Ethnopharmacological comparison of anti-gout remedies: A review of ginger (Zingiber officinale), onion (Allium cepa), and lotus seed (Nelumbo nucifera) in Ethiopian and Indian traditional medicine

Abstract

Gout is a chronic inflammatory arthropathy whose increasing global burden has intensified interest in safer, accessible, plant-based therapeutic alternatives. This comparative review examines the ethnopharmacological evidence, phytochemical composition, and mechanisms underlying the potential anti-gout effects of ginger (Zingiber officinale), onion (Allium cepa), and lotus seed (Nelumbo nucifera) within Ethiopian and Indian traditional medicine. Literature from PubMed, Scopus, Web of Science, and ethnobotanical repositories was systematically evaluated. The findings reveal substantial differences in the concordance between traditional knowledge and pharmacological evidence. Onion shows the strongest alignment, with documented traditional use and convincing preclinical evidence supporting xanthine oxidase inhibition (IC₅₀ 17.36 μg/mL) and serum urate reduction. Ginger demonstrates moderate alignment, as its established anti-inflammatory activity, including NLRP3 inflammasome inhibition, supports potential management of acute gout inflammation, although direct urate-lowering evidence remains limited. Lotus seed exhibits the weakest ethnopharmacological alignment because, despite promising nuciferine-mediated urate-lowering effects, traditional use for gout is undocumented in both contexts. Their distinct phytochemicals, including gingerols, flavonoids and organosulfur compounds, and proanthocyanidins and alkaloids, may explain these differences. Overall, onion emerges as the strongest candidate for further clinical investigation, while ginger and lotus seed require additional context-specific validation.