Pueraria lobata

Pueraria Lobata (Kudzu) is a root plant that appears to have traditional usage in alleviating migraines and hangovers.

This page features 33 unique references to scientific papers.

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How to Take

Recommended dosage, active amounts, other details

The lone study on Kudzu root used a product containing 100mg of isoflavone equivalents, which appeared to be slightly effective for promoting cognition in postmenopausal women. It is unsure if this is near the optimal dosage or not.

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Human Effect Matrix

The Human Effect Matrix looks at human studies (it excludes animal and in vitro studies) to tell you what effects pueraria lobata has on your body, and how strong these effects are.

Grade Level of Evidence
Robust research conducted with repeated double-blind clinical trials
Multiple studies where at least two are double-blind and placebo controlled
Single double-blind study or multiple cohort studies
Uncontrolled or observational studies only
Level of Evidence
? The amount of high quality evidence. The more evidence, the more we can trust the results.
Outcome Magnitude of effect
? The direction and size of the supplement's impact on each outcome. Some supplements can have an increasing effect, others have a decreasing effect, and others have no effect.
Consistency of research results
? Scientific research does not always agree. HIGH or VERY HIGH means that most of the scientific research agrees.
Notes
Attention Minor - See study
Small boost in attention in menopausal women (independent of reductions in symptoms of menopause); needs to be reinvestigated
Cognition Minor - See study
A small boost in cognition in menopausal women given the supplement; needs to be replicated and uncertain if it applies to otherwise healthy youth.
Apolipoprotein B - - See study
No alterations in Apolipoprotein B have been noted
Estrogen - - See study
No significant influence of Pueraria lobata on circulating estrogen levels (although it itself may be a phytoestrogen; weak)
Follicle-Stimulating Hormone - - See study
No significant alterations have been noted in follicle-stimulating hormone concentrations following pueraria lobata ingestion.
HDL-C - - See study
No detectable influence on HDL-C levels
LDL-C - - See study
No significant influence on circulating LDL-C has been noted with supplementation
Luteinizing Hormone - - See study
No significant alterations in luteinizing hormone has been detected with pueraria lobata ingestion.
Symptoms of Menopause - - See study
No significant influence detected on symptoms of menopause (as assessed by rating scales)
Total Cholesterol - - See study
No significant influence have been detected on total cholesterol

Scientific Research

Table of Contents:

  1. 1 Sources and Composition
    1. 1.1 Sources
    2. 1.2 Composition
  2. 2 Pharmacology
    1. 2.1 Absorption
    2. 2.2 Serum
  3. 3 Neurology
    1. 3.1 Cognition
    2. 3.2 Menopause
  4. 4 Cardiovascular Health
    1. 4.1 Cardiac Tissue
    2. 4.2 Lipids and Cholesterol
  5. 5 Interactions with Glucose Metabolism
    1. 5.1 Interventions
  6. 6 Skeletal Mass and Bone Metabolism
    1. 6.1 Interventions
  7. 7 Interactions with Fat Mass
    1. 7.1 Adipokines
    2. 7.2 Interventions
  8. 8 Inflammation and Immunology
    1. 8.1 Immunostimulation
  9. 9 Interactions with Hormones
    1. 9.1 Estrogen
  10. 10 Interactions with Organ Systems
    1. 10.1 Intestines
    2. 10.2 Liver
  11. 11 Nutrient-Nutrient Interactions
    1. 11.1 Alcohol
    2. 11.2 Salvia Miltiorrhiza
    3. 11.3 Angelica dahurica

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1Sources and Composition

1.1. Sources

Pueraria lobata (Technically Pueraria Montana variant Lobata) is a Traditional Chinese Medicine for the purposes of menopausal symptoms and the associated comorbidities (osteoporosis and cardiac impairment[1]), hangover therapy, and as a general health preservation agent; it is commonly referred to as either Kudzu or Kadzu or Gegen;[2] the term Pueraria Radix (Root of Pueraria) almost exclusively refers to this plant[3] rather than the other bioactive herb Pueraria mirifica; despite the aforementioned herb being a more potent estrogenic agent, Pueraria Lobata is one of the more popular phytoestrogenic herbs in mainland China.[4]

1.2. Composition

Pueraria Lobata contains:

With a polysaccharide content of:

  • Immunostimulating polysaccharide known as PLP[7]


2Pharmacology

2.1. Absorption

Puerarin appears to have its absorption increased linearly with increasing concentrations up to 102.7μg/mL without a changing Papp value, suggesting that passive diffusion mediates absorption at lower concentrations with a possible active transport mechanism.[8] It is mostly absorbed in the Ileum,[9] and the active efflux component appears to be mediated by MRP1 (2.6-fold absorption when inhibited by MK-571)[8] as well as P-Glycoprotein (1.8-fold absorption when inhibited by Vermapril).[9][8]

When Puerarin is incubated with either Angelica dahurica basic extract (450μg/mL) or its volatile oils (0.72μl/mL) the absorption of Puerarin is increased 1.7-fold and 3.6-fold respectively; suggesting that Angelica dahurica contains both MRP1 and Pgp inhibitors, and is in accordance with traditional combination therapy of these two herbs.[8]

Puerarin appears to be fairly well absorbed from the intestines at low concentrations, and is effluxed by both MRP and Pgp; combination therapy with Angelica dahurica can enhance absorption of Puerarin

2.2. Serum

Following oral administration of Pueraria Lobata alongside two other herbs (Danshen and Ligusticum chuanxiong in even ratios), a large oral dose of the ethanolic extract detected both Soy Isoflavones (Genistein and Daidzein) reaching serum, with a variety of Daidzein conjugates including Puerarin also being detected in serum.[5] This study also confirmed the presence of Methoxypuerarins (3' and 4') and both Formononetin and Glycitein, and noted that diglycosides of Daidzein and one of Formononetin were not detected as Phase II metabolites.[5]

The kinetics of Puerarin (after 7.5g/kg water extract of the decoction) were a half-life of 46.9 minutes (β-Half life of 925.7min) and AUC of 790.3μ min/mL; a Cmax of 1.41ug/mL (3.39umol/L) and a Tmax of 18.5 minutes; suggesting rapid absorption.[5] These parameters are somewhat similar to those achieved with the combination formula GegenQinlian,[10] and similar absorption properties were noted with the other Daidzin-based bioactives.[5]

It was noted that diglycoside metabolites (two Daidzin diglycosides and one Formononetin) were not detected as Phase II Metabolites.[5]

Supplemental dosages of Pueraria Lobata appear to increase circulating levels of isoflavones

When mice are fed a consistent diet containing 0.2% Kudzu root (25.3% Puerarin, 7.07% Daidzin, 0.8% Daidzein), serum levels can be detected of Daidzein (208-883nM) and its glycoside Puerarin (4.57-10.44nM), Dihydrodaidzein (65.36-751nM) and the endogenous metabolite Equol (8,286-29,300nM) are also detected as well as Formononetin (143+/-68nM); the range noted in this study was due to serum levels of both obese and lean mice being measured with obese mice eating more overall.[11]

It is possible most bioactivity of Pueraria Lobata is vicariously through Daidzein and Equol, which would make its bioactivities markedly similar to dietary Soy Isoflavones (good source of Daidzein, with benefits somewhat linked to endogenous production of Equol)


3Neurology

3.1. Cognition

A study in menopausal women given 100mg of Kudzu isoflavones daily noted that both Kudzu treatment and Hormone Replacement Therapy (HRT; 0.625mg CEE and 5mg MPA) noted an improvement on the scores on the MMSE rating scale.[1]

Delayed recall was improved in HRT and not in control, and Kudzu was intermediate to these two conditions yet not significantly different from either.[1] Attention span, Motor speed, and flexible thinking were noted to be increased with Kudzu.[1]

May have some cognitive enhancing properties in menopausal women

3.2. Menopause

Kudzu has been tested for its interactions with menopausal symptoms using a supplement standardized for 100mg Isoflavones for a period of 3 months, but has failed to demonstrate a reduction of symptoms (although in this study hormone replacement therapy with 0.625mg CEE/5mg MPA also failed, the authors suspected that the low baseline symptoms were to blame).[1]

Has once failed to reduce menopausal symptoms
It should be noted that the related herb, Pueraria mirifica, is more commonly touted to be catered to menopause rather than Kudzu


4Cardiovascular Health

4.1. Cardiac Tissue

In vitro, Puerarin has been noted to have beta-adrenoreceptor antagonistic properties at 0.1-3umol/L concentrations and has shown these effects following intravenous administration of 100mg/kg isolated Puerarin (cat) and inhibited the effects of beta-adrenergic agonists (Ephedrine and isoproterenol) on cardic tissue.[12]

4.2. Lipids and Cholesterol

In obese mice given 0.2% of the diet as Kudzu root for 8 months, Kudzu root failed to significantly modify triglycerides or total cholesterol relative to control.[11]

A study using 100mg Kudzu isoflavones daily for 3 months in menopausal women (otherwise health) noted that there was no change in a lipid panel (cholesterol, triglycerides, or Apolipoproteins) that was significantly different than placebo;[1] the active control of Hormone Replacement Therapy exerted benefit.


5Interactions with Glucose Metabolism

5.1. Interventions

0.2% of Kudzu root in the diet of obese mice for 8 months is associated with a decrease in fasting glucose (from 183+/-14 to 148+/-11mg/dl; 19% decrease) and improvements in both glucose tolerance (oral glucose tolerance test) as well as insulin tolerance (indicative of insulin sensitivity).[11] Lean mice fed Kudzu in a similar manner experience improvements in glucose tolerance to a smaller magnitude (not statistically significant) with no improvement to insulin tolerance.[11]


6Skeletal Mass and Bone Metabolism

6.1. Interventions

In ovariectomized mice given 5-20% of the diet as Pueraria Lobata root for 4 weeks, bone mineral density (of the femur) was increased with 20% Kuduz in the diet being as effective as the active control of 17β-estradiol[3] with another study replicating 20% and 17β-estradiol being equally effective with both increased bone mass beyond baseline and 10% of the diet appearing to normalize bone losses relative to control.[3] 5mg/kg of Puerarin in isolation also appears to exert anti-osteroporotic effects in ovarectomized mice over 8 weeks of feeding,[13] suggesting that this is the active component.

At multiple times, interventions which note improvements in bone mass and serum biomarkers of bone metabolism have failed to find increases of uterine weight (indicative of estrogenicity) either with the Kudzu plant[3] or isolated Puerarin.[13]

Appears to increase bone mineral density, although at least one study suggests that this is distinct from estrogenic effects


7Interactions with Fat Mass

7.1. Adipokines

0.2% of the diet as Kudzu root for 8 months in obese mice was associaed with an attenuation of the rise of adiponectin seen in the obese control, which brought serum concentrations to a level similar to lean control.[11] This study did not note any alterations in food intake nor body weight associated with Kudzu.[11]

7.2. Interventions

In ovariectomized rats given 100mg/kg of Pueraria Lobata flavones (exact molecules not stated, 'flavone' in this study treated as one entity) daily for 5 weeks noted that the weight gain associated with ovariectomy (research model for menopause) was attenuated, although not to the degree as the active control of 1mg/kg estrogen.[14] Similar results have been noted in obese ovariectomized mice given 80mg or Pueraria Lobata daily, where weight gain assocaited with menopause was attenuated with comparable potency to 0.25mg estradiol.[15]


8Inflammation and Immunology

8.1. Immunostimulation

A polysaccharide from Pueraria Lobata (PLP) has been reported to increased nitric oxide release from macrophages and increase MHC-II expression from dendritic cells, although with minimal efficacy in increasin splenic cell proliferation.[7] This polysaccharide appears to activate monocytic, but not lymphatic, immune cells and concentration-dependently stimulated up to 300ug/mL although never exceeding the active control of LPS.[7]

When looking at the mechanisms, it was noted that PLP-stimulated dendritic cells were characterized by increased NF-kB translocation and increased expression of all MAPKs (p38, JNK, and ERK).[7]


9Interactions with Hormones

9.1. Estrogen

In a study on ovariectomized mice, Pueraria Lobata can induce a dose-dependent activation of Estrogenic activity mediated via ERα, with activation at 1mcg/mL increasing up to 6-fold at maximal activation at 25mcg/mL;[15] it was noted that Pueraria Lobata, as well as Licorice, were both simply agonists and not Selective Estrogen Receptor Modulators (SERMs) in this study, and that the EC50 of Pueraria Lobata (5.5µg/mL) was greater than that of licorice (EC50 16µg/mL).[15]

Puerarin (daidzein-8-C glucoside) up to 100uM does not bind to either subset of the estrogen receptor.[13] As daidzein itself has affinity, it appear the 8C glucoside prevents binding via steric hindrance.[13]

In vitro, Pueraria Lobata is estrogenic with affinity for the alpha subset (ERα)

In a study assessing the estrogenicity of Pueraria Lobata against three strains of Pueraria mirifica, 10-1000mg/kg oral ingestion for these herbs resulted in a failure of Kudzu to induce vaginal cornification (indicative of biologically relevant estrogenicity); Pueraria Mirifica as well as injections of estrogen were both successful in inducing vaginal cornification while 1mg/kg Genistein (one of the two Soy Isoflavones) also failed.[16] In mice given up to 20% the diet as Kuduz for 4 weeks, there was no noticeable increase in uterine weight when compared to control[3] and a lack of uterine/vaginal effects were replicated with 80mg of the herb extract daily in ovarectomized mice.[15]

When investigating breast tissue, oral ingestion of 40-320mg of Pueraria Lobata in mice bearing breast cancer tumors (MCF-7) failed to find any evidence of Pueraria Lobata stimulating tumor growth, which usually occurs with ERα activation (and occurred in the positive control group of estradiol).[15]

One study has hypothesized that estrogenic effects are localized to adipose (or at least, not female sex organs) as some genetic biomarkers downstream of estrogen activation (downregulation of CD8B and CD79B, upregulation of GPX3 and MUP; estrogen but not Pueraria Lobata influenced Leptin and LCN2) were noted to be upregulated by Pueraria Lobata in the same mice where no uterine effects were noted.[15]

A lack of estrogenic effect has been noted on female sex organs including mammary tissue, which is thought to be either due to a lack of estrogenicity overall (and some bioactives merely mimicking it by chance) or localized estrogenicity that does not occur in sex organs


10Interactions with Organ Systems

10.1. Intestines

In chronically Alcohol treated rats, the levels of a tight-junction protein known as ZO-1 appear to be suppressed; 90-180mg/kg Puerarin acts to attenuate the decline when taken alongside ethanol in the diet;[17] this study is duplicated in Medline.[18]

10.2. Liver

90 or 180mg/kg isolated Puerarin alongside a chronically high Alcohol containing diet (36% of calories) noted that while Puerarin failed to modify the (increased with ethanol) weights of the liver Puerarin was associated with less fatty liver buildup, inflammation, and serum liver enzymes.[17]

Protective effects have been noted with Puerarin in regards to toxin and alcohol-induced liver fibrosis,[19] and 200-800mg/kg of Puerarin in rats fed CCL4 (hepatotoxin) noted dose-dependent protective effects and reduced oxidation and inflammation as assessed by liver histology.[20]


11Nutrient-Nutrient Interactions

11.1. Alcohol

The leaves of Pueraria Lobata (sometimes termed Pueraria flos) are used in Traditional Chinese Medicine for the purposes of hangover prevention and commonly used alongside Ginseng radix, Amomi Fructus rotundus, and Citri reticulatae Pericarpium.[21]

The leaves of Pueraria Lobata (sometimes termed Pueraria flos) appear to enhance the rate of acetaldehyde clearance from the body[22] and may protect against ethanol-induced neuronal injury.[23]

The root extract, which is not traditionally used, appears to inhibit the Aldehyde dehydrogenase (ALDH) enzyme[24][25] (similar to the pharmaceutical Disulfiram) which is thought to reduce tolerance and create an aversion to Alcohol from a build-up of acetaldehyde.[26] Reduced activity of the ALDH enzyme (Homozygote ALDH2*2) occurs to a greater degree in Asian populations and is known to increase the frequency of intolerance to alcohol consumption.[27][28]

It has been noted in a review[21] that the ALDH inhibitor Disulfiram has been linked to both alcohol aversion (as intended) and euphora from alcohol[29] and cocaine;[30] studies investigating the interactions of Pueraria flos and euphoria from alcohol are lacking.

The leaf extract of Kudzu appears to enhance acetaldehyde clearance from the body and possibly aid in the reduction of hangovers (in accordance with traditional claims) while the root extract may confer the opposite effects and increase insensitivity to alcohol by inhibiting the enzyme that degrades acetaldehyde

11.2. Salvia Miltiorrhiza

Salvia miltiorrhiza (Danshen) appears to have been used alongside Pueraria Lobata (Gegen) for the purpose of cardiovascular health,[31] under the combination name of DG (Danshen-Gegen)[2] which is a 7:3 ratio of Danshen to Gegen dry weight.[32]

In activated macrophages, concentration-dependent antiinflammatory effects were noted on nitric oxide, iNOS and PGE2 (weak inhibition of COX2) while cytokine release was attenuated in a dose dependent manner on IL-6 and IL-1β, with the latter cytokine noting full suppression to levels below control at 1mg/mL; TNF-α was not highly affected, and these effects were thought to be due to NF-kB inhibition.[2] The anti-inflammatory effects of the herb combination, in regards to LPS-stimulated macrophages, is synergistic (combination index 0.75) as the IC50 value of either herb (1.01 and 1.10mg/mL) is less potent than that of the combination (IC50 0.50mg/mL).[31] The anti-artherogenic effects as assessed by foam cell formation was merely additive while the inhibitory effect of either herb on vascular smooth muscle cells (vSMCs) appeared to antagonize each other when in combination.[31]

The combination formula appears to have vasorelaxant properties mediated via potassium channel activation at a concentration of 1-7mg/mL (IC50 value of 895+/-121μg/mL), and coincubation with potassium channel inhibitors reduced the maximal relaxation by 20-37%.[32]

Appears to be synergistic in regards to reducing inflammation, and additive in regards to reducing artherogenic formation; both conclusions based on in vitro research currently

When these two herbs are combined with the rhizomes of Ligusticum chuanxiong, the resulting product is known as 'TongMai Keli' (not to be confused with Tongkat Ali).[5]

11.3. Angelica dahurica

Pueraria labota and Angelicae Dahurica have traditionally been used as a herb-pair in Traditional Chinese Medicine for a variety of uses.[8]

When Puerarin is incubated with either Angelica dahurica basic extract (450μg/mL) or its volatile oils (0.72μl/mL) in vitro with intestinal cells, the absorption of Puerarin is increased 1.7-fold and 3.6-fold respectively; this suggests that Angelica dahurica can enhance the absorption of Puerarin from Pueraria Lobata.[8]

Angelica Dahurica may increase the absorption of Puerarin from Pueraria Lobata, and thus enhance bioactivities of any action in the body related to Puerarin

Scientific Support & Reference Citations

References

  1. Woo J, et al Comparison of Pueraria lobata with hormone replacement therapy in treating the adverse health consequences of menopause . Menopause. (2003)
  2. Cheung DW, et al A herbal formula containing roots of Salvia miltiorrhiza (Danshen) and Pueraria lobata (Gegen) inhibits inflammatory mediators in LPS-stimulated RAW 264.7 macrophages through inhibition of nuclear factor κB (NFκB) pathway . J Ethnopharmacol. (2013)
  3. Wang X, et al Puerariae radix prevents bone loss in ovariectomized mice . J Bone Miner Metab. (2003)
  4. Wu CT, et al Prescription profile of Chinese herbal products containing coumestrol, genestein, and/or daidzein among female users: an analysis of national health insurance data in Taiwan between 1997 and 2007 . Chin Med. (2012)
  5. Liu CF, et al In vivo metabolites and plasma exposure of TongMai Keli analyzed by UHPLC/DAD/qTOF-MS and LC/MS/MS . J Ethnopharmacol. (2013)
  6. Zhang D, et al Kakkalide ameliorates endothelial insulin resistance by suppression of reactive oxygen species (ROS)-associated inflammation . J Diabetes. (2012)
  7. Kim HS, et al A polysaccharide isolated from Pueraria lobata enhances maturation of murine dendritic cells . Int J Biol Macromol. (2013)
  8. Liang XL, et al Transport properties of puerarin and effect of Radix Angelicae Dahuricae extract on the transport of puerarin in Caco-2 cell model . J Ethnopharmacol. (2012)
  9. Liang X, et al Intestinal absorption effect of Angelica dahurica extract on puerarin of puerariae Lobatae Radix . Zhongguo Zhong Yao Za Zhi. (2012)
  10. Wang Y, et al Simultaneous determination of puerarin, daidzein, baicalin, wogonoside and liquiritin of GegenQinlian decoction in rat plasma by ultra-performance liquid chromatography-mass spectrometry . J Chromatogr B Analyt Technol Biomed Life Sci. (2009)
  11. Prasain JK, et al The Chinese Pueraria root extract (Pueraria lobata) ameliorates impaired glucose and lipid metabolism in obese mice . Phytomedicine. (2012)
  12. Lu XR, et al Blocking effect of puerarin on beta-adrenoceptors of isolated organs and the whole animal . Zhongguo Yao Li Xue Bao. (1986)
  13. Michihara S, et al Puerarin exerted anti-osteoporotic action independent of estrogen receptor-mediated pathway . J Nutr Sci Vitaminol (Tokyo). (2012)
  14. Wang JF, et al Effects of Radix Puerariae flavones on liver lipid metabolism in ovariectomized rats . World J Gastroenterol. (2004)
  15. Saunier EF, et al Estrogenic plant extracts reverse weight gain and fat accumulation without causing mammary gland or uterine proliferation . PLoS One. (2011)
  16. Malaivijitnond S, et al Using vaginal cytology to assess the estrogenic activity of phytoestrogen-rich herb . J Ethnopharmacol. (2006)
  17. Peng J, et al Puerarin Ameliorates Experimental Alcoholic Liver Injury by Inhibition of Endotoxin Gut-leakage, kupffer Cell Activation and Lipopolysaccharide Receptors Expression . J Pharmacol Exp Ther. (2012)
  18. Peng JH, et al Effects of Puerariae Radix Extract on Endotoxin Receptors and TNF-α Expression Induced by Gut-Derived Endotoxin in Chronic Alcoholic Liver Injury . Evid Based Complement Alternat Med. (2012)
  19. Zhang S, Ji G, Liu J Reversal of chemical-induced liver fibrosis in Wistar rats by puerarin . J Nutr Biochem. (2006)
  20. Li R, et al Puerarin mediates hepatoprotection against CCl(4)-induced hepatic fibrosis rats through attenuation of inflammation response and amelioration of metabolic function . Food Chem Toxicol. (2013)
  21. McGregor NR Pueraria lobata (Kudzu root) hangover remedies and acetaldehyde-associated neoplasm risk . Alcohol. (2007)
  22. Yamazaki T, et al Pharmacological studies on Puerariae Flos. IV: Effects of Pueraria thomsonii dried flower extracts on blood ethanol and acetaldehyde levels in humans . Int J Clin Pharmacol Res. (2002)
  23. Jang MH, et al Protective effects of puerariaeflos against ethanol-induced apoptosis on human neuroblastoma cell line SK-N-MC . Jpn J Pharmacol. (2001)
  24. Gao GY, Li DJ, Keung WM Synthesis of daidzin analogues as potential agents for alcohol abuse . Bioorg Med Chem. (2003)
  25. Gao GY, Li DJ, Keung WM Synthesis of potential antidipsotropic isoflavones: inhibitors of the mitochondrial monoamine oxidase-aldehyde dehydrogenase pathway . J Med Chem. (2001)
  26. Keung WM, Vallee BL Kudzu root: an ancient Chinese source of modern antidipsotropic agents . Phytochemistry. (1998)
  27. Yokoyama M, et al Hangover susceptibility in relation to aldehyde dehydrogenase-2 genotype, alcohol flushing, and mean corpuscular volume in Japanese workers . Alcohol Clin Exp Res. (2005)
  28. Yokoyama A, Omori T, Yokoyama T Alcohol and aldehyde dehydrogenase polymorphisms and a new strategy for prevention and screening for cancer in the upper aerodigestive tract in East Asians . Keio J Med. (2010)
  29. Brown ZW, et al Alcohol-induced euphoria enhanced by disulfiram and calcium carbimide . Alcohol Clin Exp Res. (1983)
  30. Hameedi FA, et al Behavioral, physiological, and pharmacological interaction of cocaine and disulfiram in humans . Biol Psychiatry. (1995)
  31. Wing-Shing Cheung D, et al The roots of Salvia miltiorrhiza (Danshen) and Pueraria lobata (Gegen) inhibit atherogenic events: a study of the combination effects of the 2-herb formula . J Ethnopharmacol. (2012)
  32. Lam FF, et al Mechanisms of the relaxant effect of a danshen and gegen formulation on rat isolated cerebral basilar artery . J Ethnopharmacol. (2010)
  33. Woo J, et al Comparison of Pueraria lobata with hormone replacement therapy in treating the adverse health consequences of menopause . Menopause. (2003)