Ashwagandha, a traditional Indian (Ayurvedic) medical herb,is thought of as “Indian ginseng.” It is often marketed simply as “Withania” and is also called winter cherry or Dunal. The berries, fruits, and roots have been used traditionally. In Western herbal medicine, most preparations are made from the root of the shrub.

Uses and Benefits: As is the case with ginseng, ashwagandha has been employed for numerous conditions in traditional Asian therapies, and lor additional disorders in contemporary herbal practice. A major traditional use of the herb is in “balancing life forces,” which may be regarded as an adaptogenic or anti-stress tonic effect. rhus, ashwagandha is considered to be a general promoter of health, or a “rasayana” that promotes rejuvenation according to traditional Ayurvedic practice.

Purported anti-inflammatory benefits have led to use in tuberculosis, liver disease, rheumatic disorders, and skin problems. The herb’s “panacea” reputation has expanded its repertoire to include therapy for weakness, stress, sexual debility, aging symptoms, and anemia, among many other conditions. It is claimed to he effective in infections, particularly those caused by fungi. The Latin species name is a tribute to its supposed effectiveness in promoting somnolence and improving sleep. Recently, AIDS and cancer have been added to the list of its proposed immunostimulant uses, although clinical evidence is lacking.

Pharmacology: Much of the pharmacologic literature on ashwagandha is in foreign journals or consists of older reports or studies carried out on rodents; or employs techniques that are difficult to evaluate. Over 35 active chemicals have been identified in the herb, including steroidallactones (such as withanolides and withaferins), alkaloids (such as somniferine, scopoletin, withanine,and anaferine), saponins, and glycosides. Additional chemicals of possible importance include choline, beta-sitosterol, flavonoids, tannins, an essential oil called ipuranol, a crystalline alcohol called withaniol, and several acylsterylglucosides or sitoindosides.

Several specific withanolides and withaferins have been shown to have antineoplastic effects in animals.Withaferins have shown anti-inflammatory, antioxidant, and antimicrobial actions. Withanolide-D and withaferin-A appear to contribute immunoactive effects. Somniferine is a hypnotic, while scopoletin is a smooth muscle relaxant in guinea pigs. The adaptogenic properties of the characteristic glycosides (sitoindosides VII and VIII) and other derivatives of Withania are sometimes explained as resulting from a state of “nonspecific increase in resistance,” resulting in enhancement of survival when under stress ; however, this concept fails to convey any insights into its action.

Clinical Trials: There are few controlled clinical trials that con­firm the multiple claims that are made for ashwagandha. Many of the published studies only evaluate multiple-herb preparations. In one double-blinded, cross-over clinical trial of osteoarthritis, 42 patients were randomized to 3 months on uncertain doses of ash­wagandha combined with other herbs or to a placebo. The herbal combination was reported to significantly reduce pain (p Adverse Effects: Based on a long history of traditional use, .ashwagandha appears to be well tolerated without significant adverse effects. There is little data from clinical studies. It is claimed anecdotally that large doses of ashwagandha products or the berries may cause gastrointestinal irritation.

Side Effects and Interactions: As a potential sedative-hypnotic, it may theoretically potentiate other sedatives; this has not been reported or studied, and such effects are unlikely to be significant.

Cautions: The herb has not been studied in nursing or pregnant women, but it has been anecdotally reported to have abortifacient properties. Like echinacea, its potential immunostimulant effect may be contraindicated in patients with autoimmune disorders; this has not been reported or studied, and significant effects are unlikely.

Preparations & Dosage: A typical daily dose is 3-6 g of powdered root, but up to 30 g/day of the herb has been advocated by commercial herbalists. Pill extracts are also available, as are tinctures and numerous herbal mixtures.

Summary Evaluation Ashwagandha is promoted for many different uses. It is taken to improve immune function and as a rejuvenator, aphrodisiac, and Ionic for general health. It is inappropriately promoted by some marketers as a treatment for serious diseases such as multiple sclerosis, cancers, and AIDS. It is often employed as a sedative and antiarthritic for self-therapy. However, its value has not been adequately established for any of the numerous clinical conditions to which it has been applied.