in Scutellaria baicalensis with antiandrogenic and growth-inhibitory activities toward prostate carcinoma. Clin Cancer Res 2005;11(10):3905-14.
- Chang WH, Chen CH, Lu, FJ. Different effects of baicalein, baicalin, and wogonin on mitochondrial function, glutathione content and cell cycle progression in human hepatoma cell lines. Planta Medica 2002;68:128-32.
- Ueda S, Nakamura H, Masutani H, et al. Baicalin induces apoptosis via mitochondrial pathway as prooxidant. Molecular Immunology 2002;38:781-91.
- Cheng Y, He G, Mu X, et al. Neuroprotective effect of baicalein against MPTP neurotoxicity: Behavioral, biochemical and immunohistochemical profile. Neurosci Lett. Aug 15 2008;441(1):16-20.
- Kim DH, Kim S, Jeon SJ, et al. The effects of acute and repeated oroxylin A treatments on Abeta(25-35)-induced memory impairment in mice. Neuropharmacology. Jul 10 2008.
- Park HG, Yoon SY, Choi JY, et al. Anticonvulsant effect of wogonin isolated from Scutellaria baicalensis. Eur J Pharmacol. Nov 28 2007;574(2-3):112-119.
- Takeshita K, Saisho Y, Kitamura K, et al. Pneumonitis induced by Ou-gon (scullcap). Internal Medicine 2001;40:764-8.
- Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-Care Professionals. 1st ed. London: Pharmaceutical Press; 1996.
- Huang KC. The Pharmacology of Chinese Herbs. 2nd ed. New York: CRC Press; 1999.
- Lai MY, Hsiu SL, Chen CC, Hou YC, Chao PD. Urinary pharmacokinetics of baicalein, wogonin and their glycosides after oral administration of Scutellariae Radix in humans. Biol Pharm Bull. Jan 2003;26(1):79-83.
- Tarrago T, Kichik N, Claasen B, Prades R, Teixido M, Giralt E. Baicalin, a prodrug able to reach the CNS, is a prolyl oligopeptidase inhibitor. Bioorg Med Chem. Apr 29 2008.
- Brinker F. Herb Contraindications and Drug Interactions. 3rd ed. Sandy (OR): Eclectic Medical Publications; 2001.
- Fan L, Zhang W, Guo D, et al. The effect of herbal medicine baicalin on pharmacokinetics of rosuvastatin, substrate of organic anion-transporting polypeptide 1B1. Clin Pharmacol Ther. 2008 Mar;83(3):471-6.
- Takahashi H, Chen MC, Pham H, et al. Baicalein, a component of Scutellaria baicalensis, induces apoptosis by Mcl-1 down-regulation in human pancreatic cancer cells. Biochim Biophys Acta. 2011 Aug;1813(8):1465-74.
- Chang WT, Li J, Huang HH, et al. Baicalein protects against doxorubicin-induced cardiotoxicity by attenuation of mitochondrial oxidant injury and JNK activation. J Cell Biochem. 2011 May 26. doi: 10.1002/jcb.23201.
- Li T, Li N, Guo Q, et al. Inhibitory effects of wogonin on catalytic activity of cytochrome P450 enzyme in human liver microsomes. Eur J Drug Metab Pharmacokinet. 2011 Jun 29.
- Li L, Bao H, Wu J, et al. Baicalin is anti-inflammatory in cigarette smoke-induced inflammatory models in vivo and in vitro: A possible role for HDAC2 activity. Int Immunopharmacol. 2012 May;13(1):15-22.
- Chalasani N, Vuppalanchi R, Navarro V, et al. Acute liver injury due to flavocoxid (Limbrel), a medical food for osteoarthritis: a case series.Ann Intern Med. 2012 Jun 19;156(12):857-60, W297-300.
Consumer Information
How It Works
Bottom Line: Scutellaria baicalensis has been used in traditional medicine to treat many medical conditions. Studies on its anticancer effects are underway.
Scutellaria baicalensis, also known as Huang Qin or Chinese skullcap, is a root extract used in traditional medicine, often in combination with other herbs. Scientists are not sure exactly how it works; it has been studied to some extent in the laboratory, but not in humans. Isolated liver cancer and leukemia cell lines, when exposed to extracts from this herb, undergo apoptosis (cell death). The extracts also reduce inflammation, act as antioxidants, and kill gram-positive bacteria in the laboratory setting. In animals, the extracts help lower blood cholesterol levels under certain conditions. However, it is not yet clear if any of these effects occur in the human body.
Purported Uses
- To treat atherosclerosis
Studies in animals show that extracts of this herb may help lower blood cholesterol levels under certain conditions, but human studies have not been conducted.
- To treat cancer
Extracts from this herb cause cell death in isolated liver cancer and leukemia cell lines in the laboratory setting, but human data are lacking.
- To treat hepatitis
The herbal formulation sho-saiko-to, which contains Huang Qin, has been studied for its possible liver-protectant effects.
- To reduce inflammation
Laboratory data support this use, but clinical data are lakcing.
Research Evidence
Scutellaria baicalensis has not been studied in clinical trials as a single agent, but only in combination with other herbs in formulations such as PC-SPES and sho-saiko-to. (Please see these monographs for more information).
Patient Warnings
- Some products that contain scullcap have been found to be contaminated with a similar-looking plant known as germander (Teucrium chamaedrys), which can cause liver damage.
Do Not Take If
- You are taking warfarin or other blood thinners (skullcap can increase the risk of bruising and bleeding).
- You are on statins (skullcap can decrease the blood level of these drugs).
- If you are taking drugs that are substrates of Cytochrome P450 (skullcap may increase the risk of side effects of these drugs).
Side Effects
- Liver damage
- Pneumonitis (inflammation of the lung due to bacterial or viral infection)
- Case Report: Acute liver injury has been reported in patients following consumption of a formula containing baicalin derived from S. baicalensis for osteoarthritis.
Last updated: March 8, 2012
agonist (A-guh-nist)
A drug or substance that binds to a receptor inside a cell or on its surface and causes the same action as the substance that normally binds to the receptor.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)anti-inflammatory (AN-tee-in-FLA-muh-TOR-ee)
Having to do with reducing inflammation.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)antibacterial (AN-tee-bak-TEER-ee-ul)
A substance that kills bacteria or stops them from growing and causing disease.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)anticonvulsant (AN-tee-kun-VUL-sunt)
A drug or other substance used to prevent or stop seizures or convulsions. Also called antiepileptic.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)antioxidant (AN-tee-OK-sih-dent)
A substance that protects cells from the damage caused by free radicals (unstable molecules made by the process of oxidation during normal metabolism). Free radicals may play a part in cancer, heart disease, stroke, and other diseases of aging. Antioxidants include beta-carotene, lycopene, vitamins A, C, and E, and other natural and manufactured substances.
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(http://www.cancer.gov/dictionary)apoptosis (A-pop-TOH-sis)
A type of cell death in which a series of molecular steps in a cell leads to its death. This is the body’s normal way of getting rid of unneeded or abnormal cells. The process of apoptosis may be blocked in cancer cells. Also called programmed cell death.
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(http://www.cancer.gov/dictionary)bacteria (bak-TEER-ee-uh)
A large group of single-cell microorganisms. Some cause infections and disease in animals and humans. The singular of bacteria is bacterium.
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(http://www.cancer.gov/dictionary)barrier (BAYR-ee-er)
Something that blocks, prevents, separates, or limits.
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(http://www.cancer.gov/dictionary)bile (bile)
A fluid made by the liver and stored in the gallbladder. Bile is excreted into the small intestine, where it helps digest fat.
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(http://www.cancer.gov/dictionary)blood (blud)
A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
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(http://www.cancer.gov/dictionary)cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
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(http://www.cancer.gov/dictionary)cardiotoxicity (KAR-dee-oh-tok-SIH-sih-tee)
Toxicity that affects the heart.
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(http://www.cancer.gov/dictionary)cell (sel)
The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
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(http://www.cancer.gov/dictionary)cholesterol (koh-LES-teh-rol)
A waxy, fat-like substance made in the liver, and found in the blood and in all cells of the body. Cholesterol is important for good health and is needed for making cell walls, tissues, hormones, vitamin D, and bile acid. Cholesterol also comes from eating foods taken from animals such as egg yolks, meat, and whole-milk dairy products. Too much cholesterol in the blood may build up in blood vessel walls, block blood flow to tissues and organs, and increase the risk of developing heart disease and stroke.
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Having to do with the examination and treatment of patients.
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(http://www.cancer.gov/dictionary)concentration (KON-sen-TRAY-shun)
In science, the amount of a substance, such as a salt, that is in a certain amount of tissue or liquid, such as blood. A substance becomes more concentrated when less water is present. For example, the salt in urine may become more concentrated when a person doesn’t drink enough water.
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(http://www.cancer.gov/dictionary)diazepam (dy-A-zeh-pam)
A drug used to treat mild to moderate anxiety and tension and to relax muscles. It is a type of benzodiazepine. Also called Valium.
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(http://www.cancer.gov/dictionary)epithelium (eh-pih-THEE-lee-um)
A thin layer of tissue that covers organs, glands, and other structures within the body.
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(http://www.cancer.gov/dictionary)extract (EK-strakt)
In medicine, a preparation of a substance obtained from plants, animals, or bacteria and used as a drug or in drugs.
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(http://www.cancer.gov/dictionary)flavonoid (FLAY-vuh-noyd)
A member of a group of substances found in many plants and plant-based foods. Flavonoids have shown antioxidant effects.
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(http://www.cancer.gov/dictionary)hepatitis (HEH-puh-TY-tis)
Disease of the liver causing inflammation. Symptoms include an enlarged liver, fever, nausea, vomiting, abdominal pain, and dark urine.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)hepatoma (HEH-puh-TOH-muh)
A liver tumor.
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(http://www.cancer.gov/dictionary)herbal (ER-bul)
Having to do with plants.
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(http://www.cancer.gov/dictionary)histamine (HIS-tuh-meen)
A substance that has many effects in the body. It is released from some types of white blood cells during allergic reactions. It causes small blood vessels to dilate (widen) and become leaky, which can cause tissues to swell. It also causes smooth muscles to contract, gastric acid to be made, and the heart rate to increase. Histamine is used in tests for allergies, asthma, and gastric acid secretion. It is a type of neurotransmitter.
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(http://www.cancer.gov/dictionary)in vitro (in VEE-troh)
In the laboratory (outside the body). The opposite of in vivo (in the body).
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(http://www.cancer.gov/dictionary)inflammation (IN-fluh-MAY-shun)
Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.
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(http://www.cancer.gov/dictionary)intracellular (IN-truh-SEL-yoo-ler)
Inside a cell.
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A measure of volume for a liquid, using the metric system. One L is equal to 1,000 cubic centimeters (cc), 1,000 milliliters (mm), or 1.0567 quarts (qt). Also called liter.
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(http://www.cancer.gov/dictionary)leukemia (loo-KEE-mee-uh)
Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of blood cells to be produced and enter the bloodstream.
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(http://www.cancer.gov/dictionary)liver (LIH-ver)
A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.
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(http://www.cancer.gov/dictionary)liver cancer (LIH-ver KAN-ser)
Primary liver cancer is cancer that forms in the tissues of the liver. Secondary liver cancer is cancer that spreads to the liver from another part of the body.
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(http://www.cancer.gov/dictionary)lung (lung)
One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.
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(http://www.cancer.gov/dictionary)M
In chemistry, M is the amount of a substance that has 6.023 x 10(23) atoms or molecules of that substance. Also called mole (chemical).
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(http://www.cancer.gov/dictionary)medicine (MEH-dih-sin)
Refers to the practices and procedures used for the prevention, treatment, or relief of symptoms of a diseases or abnormal conditions. This term may also refer to a legal drug used for the same purpose.
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(http://www.cancer.gov/dictionary)metabolism (meh-TA-buh-lih-zum)
The chemical changes that take place in a cell or an organism. These changes make energy and the materials cells and organisms need to grow, reproduce, and stay healthy. Metabolism also helps get rid of toxic substances.
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(http://www.cancer.gov/dictionary)PC-SPES
A mixture of eight herbs that has been sold as a dietary supplement and promoted as a way to keep the prostate healthy and to treat prostate cancer. PC-SPES has been studied in the treatment of prostate cancer, but has been taken off the market in the U.S. because of safety concerns.
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(http://www.cancer.gov/dictionary)pharmacology (FAR-muh-KAH-loh-jee)
The study of the origin, chemistry, and uses of drugs and their effects on the body.
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(http://www.cancer.gov/dictionary)pneumonitis (NOO-moh-NY-tis)
Inflammation of the lungs. This may be caused by disease, infection, radiation therapy, allergy, or irritation of lung tissue by inhaled substances.
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(http://www.cancer.gov/dictionary)receptor (reh-SEP-ter)
A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell.
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(http://www.cancer.gov/dictionary)sedative (SEH-duh-tiv)
A drug or substance used to calm a person down, relieve anxiety, or help a person sleep.
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(http://www.cancer.gov/dictionary)Sho-saiko-to (shoh-sah-ee-koh-toh)
A Japanese formulation of seven Chinese herbs that is being studied as a treatment for cancer.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)statin (STA-tin)
Any of a group of drugs that lower the amount of cholesterol and certain fats in the blood. Statins inhibit a key enzyme that helps make cholesterol. Statin drugs are being studied in the prevention and treatment of cancer.
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(http://www.cancer.gov/dictionary)viral (VY-rul)
Having to do with a virus.
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