Sacred lotus

Scientific Name(s): Nelumbo nucifera Gaertn. Family: Nymphaeaceae. 1 , 2

Common Name(s): Indian lotus , Chinese water lily , sacred lotus , kamala , padma 1 , 2

Uses

There are numerous reported pharmacologic investigations of sacred lotus, including antioxidant, hepatoprotective, immunomodulatory, anti-infective, hyperlipidemic, and psychopharmacologic activity. However, clinical trials are lacking.

Dosing

Commercial manufacturers offer sacred lotus in various dosage forms, including powder, tincture, dried petals, seeds, and leaves, and combination products in capsule form. Lotus root is also available as a health beverage and food. Cosmetic formulations are also available.

Contraindications

Avoid use if hypersensitivity exists to any constituents of sacred lotus.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Due to potential drug interactions, sacred lotus should be used cautiously by patients being treated for diabetes, high cholesterol, psychiatric or cardiac conditions, or erectile dysfunction.

Toxicology

No mortality or behavioral changes were observed in acute toxicity studies of an alcoholic seed extract in mice given a dose of up to 1,000 mg/kg body weight for 24 hours. The plant species may contain high levels of cadmium, copper, and lead.

Botany

N. nucifera is an aquatic plant native to eastern Asia and northern Australia. 1 , 2 , 3 The plant has long stems with leaves and flowers, requires plenty of space and sun, and grows up to 5.7 m in height. The ovoid fruit is a collection of indehiscent nutlets growing 1 m long and 1.5 cm wide, with a brown to black pericarp. The seeds fill the innermost portion of the flower. The chemical composition of the fruit wall and seed coat enhances the longevity of the fruits. 4 The leaves are either aerial and cup shaped or floating and flat, with the aerial leaves ranging from 24 to 33 cm in length, and the floating leaves ranging from 23 to 30 cm. The leaves are large in diameter, ranging from 20 to 90 cm. 2 The white to pinkish flowers are solitary and range from 10 to 25 cm in diameter, 5 with sepals, petals, and stamens grouped in a spiral pattern. The sacred lotus is the national flower of India and is cultivated for its elegant scent. The white to yellowish brown rhizome is 60 to 140 cm long and 0.5 to 2.5 cm in diameter, with a tough, fibrous outer layer, dense middle layer, and a spongy, inner layer. 2 , 4

History

The sacred lotus has been cultivated in eastern Asia for over 3,000 years and has been used as food and medicine, as well as in religious and cultural activities. The Egyptians worshiped the flowers, fruits, and sepals of the plant, commonly found along the banks of the Nile River. In addition to being consumed all over the world as a dietary staple, the plant is used ornamentally, and all parts have medicinal uses. 2

The seeds and fruits have been used in Asia to treat GI ailments (eg, poor digestion, enteritis, chronic diarrhea), insomnia, cardiovascular disease (eg, heart palpitations, hypertension, arrhythmia), nervous disorders, skin conditions (eg, dermatopathy, leprosy, tissue inflammation), halitosis, cancer, and high fevers, as an antiemetic, poison antidote, and diuretic, and in men's health (eg, spermatorrhea) and women's health (ie, leucorrhea, menorrhagia). The seeds have also been used for hemostasis function. Honey mixed with the seed powder is reputedly helpful in treating cough. 2 , 6 , 7 , 8 , 9

The leaf juice has been used to treat diarrhea, and when mixed with a leaf decoction, to treat sunstroke. The diuretic and astringent activities of the leaf extract are used to alleviate sweating and to treat fever. Medicinally, the leaves have been used to treat various bleeding conditions, including hematemesis, epistaxis, hemoptysis, hematuria, and metrorrhagia. The leaves have also been used to treat obesity and hyperlipidemia. The stem has been used in traditional Ayurvedic medicine as an anthelmintic and to treat strangury. Lotus leaf is a major ingredient of antioxidant beverages and teas in China, with annual production exceeding 800,000 tons. 2 , 6 , 7 , 8 , 9 , 10

Sacred lotus flowers have traditionally been used to treat various bleeding disorders, cholera, fever, vascular disorders of the liver, hyperdipsia, and abdominal cramps, and as a cardiac tonic. Eye infections have been treated with lotus honey. 2 , 6 , 7 , 8 , 9

The rhizome has been used as a tonic and to treat bleeding disorders (ie, nasal bleeding, hemoptysis, hematuria, bleeding of the uterus). It is included in Chinese herbal formulations to treat cancer, chronic liver cirrhosis, and tissue inflammation. Hemorrhoids, dysentery, and dyspepsia have been treated with powdered formulations of the rhizome. An external paste formulation has been effective in treating scabies and ring worm. 2 , 6 , 7 , 8 , 9

Chemistry

Pharmacologically active constituents have been isolated from the seed, leaf, flower, and rhizome. The chemical constituents include alkaloids, steroids, triterpenoids, flavonoids, glycosides, and polyphenols, as well as a variety of minerals. 2 , 11 , 12 , 13 , 14 , 15

The seeds are rich in protein, amino acids, unsaturated fatty acids, minerals, starch, and tannins. Numerous alkaloids are the major secondary metabolites in the seeds. 2 , 15 A description of the chemical composition of the seed polysaccharides is also available. 2 , 4

N -nornuciferine, O -nornuciferine, nuciferine, and roemerine are the 4 main aporphine alkaloids responsible for the pharmacological properties of the plant. 13 Numerous chemical analyses document a number of alkaloids in the leaves. 2 , 11 , 12 , 13 , 14 Several flavonoids are located in the leaves and stamens; the stamens contain kaempferol and 7 of its glycosides. 2

The starch in the rhizomes is comparable to maize and potato starch, with a fresh rhizome containing 31.2% starch. Vitamin content includes: thiamine (0.22 mg per 100 g), riboflavin (0.6 mg per 100 g), niacin (2.10 mg per 100 g), and ascorbic acid (1.5 mg per 100 g). An asparagine-like amino acid (2%) has also been isolated in the rhizomes.

Uses and Pharmacology

Numerous pharmacologic analyses have been performed on sacred lotus investigating its use as an antioxidant and hepatoprotective, as well as a treatment for diabetes, infectious disease, and hyperlipidemia. Immunomodulatory and psychopharmacologic activity have also been explored.

Antioxidant

Although the mechanism is not completely understood, antioxidant activity may be due to the presence of phenolics, alkaloids, and saponins. 6

In vitro and animal data

Four different chemical analyses document high antioxidant activity from the rhizome knot. 16 A whole rhizome extract had significant scavenging activity for small carbon-centered radicals. 16 A hydroalcoholic seed extract exhibited strong free radical scavenging activity in rats comparable with that of standard vitamin E treatment at 50 mg/kg. 6 Chemical constituents from the seed pod have lipid auto-oxidative, lipoxygenase, and free radical scavenging activity. 17 Lotus germ oil inhibited lipid peroxidation in mice liver and kidney tissues and blocked autohemolysis of mice red blood cells in a dose-dependent manner. 18 High antioxidant activity was also found in the germ oil in a lipid system (ie, lard peroxidation). The phenolic compounds and tocopherols may contribute to the antioxidant activity of lotus germ oil. 18 A leaf methanol extract 19 exhibited concentration-dependent antioxidant activity against hemoglobin-induced linoleic acid peroxidation, which may be related to its flavonoid content. 20

Clinical data

No human clinical data are available regarding the antioxidant activity of sacred lotus.

Hepatoprotection
In vitro and animal data

Ethanol seed extracts exhibited hepatoprotective effects against production of serum enzymes and cytotoxicity caused by carbon tetrachloride. The extract also protected against the genotoxic and cytotoxic effects of aflatoxin B1. 21 Armepavine, an active compound in sacred lotus, has antifibrotic effects in rats by activating the anti–NF-kappaB pathway. Armepavine yielded better results compared with silymarin (ie, milk thistle) in reducing certain metabolic parameters in hepatic fibrosis. 22 A dose of 300 and 500 mg/kg of lotus leaf extract in rats was comparable to 100 mg/kg of silymarin against liver-induced injury by carbon tetrachloride. 23 Hepatitis B has been treated with a combination Chinese herbal product containing sacred lotus leaf. 24

Clinical data

No human clinical data are available regarding the hepatoprotective activity of sacred lotus.

Immunomodulation
In vitro and animal data

A lotus seed ethanol extract inhibited cell-cycle progression, cytokine gene expression, and cell proliferation in human peripheral blood mononuclear cells (PBMCs). 25 ( S )-armepavine from sacred lotus immunomodulatory activity 26 , 27 includes: (1) inhibition of concanavalin A–induced splenocyte proliferation; (2) suppression of cytokine mRNA expression in splenocytes; (3) improved kidney function with reduction of immune complex deposition and glomerular hypercellularity; and (4) reduced autoantibody and T cell-mediated cytokine production in sera.

( S )-armepavine also inhibits interleukin-2 and interferon-gamma transcripts in human PBMCs without direct cytotoxicity. 26 , 27 Hydroalcoholic rhizome and seed extracts changed total and differential white blood cell counts, improved phagocytosis, and potentiated immune inflammatory reactions. 28

Clinical data

No human clinical data are available regarding the immunomodulatory activity of sacred lotus.

Infection
In vitro and animal data

Ethanol seed extracts inhibited herpes simplex virus type 1 (HSV-1) multiplication in HeLa cells without cytotoxicity by inhibiting gene expression of HSV-1. 29 Alkaloids and flavonoids from a 95% ethanol leaf extract had anti-HIV activity. 30 Antifungal activity against Candida albicans and antimalarial activity was found for various leaf constituents with no observed cytotoxicity. 31 Antibacterial activity is documented for rhizome extracts against Staphylococcus aureus , Escherichia coli , Bacillus subtilis , Bacillus pumilis , and Pseudomonus aeruginosa . 2 A rhizome extract had antifungal and antiyeast activity comparable with griseofulvin against 5 different strains of fungi and yeast, including C. albicaus , Aspergillus niger , Aspergillus fumigatus , and Trichophytum mentagopyhtes . 2

Clinical data

No human clinical data are available regarding the use of sacred lotus for treating infection.

Effects on lipids and obesity
In vitro and animal data

A Chinese herbal mixture containing sacred lotus reduced serum triglycerides and cholesterol in rats fed a high-fat diet. 32 An ethanol leaf extract stimulated lipolysis in visceral and subcutaneous adipose tissues in mice. 33 The pathway involved the beta-adrenergic receptor mediated in energy expenditure and prevention of diet-induced obesity. The ethanol leaf extract also suppressed body weight gain in mice fed a high-fat diet. 33 A flavonoid-enriched leaf extract reduced blood and liver lipids, lipid peroxidation, release of the liver enzymes AST and ALT, the LDL-C to HDL-C ratio, and lipid accumulation in the liver in a high-fat diet animal model. 34 , 35 The effect of the leaf extract on the high-fat–induced lipid metabolic disorder was comparable with results of silymarin and simvastatin treatment. The flavonoids from the leaf extract may exert antiatherogenic properties by inhibiting vascular smooth muscle cell proliferation and migration. 36

Sacred lotus leaf extract has been used to treat obesity in China. The effects of the leaf extract on obesity, digestive enzymes, lipid metabolism, and thermogenesis were studied in mice induced with a high-fat diet. 37 The extract inhibited intestinal absorption of carbohydrate and lipid by inhibiting alpha-amylase and lipase; up-regulated lipid metabolism in adipocytes; prevented increases in body weight; and increased thermogenesis. An antiobesity herbal product that included sacred lotus inhibited fat accumulation by down-regulating major transcription factors in the adipogenesis pathway and lipid metabolizing enzymes utilized for accumulation of fat in adipocytes. 38

Clinical data

No human clinical data are available regarding the effects of sacred lotus on lipids and obesity.

Diabetes
Animal data

An ethanol rhizome extract reduced the blood sugar level of normal rats and glucose-fed hyperglycemic and streptozotocin-induced diabetic rats. 39 In normal rats, the rhizome extract improved glucose tolerance and increased the effectiveness of injected insulin. The activity of the extract was comparable with that of tolbutamide, a sulfonylurea oral hypoglycemic drug, at 73% and 67% in normal and diabetic rats, respectively. Neferine, isolated from the green seed embryo, was comparable with rosiglitazone in enhancing insulin sensitivity and improving fasting blood glucose, triglycerides, and inflammatory cytokines in insulin-resistant rats. 40 The mechanism of action may involve reducing release of tumor necrosis factor-alpha by activating the gamma peroxisome proliferator-activated receptor (PPAR) as well as decreasing insulin compensatory release from pancreatic islet cells. A Chinese herbal formulation decreased abnormal glucose and improved cholesterol, triglycerides, low-density lipoprotein-C (LDL-C), and high-density lipoprotein-C (HDL-C) in rats fed a high-fat diet after 4 weeks of treatment. 41 , 42 Potential mechanisms of action include inhibition of intestinal glucosidase, inhibition of lipase, and free radical scavenging activity. 41 Quercetin and glycosides in the leaves may inhibit lens aldose reductase, an enzyme associated with diabetic complications. 11 , 43

Clinical data

No human clinical data are available regarding the use of sacred lotus in diabetes.

Psychopharmacologic activity
In vitro and animal data

The alkaloids asimilobine and lirinidine, isolated from the leaves of sacred lotus, inhibited the contraction of rabbit isolated aorta induced by serotonin. 44 Neferine from lotus seed embryos may have antidepressant activity as indicated by its anti-immobility effects in mice in a forced swimming test. 45 Neferine is a direct 5-hydroxytryptamine (5-HT) _1A receptor agonist and may inhibit 5-HT reuptake or activation of 5-HT metabolism. The antidepressant effect was comparable with that of maprotiline and imipramine. In mice, a methanol rhizome extract may improve learning and memory by enhancing neurogenesis through increased cell proliferation and cell differentiation in the dentate gyrus of the hippocampus. 46 Sacred lotus seed extract improved scopolamine-induced dementia in rats by inhibiting acetylcholinesterase activity and inducing choline acetyltransferase expression. 47 One study documented cholinesterase inhibitory activities from sacred lotus stamen-derived compounds. 9 Methanol seed extracts containing neferine inhibited locomotor activity at 50 mg/kg and elicited potent effects at 100 mg/kg. Neferine induced sedation, hypothermia, antifever effects, and anxiolytic effects comparable with those of diazepam but with a different mechanism. 48 Methanol rhizome extracts also have a minor sedative activity. 49 Leaf extract administered to mice attenuated induced and long-term stress and appeared to have adaptogenic activity comparable with that of diazepam. 50

Clinical data

No human clinical data are available regarding the psychopharmacologic activity of sacred lotus.

Other pharmacological effects
Allergies

A stamen methanol extract containing kaempferol inhibited key receptors and attenuated immunoglobulin E–mediated allergic reactions. 7 , 51

Antiarrhythmic effects

Neferine antagonized arrhythmias induced by aconitine in rats, calcium chloride in mice, and coronary occlusion-reperfusion in dogs. Neferine's anti-arrhythmic effect may involve blocking human-ether-à-go-go-related gene channels associated with repolarization of the cardiac action potential. 52

Antifertility effects

A petroleum ether seed extract administered to mice exhibited antiestrogenic, antiprogestational, and contraceptive activity at a dose of 3 mg/kg body weight. 53

Antipyretic

Ethanol stalk extract at 200 mg/kg reduced normal body temperature for up to 3 hours and for up to 6 hours at 400 mg/kg in rats. The activity was comparable with paracetamol. 54

Diuretic effects

A methanol rhizome extract in rats produced natriuretic and chloruretic activity. Dose-dependent effects were documented in urine volume and electrolyte excretion. 55

Erectile dysfunction activity

Neferine isolated from green seed embryo increased the concentration of cyclic adenosine monophosphate in rabbit corpus cavernosum tissue by inhibiting phosphodiesterase activity. 56 A combination Chinese herbal product containing sacred lotus seed has been used to treat sexual impotence and premature ejaculation in men. 57

GI effects

A rhizome extract was effective in reducing diarrhea in rats. 58

Uses for inflammation

A methanol rhizome extract at dosages of 200 and 400 mg/kg inhibited induced inflammation in rats. The anti-inflammatory activity was comparable with that of phenylbutazone and dexamethasone. 59 Kaempferol, isolated from sacred lotus, reduced the influx of cytokines and reactive oxygen species in aged rat gingival tissues. 60 Isoliensinine isolated from the seeds reduced bleomycin-induced pulmonary fibrosis in mice. 61 The protective effect was associated with antioxidant activity and reduced expression of inflammatory mediators.

Dosage

Most animal studies document a dosage range of 100 to 400 mg/kg, depending on which portion of the plant is used. Commercial manufacturers offer sacred lotus in various dosage forms, including powder, tincture, dried petals, seeds, and leaves, and combination products in capsule form. Lotus root is also available as a health beverage and food. 62 Sacred lotus is used cosmetically in mascara, eye shadow, lipstick, nail polish, creams, perfumes, shampoo, tonics for preventing gray hair, and tanning reagents. 63 , 64 , 65

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

Sacred lotus may interact with drugs used to treat diabetes, liver conditions, and infections, as well as with lipid-lowering, psychotropic, cardiac, or erectile dysfunction medications.

Adverse Reactions

Due to potential drug interactions, sacred lotus should be used cautiously by patients being treated for diabetes, high cholesterol, psychiatric or cardiac conditions, or erectile dysfunction.

Contraindication

Avoid use if hypersensitivity exists to any constituents of sacred lotus.

Toxicology

No mortality or behavioral changes were observed in acute toxicity studies of an alcoholic seed extract in mice up to a dose of 1,000 mg/kg body weight for 24 hours. 6 The plant species may contain high levels of cadmium, copper, and lead. 66

Bibliography

1. Kreunen SS, Osborn JM. Pollen and anther development in Nelumbo (Nelumbonaceae). Am J Bot . 1999;86(12):1662-1676.
2. Mukherjee PK, Mukherjee D, Maji AK, Rai S, Heinrich M. The sacred lotus ( Nelumbo nucifera )—phytochemical and therapeutic profile. J Pharm Pharmacol . 2009;61(4):407-422.
3. Masuda J, Urakawa T, Ozaki Y, Okubo H. Short photoperiod induces dormancy in Lotus ( Nelumbo nucifera ). Ann Bot . 2006;97(1):39-45.
4. Van Bergen PFV, Hatcher PG, Boon JJ, Collinson ME, de Leeuw JW. Macromolecular composition of the propagule wall of Nelumbo nucifera . Phytochemistry . 1997;45(3):601-610.
5. Li JK, Huang SQ. Flower thermoregulation facilitates fertilization in Asian sacred lotus. Ann Bot . 2009;103(7):1159-1163.
6. Rai S, Wahile A, Mukherjee K, Saha BP, Mukherjee PK. Antioxidant activity of Nelumbo nucifera (sacred lotus) seeds. J Ethnopharmacol . 2006;104(3):322-327.
7. Shim SY, Choi JS, Byun DS. Kaempferol isolated from Nelumbo nucifera stamens negatively regulates FcepsilonRI expression in human basophilic KU812F cells. J Microbiol Biotechnol . 2009;19(2):155-160.
8. Liao H, Banbury LK, Leach DN. Antioxidant activity of 45 Chinese herbs and the relationship with their TCM characteristics. Evid Based Complement Alternat Med . 2008;5(4):429-434.
9. Jung HA, Jung YJ, Hyun SK, et al. Selective cholinesterase inhibitory activities of a new monoterpene diglycoside and other constituents from Nelumbo nucifera stamens. Biol Pharm Bull . 2010;33(2):267-272.
10. Huang B, Ban X, He J, Tong J, Tian J, Wang Y. Comparative analysis of essential oil components and antioxidant activity of extracts of Nelumbo nucifera from various areas of China. J Agric Food Chem . 2010;58(1):441-448.
11. Lim SS, Jung YJ, Hyun SK, Lee YS, Choi JS. Rat lens aldose reductase inhibitory constituents of Nelumbo nucifera stamens. Phytother Res . 2006;20(10):825-830.
12. Kunitomo J, Yoshikawa Y, Tanaka S, Imori Y, Isol K, Masada K, et al. Alkaloids of Nelumbo nucifera . Phytochemistry . 1973;12(3):699-701.
13. Luo X, Chen B, Liu J, Yao S. Simultaneous analysis of n-nornuciferine, o- nornuciferine, nuciferine, and roemerine in leaves of Nelumbo nucifera Gaertn by high-performance liquid chromatography-photodiode array detection-electrospray mass spectrometry. Anal Chim Acta . 2005;538(1-2):129-133.
14. Zheng Z, Wang M, Wang D, Duan W, Wang X, Zheng C. Preparative separation of alkaloids from Nelumbo nucifera leaves by conventional and pH-zone-refining counter-current chromatography. J Chromatogr B Analyt Technol Biomed Life Sci . 2010;878(19):1647-1651.
15. Nishibe S, Tsukamoto H, Kinoshita H, Kitagawa S, Sakushima A. Alkaloids from embryo of the seed of Nelumbo nucifera . J Nat Prod . 1986;49(3):547-548.
16. Hu M, Skibsted L. Antioxidative capacity of rhizome extract and rhizome knot extract of edible lotus ( Nelumbo nuficera ). Food Chem . 2002;76(3):327-333.
17. Ling ZQ, Xie BJ, Yang EL. Isolation, characterization, and determination of antioxidative activity of oligomeric procyanidins from the seedpod of Nelumbo nucifera Gaertn. J Agric Food Chem . 2005;53(7):2441-2445.
18. Li J, Zhang M, Zheng T. The in vitro antioxidant activity of lotus germ oil from supercritical fluid carbon dioxide extraction. Food Chem . 2009;115(3):939-944.
19. Wu MJ, Wang L, Weng CY, Yen JH. Antioxidant activity of methanol extract of the lotus leaf ( Nelumbo nucifera Gertn.). Am J Chin Med . 2003;31(5):687-698.
20. Lin HY, Kuo YH, Lin YL, Chiang W. Antioxidative effect and active components from leaves of Lotus ( Nelumbo nucifera ). J Agric Food Chem . 2009;57(15):6623-6629.
21. Sohn DH, Kim YC, Oh SH, Park EJ, Li X, Lee BH. Hepatoprotective and free radical scavenging effects of Nelumbo nucifera . Phytomedicine . 2003;10(2-3):165-169.
22. Weng TC, Shen CC, Chiu YT, Lin YL, Kuo CD, Huang YT. Inhibitory effects of armepavine against hepatic fibrosis in rats. J Biomed Sci . 2009;16:78.
23. Huang B, Ban X, He J, Tong J, Tian J, Wang Y. Hepatoprotective and antioxidant activity of ethanolic extracts of edible lotus ( Nelumbo nucifera Gaertn.) leaves. Food Chem . 2010;120(3):873-878.
24. Li J, Zhou P, Huang H, Sheng D. Pharmaceutical composition containing total flavones extracts from Nelumbo and Hypericum for treating hepatitis B. Faming Zhuanil Shenqing Gongkai Shuomingshu. Patent 101167805. November 14, 2007.
25. Liu CP, Tsai WJ, Lin YL, Liao JF, Chen CF, Kuo YC. The extracts from Nelumbo nucifera suppress cell cycle progression, cytokine genes expression, and cell proliferation in human peripheral blood mononuclear cells. Life Sci . 2004;75(6):699-716.
26. Liu CP, Tsai WJ, Shen CC, et al. Inhibition of (S)-armepavine from Nelumbo nucifera on autoimmune disease of MRL/MpJ-lpr/lpr mice. Eur J Pharmacol . 2006;531(1-3):270-279.
27. Liu CP, Kuo YC, Shen CC, et al. (S)-armepavine inhibits human peripheral blood mononuclear cell activation by regulating Itk and PLCg activation in a PI-3K-dependent manner. J Leukoc Biol . 2007;81(5):1276-1286.
28. Mukherjee D, Khatua TN, Venkatesh P, Saha BP, Mukherjee PK. Immunomodulatory potential of rhizome and seed extracts of Nelumbo nucifera Gaertn. J Ethnopharmacol . 2010;128(2):490-494.
29. Kuo YC, Lin YL, Liu CP, Tsai WJ. Herpes simplex virus type 1 propagation in HeLa cells interrupted by Nelumbo nucifera . J Biomed Sci . 2005;12(6):1021-1034.
30. Kashiwada Y, Aoshima A, Ikeshiro Y, et al. Anti-HIV benzylisoquinoline alkaloids and flavonoids from the leaves of Nelumbo nucifera , and structure-activity correlations with related alkaloids. Bioorg Med Chem . 2005;13(2):443-448.
31. Agnihotri VK, ElSohly HN, Khan SI, et al. Constituents of Nelumbo nucifera leaves and their antimalarial and antifungal activity. Phytochem Lett . 2008;1(2):89-93.
32. la Cour B, Mℴlgaard P, Yi Z. Traditional Chinese medicine in treatment of hyperlipidaemia. J Ethnopharmacol . 1995;46(2):125-129.
33. Ohkoshi E, Miyazaki H, Shindo K, Watanabe H, Yoshida A, Yajima H. Constituents from the leaves of Nelumbo nucifera stimulate lipolysis in the white adipose tissue of mice. Planta Med . 2007;73(12):1255-1259.
34. Lin MC, Kao SH, Chung PJ, Chan KC, Yang MY, Wang CJ. Improvement for high fat diet-induced hepatic injuries and oxidative stress by flavonoid-enriched extract from Nelumbo nucifera leaf. J Agric Food Chem . 2009;57(13):5925-5932.
35. Wu CH, Yang MY, Chan KC, Chung PJ, Ou TT, Wang CJ. Improvement in high-fat diet-induced obesity and body fat accumulation by a Nelumbo nucifera leaf flavonoid-rich extract in mice. J Agric Food Chem . 2010;58(11):7075-7081.
36. Ho HH, Hsu LS, Chan KC, Chen HM, Wu CH, Wang CJ. Extract from the leaf of nucifera reduced the development of atherosclerosis via inhibition of vascular smooth muscle cell proliferation and migration. Food Chem Toxicol . 2010;48(1):159-168.
37. Ono Y, Hattori E, Fukaya Y, Imai S, Ohizumi Y. Anti-obesity effect of Nelumbo nucifera leaves extract in mice and rats. J Ethnopharmacol . 2006;106(2):238-244.
38. Lee H, Kang R, Yoon Y. SH21B, an anti-obesity herbal composition, inhibits fat accumulation in 3T3-L1 adipocytes and high fat diet-induced obese mice through the modulation of the adipogenesis pathway. J Ethnopharmacol . 2010;127(3):709-717.
39. Mukherjee PK, Saha K, Pal M, Saha BP. Effect of Nelumbo nucifera rhizome extract on blood sugar level in rats. J Ethnopharmacol . 1997;58(3):207-213.
40. Pan Y, Cai B, Wang K, et al. Neferine enhances insulin sensitivity in insulin resistant rats. J Ethnopharmacol . 2009;124(1):98-102.
41. Tao W, Deqin Z, Yuhong L, et al. Regulation effects on abnormal glucose and lipid metabolism of TZQ-F, a new kind of Traditional Chinese Medicine. J Ethnopharmacol . 2010;128(3):575-582.
42. Zhang W. Chinese medicinal composition for treating diabetes, and its preparation method. Faming Zhuanil Shenqing Gongkai Shuomingshu. Patent 101204571. December 19, 2007.
43. Jung HA, Jung YJ, Yoon NY, et al. Inhibitory effects of Nelumbo nucifera leaves on rat lens aldose reductase, advanced glycation endproducts formation, and oxidative stress. Food Chem Toxicol . 2008;46(12):3818-3826.
44. Shoji N, Umeyama A, Saito N, et al. Asimilobine and lirinidine, serotonergic receptor antagonists, from Nelumbo nucifera . J Nat Prod . 1987;50(4):773-774.
45. Sugimoto Y, Furutani S, Nishimura K, et al. Antidepressant-like effects of neferine in the forced swimming test involve the serotonin1A (5-HT1A) receptor in mice. Eur J Pharmacol . 2010;634(1-3):62-67.
46. Yang WM, Shim KJ, Choi MJ, et al. Novel effects of Nelumbo nucifera rhizome extract on memory and neurogenesis in the dentate gyrus of the rat hippocampus. Neurosci Lett . 2008;443(2):104-107.
47. Oh JH, Choi BJ, Chang MS, Park SK. Nelumbo nucifera semen extract improves memory in rats with scopolamine-induced amnesia through the induction of choline acetyltransferase expression. Neurosci Lett . 2009;461(1):41-44.
48. Sugimoto Y, Furutani S, Itoh A, et al. Effects of extracts and neferine from the embryo of Nelumbo nucifera seeds on the central nervous system. Phytomedicine . 2008;15(12):1117-1124.
49. Mukherjee PK, Saha K, Balasubramanian R, Pal M, Saha BP. Studies on psychopharmacological effects of Nelumbo nucifera Gaertn. rhizome extract. J Ethnopharmacol . 1996;54(2-3):63-67.
50. Kulkarni MP, Juvekar AR. Attenuation of acute and chronic restraint stress-induced perturbations in experimental animals by Nelumbo nucifera Gaertn. Indian J Pharm Sci . 2008;70(3):327-332.
51. Toyoda M, Tanaka K, Hoshino K, Akiyama H, Tanimura A, Saito Y. Profiles of potentially antiallergic flavonoids in 27 kinds of health tea and green tea infusions. J Agric Food Chem . 1997;45:2561-2564.
52. Gu DF, Li XL, Qi ZP, et al. Blockade of HERG K+ channel by isoquinoline alkaloid neferine in the stable transfected HEK293 cells. Naunyn Schmeidebergs Arch Pharmacol . 2009;380(2):143-151.
53. Mazumder UK, Gupta M, Pramanik G, Mukhopadhyay RK, Sarkar S. Antifertility activity of seed of Nelumbo nucifera in mice. Indian J Exp Biol . 1992;30(6):533-534.
54. Sinha S, Mukherjee PK, Mukherjee K, Pal M, Mandal SC, Saha BP. Evaluation of antipyretic potential of Nelumbo nucifera stalk extract. Phytother Res . 2000;14(4):272-274.
55. Mukherjee PK, Pal M, Saha K, Saha BP, Das J. Diuretic activity of extract of the rhizomes of Nelumbo nucifera Faertn. (Fam. Nymphaeaceae). Phytother Res . 1996;10(5):424-425.
56. Chen J, Liu JH, Wang T, Xiao HJ, Yin CP, Yang J. Effects of plant extract neferine on cyclic adenosine monophosphate and cyclic guanosine monophosphate levels in rabbit corpus cavernosum in vitro. Asian J Androl . 2008;10(2):307-312.
57. Chen J. Chinese medicinal oral liquid for treating male sexual dysfunction and its preparation method. Faming Zhuanil Shenqing Gongkai Shuomingshu. Patent 101129730. August 20, 2007.
58. Talukder MJ, Nessa J. Effect of Nelumbo nucifera rhizome extract on the gastrointestinal tract of rat. Bangladesh Med Res Counc Bull . 1998;24(1):6-9.
59. Mukherjee PK, Saha K, Das J, Pal M, Saha BP. Studies on the anti-inflammatory activity of rhizomes of Nelumbo nucifera . Planta Med . 1997;63(4):367-369.
60. Kim HK, Park HR, Lee JS, Chung TS, Chung HY, Chung J. Down-regulation of iNOS and TNF-alpha expression by kaempferol via NF-kappaB inactivation in aged rat gingival tissues. Biogerontology . 2007;8(4):399-408.
61. Xiao JH, Zhang JH, Chen HL, Feng XL, Wang JL. Inhibitory effects of isoliensinine on bleomycin-induced pulmonary fibrosis in mice. Planta Med . 2005;71(3):225-230.
62. Xu Z, Liu Y. Health beverage prepared from lotus root. Faming Zhuanil Shenqing Gongkai Shuomingshu. Patent 101167554. November 2, 2007.
63. Jeon S, Kim NH, Koo BS, Kim JY, Lee AY. Lotus ( Nelumbo nuficera ) flower essential oil increased melanogenesis in normal human melanocytes. Exp Mol Med . 2009;41(7):517-525.
64. Kuzuu M, Moriya T. Mucins from plant exts. as drugs, health foods, and cosmetics. Jpn Kokai Tokkyo Koho. Patent 2008127379. November 17, 2006.
65. Park SG, Jang MS, Oh MS, et al. Composition containing nelumbo extract having whitening, anti-aging, and anti-wrinkling effects. Repub. Korea. Patent 828193. November 6, 2006.
66. Ebrahimpour M, Mushrifah I. Heavy metal concentrations (Cd, Cu, and Pb) in five aquatic plant species in Tasik China, Malaysia. Environ Geol . 2008;54(4):689-698.

Copyright © 2009 Wolters Kluwer Health