Gastrodia (Gastrodia elata Blume): A Comprehensive Reference
1. Identity
1.1 Botanical and Chemical Names
Gastrodia elata Blume belongs to the family Orchidaceae and is commonly known in Chinese as tianma. It is also called "Red arrow," "Dingfeng grass," and other regional names throughout China. The Latin binomial Gastrodia elata Blume is the accepted scientific designation; the pharmaceutical drug material is referred to as Gastrodiae Rhizoma (or Rhizoma Gastrodiae) in pharmacopeial literature.
G. elata, commonly called "Tianma" in Chinese, is an obligate mycoheterotrophic plant also referred to as "Chi Jian," "Du Yao Zhi," or "Ding Feng Cao." It is a heterotrophic plant that only grows on the fungus Armillaria and has a wide geographical range in China, Japan, Korea, Bhutan, and India.
1.2 Botanical Description and Growth
The plant prefers to grow in sparse forests, open places in forests, forest margins, and thicket margins. The plant is mainly cultivated in Hubei, Sichuan, Yunnan, Guizhou, and Shaanxi provinces of China. Its obligate dependence on Armillaria fungi for nutrition makes cultivation complex and limits the natural supply of wild material. Wild G. elata is considered more biologically active than cultivated material.
1.3 Medicinal Part
The dried tuber, Gastrodiae Rhizoma (known as Tianma in Chinese), has been used frequently throughout history as a Chinese herbal remedy due to its outstanding medicinal value. Gastrodiae Rhizoma is the main portion of G. elata's clinical application; raw materials or other parts of the plant have not been formally utilized in medicine.
1.4 Pharmacopeial Recognition
Gastrodin (GAS) and p-hydroxybenzyl alcohol (HBA) are used as quality guidelines of G. elata in the Chinese Pharmacopoeia (2015 version), where their combined content must be not less than 0.25%. Gastrodin is used as the sole quality criterion in the European Pharmacopoeia, where its content must be not less than 0.20%. Gastrodin is also included in the International Pharmacopoeia (5th edition).
In 2023, the National Health Commission of the People's Republic of China and the State Administration for Market Regulation jointly issued a document to include G. elata in the list of substances that traditionally serve as both food and traditional Chinese medicinal botanical drugs.
1.5 Common Preparations and Dosage Forms
At present, the primary method of using Gastrodia elata is still traditional decoction, and related formulations mainly consist of traditional Chinese medicine, with only gastrodin being used in clinical single-agent preparations.
There are nine preparations listed in the Pharmacopoeia of the People's Republic of China: Tianma Pills, Tianma Headache Tablets, Tianma Gouteng Granules, Tianma Shouwu Tablets, Tianma Qufeng Patches, Tianma Xingnao Capsules, Bantian Ma Pills, Quan Tianma Capsules, and Strong Tianma Duzhong Pills. These preparations are used to treat headaches, chills, dizziness, tinnitus, vertigo, tremor, insomnia, loss of memory, slow response, backache, epilepsy, convulsions, numbness, and other ailments.
A variety of preparation forms are used for Gastrodiae Rhizoma, including injection, pill, tablet, and mixture forms. Gastrodin injection is a monomer formulation frequently prescribed in clinical settings to treat conditions such as diabetes, hypertension, coronary heart disease, and sleeplessness.
To reduce the frequency of administration, fluctuations in blood drug concentration, and side effects, some newer dosage forms have been developed, such as gastrodia dispersible tablets, sustained-release tablets, sustained-release pellets, and osmotic pump tablets.
Currently, the only single-component whole-herb preparation listed in the pharmacopoeia is "Whole Gastrodia Elata Capsules," which is indicated for dizziness and headache attributed to liver wind disturbing the upper body.
2. Traditional and Historical Use
2.1 Origins and Documentation
The dried tuber of Gastrodia elata, a perennial orchid with a 2,200-year medicinal history, was documented in the Shennong Bencaojing (approximately 200 BCE), and remains a cornerstone of traditional Chinese medicine (TCM) and contemporary integrative therapies across Asia.
It is one of the three orchids listed in the earliest known Chinese Materia Medica (Shennong Bencaojing, c. 100 AD). Dominating traditional Asian medicine, G. elata has a usage of over 2,000 years and was first recorded in the Shennong Bencaojing, described as having a pungent and warm flavor. The Shen Nong's Herbal Classic described Gastrodiae Rhizoma's flavor as pungent and its property as warm.
2.2 Traditional Chinese Medicine Framework
Gastrodiae Rhizoma mainly enters the meridian of the liver, with the function of expelling wind and relieving convulsion, and is often used in Chinese medicine for the treatment of internal movement of liver wind. In the Pharmacopoeia of the People's Republic of China, Tianma is indicated primarily to calm wind and stop spasms, soothe liver Yang, dispel wind, and unblock channels.
Long-term use of Gastrodiae Rhizoma is associated with tonifying qi and increasing longevity. Its long-term consumption has traditionally been considered beneficial for energy, strength, weight loss, longevity, and life extension.
Initially prescribed for neurological disorders (e.g., epilepsy, stroke prophylaxis) and hypertension, modern research has expanded its therapeutic portfolio to include anti-aging, antitumor, and osteoprotective applications.
2.3 Historical Indications and Classical Texts
In historical use, the herb has been widely applied in various diseases, such as infantile convulsions, epilepsy, tetanus, headache, dizziness, limb numbness, rheumatism, and arthralgia. The text Ben Cao Bei Yao (Qing dynasty, 1683 AD) described the use of Gastrodiae Rhizoma to treat febrile convulsions in children.
Classical texts rank the species highly: The Compendium of Materia Medica notes that it has "no taboos when taking it" and recommends it for wind deficiency, dizziness, and headache.
2.4 Geographic Spread of Traditional Use
Gastrodia elata has long been widely studied as a traditional botanical medicine in Asia, especially in China, the Korean peninsula, Japan, and Russia. In traditional Chinese medicine, Rhizoma Gastrodiae is mainly used for hypertension, headache, stroke, limb numbness, hemiplegia, and arthritis.
2.5 Traditional Formulas
It was blended with other drugs to create a variety of well-known traditional medicinal prescriptions, which included Tianma Gouteng Yin (TGY), Banxia Baizhu Tianma Tang (BBTT), Tianma Xifeng Tang (TXT), and Tianma Zexie Tang (TZT). The herb, specifically the rhizome, is also used in Sichuan cuisine as tian-ma.
3. Key Constituents and Active Compounds
3.1 Overall Phytochemical Profile
To date, more than 435 chemical constituents have been identified from Gastrodia elata, including 276 chemical constituents, 72 volatile components, and 87 synthetic compounds, which are the primary bioactive compounds. These include aromatic compounds, organic acids and esters, steroids, saccharides and their glycosides. Hundreds of compounds, including phenols, glycosides, polysaccharides, steroids, organic acids, and others, have been isolated and identified from this plant.
3.2 Primary Bioactive Compounds
The primary bioactive compounds of Gastrodia elata include gastrodin, p-hydroxybenzyl alcohol (p-HBA), vanillyl alcohol, polysaccharides, and β-sitosterol.
- Gastrodin (gastrodine): Gastrodin is a phenolic glycoside of 4-hydroxybenzyl alcohol and is selected as one of the standard compounds for evaluating the quality of Gastrodia elata. Gastrodin is the principal active component derived from the traditional Chinese medicinal plant Gastrodia elata Blume. It carries the PubChem CID 115067.
- p-Hydroxybenzyl alcohol (p-HBA): p-Hydroxybenzyl alcohol has been shown to promote neuroprotective effects via anti-apoptosis. The parishin analogues, including parishin A–W, cannot cross the blood-brain barrier to exert central effects due to their high molecular weight, but the hydrolysate p-hydroxybenzyl alcohol is capable of exerting central neuroprotective effects.
- 4-Hydroxybenzaldehyde: Gastrodin and 4-hydroxybenzyl alcohol have a stronger ability in eliminating reactive oxygen species (ROS), avoiding oxidative damage to cells, and improving cell lifespan. 4-Hydroxybenzaldehyde and 4-hydroxy-3-methoxybenzaldehyde in Rhizoma Gastrodiae can effectively inhibit the activity of GABA transaminase, and aldehyde and hydroxyl groups are necessary for inhibiting GABA transaminase activity.
- Parishins (A, B, C, and analogues): Parishin (PubChem CID 44421666), Parishin B (PubChem CID 44715528), and Parishin C (PubChem CID 46173915) are among the identified characteristic compounds.
- Vanillin and vanillyl alcohol: Vanillin potentiates GABA receptor activity, enhancing inhibitory neurotransmission and reducing seizure susceptibility.
- β-Sitosterol: Identified as one of the major constituents alongside the phenolic compounds, contributing to the plant's broader biological activities.
- Polysaccharides: Polysaccharides mitigate neuroinflammation by inhibiting microglial activation and cytokine release (e.g., TNF-α, IL-6), while also promoting synaptic plasticity via BDNF upregulation.
The Chinese Pharmacopoeia requires medicinal rhizomes to contain a minimum of 0.25% gastrodin + gastrodigenin by dry weight. Gastrodin and gastrodigenin are considered the two signature compounds of this herb.
3.3 Pharmacokinetics
After being absorbed into the blood, gastrodin is widely distributed in various tissues of rats and can enter the brain through the blood-brain barrier. Botanical drug interactions in TCM formulations enhance gastrodin's blood-brain barrier penetration, elucidating clinical efficacy.
4. Mechanisms of Action
4.1 Neuroprotective Mechanisms
Gastrodin, the major glycoside, exhibits antioxidant and anti-inflammatory properties by modulating Nrf2/HO-1 and NF-κB pathways, reducing oxidative stress and neuroinflammation in neurodegenerative and ischemic conditions.
Gastrodin exerts neuroprotection by scavenging reactive oxygen species, suppressing pro-inflammatory cytokines, and enhancing GABAergic transmission, thereby alleviating oxidative stress and neuronal apoptosis.
p-HBA and vanillyl alcohol, phenolic derivatives, enhance GABAergic transmission and scavenge free radicals, supporting neuroprotection and alleviating seizures or anxiety-related behaviors.
The plant exerted neuroprotection against beta-amyloid (Aβ)-induced toxicity, with the neuroprotective property of Tianma being attributed to its ability to inhibit stress-related proteins and induce neuroprotective genes.
4.2 Cardiovascular Mechanisms
Modern pharmacological research shows that gastrodin can improve the function of vascular endothelial cells, inhibit the stimulation of the sympathetic nervous system, and reduce the level of Ang II, aldosterone (ALD), and angiotensin type 1 receptor (AT1R) so as to intervene in the RAAS to reduce blood pressure.
It can also antagonize the vasoconstriction effect of catecholamine transmitters, non-competitively antagonize potential-dependent calcium channels and receptor-operated calcium channels, and prevent the influx and release of Ca²⁺, leading to vasodilation.
4.3 Anti-inflammatory and Antioxidant Mechanisms
GE polysaccharides modulate the gut-brain axis and suppress microglial activation, mitigating neuroinflammation. Experimental research has confirmed that Gastrodia elata extract effectively downregulates serum levels of IL-6, TNF-α, and IL-1β by modulating the IGF1-TREM2 signaling axis and the AMPK-SIRT1-FoxO1-NF-κB pathway.
4.4 Anticonvulsant Mechanisms
Gastrodin, a component of Gastrodia elata, was shown to alter GABA metabolism in the gerbil hippocampus. The anticonvulsive effects of Gastrodia elata appear to be mediated by its free radical-scavenging activities.
5. Scientific Evidence by Area of Use
5.1 Migraine
A meta-analysis (published 2022, Frontiers in Neurology) evaluated the efficacy and safety of gastrodin, the main component of Gastrodia elata, in the treatment of migraine.
Ten electronic databases were searched for randomized controlled trials (RCTs) of gastrodin for migraine published before September 2021, analyzed with RevMan 5.3 and evaluated by GRADEpro, with a total of 1,332 subjects included in 16 RCTs.
The meta-analysis showed that gastrodin was significantly effective in treating migraine (RR = 1.21, 95% CI = [1.17, 1.27]), reducing the pain degree (MD = −1.65, 95% CI = [−2.28, −1.02]), reducing the frequency of migraine attack (SMD = −2.77, 95% CI = [−3.92, −1.62]), and shortening the duration of migraine attack (SMD = −1.64, 95% CI = [−2.35, −0.93]).
Gastrodin in the effective components of Gastrodia elata preparations may inhibit the occurrence of migraine by restraining the expression of calcitonin gene-related peptide (CGRP). The overall quality of included RCTs was variable, the patient populations were predominantly Chinese, and independent replication in non-Asian populations is lacking. The meta-analysis evidence is therefore promising but not yet conclusive for international clinical practice.
5.2 Tension-Type Headache
A systematic review and meta-analysis of gastrodin for tension-type headache retrieved 177 articles, finally including 8 articles for analysis with a total sample size of 1,091 cases (565 in the treatment group and 526 in the control group). The overall quality of the included studies was not high.
In terms of headache frequency, the gastrodin group performed better than the Western medicine comparison group (MD = −2.90, 95% CI [−3.76, −2.03], P < 0.00001). The efficacy of gastrodin as a Chinese herbal medicine extract in the treatment of tension-type headache has been affirmed by this review, though evidence quality limitations require further high-quality trials.
5.3 Hypertension
A systematic review and meta-analysis titled "The effects of gastrodin injection on hypertension" was published in the journal Medicine in 2020.
Compared with conventional therapy alone, gastrodin injection (GI) combined with conventional therapy was found to decrease systolic blood pressure (WMD −6.67, 95% CI: −10.30, −3.04; k = 9, I² = 89.3%), decrease diastolic blood pressure (WMD −4.52, 95% CI: −7.79, −1.26; k = 9, I² = 92.3%), and improve clinical efficacy (RR 1.18, 95% CI: 1.10, 1.26; k = 6, I² = 12.6%).
The current evidence showed that gastrodin injection combined with conventional therapy can improve systolic blood pressure, diastolic blood pressure, and clinical efficacy, and GI may become a supplementary treatment for hypertension. Notably, the high heterogeneity observed in the blood pressure outcomes (I² = 89–92%) indicates substantial variability across studies, and most included trials originated from China. The evidence is preliminary and limited by these methodological constraints.
Gastrodin is widely used in combination with conventional therapy for hypertension and has a significant effect on attenuating increased blood pressure and improving related symptoms such as dizziness and headache, and is reported to be beneficial to elderly patients with refractory hypertension.
5.4 Vertigo and Dizziness
Clinical studies have shown that gastrodin has a good effect on the treatment of vertigo, with the ability to improve hemodynamics, which quickly eliminated dizziness, vertigo, nausea, vomiting, tinnitus, and other symptoms caused by cervical spondylosis and atherosclerosis. Gastrodin may improve microcirculation and cardiovascular compliance and promote fibrinolytic activity and anti-ischemic-reperfusion injury.
5.5 Neurological and Neurodegenerative Diseases
Current studies primarily focus on G. elata and its active ingredients for the treatment of neurological diseases such as Parkinson's disease, Alzheimer's disease, epilepsy, convulsions, depression, schizophrenia, as well as enhancing learning and memory, and preventing or treating cerebral ischemic injury.
Vascular Dementia: Gastrodin has been used in the treatment of migraine, epilepsy, Parkinson's disease, dementia, and depression in recent years; it can improve cognitive function and related neuropsychiatric symptoms through various effects and is considered a promising treatment for dementia. Although there is still a lack of robust evidence-based clinical explorations, published work has reviewed the mechanisms and methods of gastrodin in the treatment of vascular dementia to provide a reference for clinical therapy. Evidence in this area remains largely preclinical or based on small-scale clinical studies.
Alzheimer's Disease: Gastrodia elata (Tianma) has demonstrated CNS effects including anticonvulsant, anti-hypertensive, and learning and memory-enhancing activities. The plant exerted neuroprotection against beta-amyloid (Aβ)-induced toxicity, with its neuroprotective property attributed to its ability to inhibit stress-related proteins and induce neuroprotective genes. However, evidence in humans with Alzheimer's disease remains preliminary, based primarily on in vitro and animal models.
Parkinson's Disease: Studies on the pharmacological effects of gastrodin on the CNS indicate that it may exert anti-neurodegenerative and cerebrovascular protective effects through various mechanisms. Clinical evidence in Parkinson's disease is limited and has not been established through well-powered randomized controlled trials.
5.6 Epilepsy and Convulsions
Extracts have demonstrated nervous system activities including sedative-hypnotic, anticonvulsant, and antiepileptic effects in experimental models. Using a kainic-acid-treated mouse model, researchers demonstrated that administration of Gastrodia elata extract dramatically decreased the counts of convulsive behaviors and delayed the onset time. These findings are primarily from animal and in vitro studies; robust, well-designed human RCTs specifically for epilepsy as a standalone indication are lacking in the published literature accessible to this review.
5.7 Depression and Anxiety
Studies on the pharmacological effects of gastrodin on the CNS indicate that it may exert ameliorative effects on depression and anxiety through various mechanisms. Modern pharmacological studies have shown that its active ingredients possess anti-anxiety and anti-depressant effects. Evidence in this area remains largely in vitro and in vivo (animal-based), with limited human clinical trial data.
5.8 Sleep Disorders
Gastrodia elata has a wide range of applications for issues such as neurasthenia, insomnia, and dizziness. Gastrodin injection has been prescribed in clinical settings to treat sleeplessness. Dedicated human RCT data specifically examining sleep as a primary endpoint are currently limited, and the sleep-related evidence base is considered preliminary.
5.9 Cardiovascular Protective Effects
Gastrodia extracts have also shown cardiovascular and cerebrovascular system activities including antihypertensive, antiplatelet aggregation, and anti-inflammatory effects in experimental studies. Gastrodin may improve microcirculation and cardiovascular compliance and promote fibrinolytic activity. Human clinical data in the cardiovascular domain is most extensively represented in the hypertension literature reviewed above.
6. Body Systems and Health Areas
The pharmacological effects of Gastrodia elata include nervous system and cardiovascular system activities, which have been comprehensively summarized in peer-reviewed literature. Based on published scientific evidence, the following body systems and health areas are associated with gastrodia:
- Central nervous system: Gastrodin, the main active metabolite of Gastrodia elata, has wide-ranging pharmacological effects, mostly related to CNS disorders. Areas include neurodegenerative disease, epilepsy, headache, dizziness, depression, anxiety, and sleep regulation.
- Cardiovascular system: Blood pressure regulation, vascular endothelial function, lipid regulation, and cerebrovascular protection.
- Anti-inflammatory pathways: Demonstrated modulation of key inflammatory signaling pathways including IGF1-TREM2 and AMPK-SIRT1-FoxO1-NF-κB.
- Immune function: Historically used as an anti-immune drug in traditional Chinese medicine.
- Antioxidant systems: Direct ROS scavenging and upregulation of antioxidant pathways including Nrf2/HO-1.
7. Dosage Forms and Dosages Reported in Studies
Dosages reported in the scientific literature span a range of formulations. The following are drawn directly from peer-reviewed sources:
- Gastrodin injection (clinical, hypertension meta-analysis): The current evidence is derived from RCTs using gastrodin injection (GI) combined with conventional therapy, demonstrating improvements in systolic and diastolic blood pressure and clinical efficacy. Specific dosing regimens for individual injections varied across the 13 included RCTs.
- Oral gastrodin (migraine meta-analysis): A total of 1,332 subjects were included across 16 RCTs evaluating oral gastrodin for migraine. Exact doses varied across trials.
- Water extract toxicology (preclinical NOAEL): A 28-day repeated-dose toxicity assessment of water extract of G. elata (WGE) at doses of 2,040, 4,080, and 8,065 mg/kg body weight orally in mice revealed no adverse effects on behavior, mortality, body weight, haematology, clinical biochemistry, or organ weight.
- Chinese Pharmacopoeia preparations: Nine preparations are listed in the Pharmacopoeia of the People's Republic of China, each with specific dosing as detailed in the official monograph, which is the authoritative source for approved clinical dosing.
Published pharmacokinetic data indicate that gastrodin undergoes rapid absorption and elimination. Specific absolute oral dose values for clinical use in humans are not uniformly reported across the peer-reviewed literature accessed in this review, beyond the formulation-specific ranges in the cited meta-analyses.
8. Safety Considerations and Interactions
8.1 Preclinical Toxicology
Water extract of G. elata (WGE) has no significant mutagenic or toxic properties, and the no-observed-adverse-effect level (NOAEL) of WGE can be defined as at least 8,065 mg/kg/day orally for 28 days for male and female mice.
WGE did not induce clastogenic effects in Chinese hamster ovary (CHO-K1) cells with or without S9 activation. Chronic toxicity studies have indicated that G. elata has no significant mutagenic or toxic properties.
8.2 Traditional Safety Record
Gastrodiae Rhizoma was commonly employed in ancient China due to its clear curative and non-toxic impact. The Compendium of Materia Medica notes that it has "no taboos when taking it."
8.3 Cytochrome P450 Interactions
In rat studies, unprocessed G. elata had no effects on rat CYP1A2 and did not affect CYP2C9 activity, but cooked-processed G. elata (CGE) induced CYP2C9 activity. Moreover, CGE was more potent than unprocessed G. elata for inhibitory effect on CYP3A4 activity. These results provide useful scientific data for the safe clinical application of either extract of G. elata or in combination with other drugs, suggesting the need for caution regarding herb-drug interactions via CYP enzyme modulation, particularly when using cooked or processed forms.
8.4 Need for Further Human Safety Data
Despite various publications on Gastrodia elata Blume, there is still a need for definitive research and clarification of other bioactive compounds using bioactivity-guided isolation strategies. The possible mechanism of action as well as potential synergistic or antagonistic effects of multi-component mixtures need to be evaluated. It is also necessary to conduct more quality control and toxicological studies in human subjects in order to maintain its efficacy stable in the body and validate its safety in clinical uses.
8.5 Limitations of the Current Evidence Base
Even though Gastrodiae Rhizoma has a long history of medical use, there are some shortages in clinical research. The treatment of cardiovascular and cerebrovascular illnesses has received the majority of attention in research, which has primarily overlooked clinical trials of other pharmacological actions.
The utilization of Gastrodia resources remains suboptimal, with many traditional formulas receiving insufficient attention in research and development. Most available clinical studies originate from China, employ relatively small sample sizes, and carry risk of bias due to limited blinding and inconsistent reporting standards. Independent, large-scale replication across different ethnic and geographic populations is a recognized gap in the current evidence base.
References
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