Ginseng (American ginseng, Asian ginseng, Chinese ginseng, Korean ...

Ginseng (American ginseng, Asian ginseng,
Chinese ginseng, Korean red ginseng, Panax
ginseng: Panax spp. including P. ginseng C.C.
Meyer and P. quinquefolius L., excluding
Eleutherococcus senticosus)

Natural Standard Bottom Line Monograph, Copyright © 2008 (www.naturalstandard.com).
Commercial distribution prohibited. This monograph is intended for informational purposes only,
and should not be interpreted as specific medical advice. You should consult with a qualified
healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifical y, high-quality data regarding
safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it
is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly
published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that
patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and
alternatives should be careful y considered. The below monograph is designed to provide historical background and
an overview of clinical y-oriented research, and neither advocates for or against the use of a particular therapy.

Related Terms:
General: Allheilkraut, Araliaceae (family), chikusetsu ginseng, chosen ninjin, dwarf ginseng,
Eleutherococcus senticosus, five-fingers, five-leaf ginseng, ginseng radix, G115®,
Ginsengwurzel, ginsenosides (Rb1, Rb2, Rc, Rd, Re, Rf and Rg1), GTTC (Ginseng and Tang-
kuei Ten Combination), hakusan, hakushan, higeninjin, hongshen, hungseng, hungsheng,
hunseng, insam, jenseng, jenshen, jinpi, kao-li-seng, korean ginseng, hua qi shen,
kraftwurzel, man root, minjin, nhan sam, ninjin, ninzin, niuhan, Oriental ginseng, otane ninjin,
panax de chine, panax notoginseng, panax vietnamensis (Vietnamese Ginseng), Panax
psuedoginseng Wall. var. notoginseng, Panax psuedoginseng var. major, Panax
psuedoginseng, Panax trifolius L., pannag, proprietary ginseng root extract (Cold-FX, CV
Technologies Inc., Edmonton, AB), racine de ginseng, renshen, sanchi ginseng, san-pi, sang,
schinsent, sei yang sam, seng, shanshen, shen-sai-seng, shenshaishanshen, shenghaishen,
siyojin, t'ang-sne, tartar root, true ginseng, tyosenninzin, Western ginseng, Western sea
ginseng, xi shen, xi yang shen, yakuyo ninjin, yakuyo ninzin, yang shen yeh-shan-seng, yuan-
seng, yuansheng, zhuzishen.
Panax ginseng synonyms: Asian ginseng, Asiatic ginseng, Chinese ginseng, Gincosan (a
combination of 120mg Ginkgo biloba and 200mg Panax ginseng), ginseng asiatique, ginseng
radix, ginseng root, Japanese ginseng, jintsam, Korean red, Korean red ginseng, ninjin,
Oriental ginseng, P. ginseng, P. schinseng, red ginseng, ren shen, sang, shen.
American ginseng synonyms: Anchi ginseng, Canadian ginseng, North American ginseng,
Ontario ginseng, P. quinquefolius, red berry, ren shen, sang, tienchi ginseng, Wisconsin
ginseng.
Siberian ginseng synonyms: Acanthopanax senticosus, ci wu jia, ciwujia, devil's bush,
devil's shrub, eleuthera, eleuthero, eleuthero ginseng, eleutherococ, eleutherococcus,
eleutherococci radix, Eleutherococcus senticosus, shigoka, touch-me-not, wild pepper, wu-jia,
wu-jia-pi, ussuri, ussurian thorny pepperbrush.



The term ginseng refers to several species of the genus Panax. For more than 2,000 years,
the roots of this slow-growing plant have been valued in Chinese medicine. The two most

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commonly used species are Asian ginseng (Panax ginseng C.A. Meyer), which is mostly
extinct in its natural range but is still cultivated, and American ginseng (P. quinquefolius L.),
which is both harvested from the wild and cultivated. Panax ginseng should not be confused
with Siberian ginseng (Eleutherococcus senticosus). In Russia, Siberian ginseng was
promoted as a cheaper alternative to ginseng and was believed to have identical benefits.
However, Siberian ginseng does not contain the ginsenosides that are present in the Panax
species, which are believed to be active ingredients and have been studied scientifically.



Uses
Grade*
These uses have been tested in humans or animals. Safety and effectiveness have not always been
proven. Some of these conditions are potentially serious, and should be evaluated by a qualified
healthcare provider.
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results.

Congestive heart failure


Evidence from a small amount of research is unclear in this area.
C


Coronary artery (heart) disease

Several studies from China report that ginseng in combination with various other

herbs may reduce symptoms of coronary artery disease. Without further evidence of
C

the effects of ginseng specifically, a firm conclusion cannot be reached.

Exercise performance

Ginseng is commonly used by athletes with the intention of improving stamina.

However, it remains unclear if ginseng taken by mouth significantly affects exercise
C
performance. Numerous studies have been published in this area, with mixed

results. Better studies are necessary before a clear conclusion can be reached.

Fatigue

A small amount of research using ginseng extract G115® (with or without

multivitamins) reports improvements in patients with fatigue of various causes.
C

However, these results are preliminary, and studies have not been high quality.

Fistula (anal)

Preliminary evidence in infants with peri-anal abscess or fistula-in-ano suggests that

a treatment of GTTC (Ginseng and Tang-kuei Ten Combination) may accelerate
C

recovery. Further research is needed to confirm these results.

High blood pressure

Preliminary research suggests that ginseng may lower blood pressure (systolic and

diastolic). It is not clear what doses may be safe or effective. Well-conducted studies
C

are needed to confirm these early results.

Immune system enhancement

A small number of studies report that ginseng may stimulate activity of immune cells

in the body, improve the effectiveness of antibiotics in people with acute bronchitis,
C
and enhance the body's response to influenza vaccines. Additional studies are

necessary before a clear conclusion can be reached.

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Intracranial pressure (ICP)

Preliminary study of Xuesaitong injection (XSTI, a preparation of Panax

notoginseng) reports that it may help to decrease intracranial pressure and benefit
C

coma patients. Further study is needed to confirm these results.

Low white blood cell counts

Poorly described preliminary research reports improved blood counts in patients with
aplastic anemia using ginseng in combination with other herbs, and improved white

blood cell counts in patients with neutropenia using high doses of ginsenosides.
C

Reliable studies are needed before a conclusion can be reached. Notably, there are
reports of blood cell counts dropping after ginseng use.

Menopausal symptoms

Evidence from a small amount of research is unclear in this area. Some studies

report improvements in depression and sense of well-being, without changes in
C

hormone levels.

Methicillin-resistant Staphylococcus aureus (MRSA)

In patients treated with Hochu-ekki-to, which contains ginseng and several other

herbs, urinary MRSA has been reported to decrease after a 10-week treatment
C
period. Further study of ginseng alone is necessary in order to draw firm

conclusions.

Multi-infarct dementia

A small study conducted in patients with multi-infarct dementia reports that an herbal

combination known as Fuyuan mixture, which contains ginseng, may have
C
therapeutic benefits. The effects of ginseng alone are not clear, and no firm

conclusion can be drawn.

Quality of life

Preliminary research of Siberian ginseng (E. senticosus) administration in the elderly
suggests that some aspects of mental health and social functioning (and overall

health-related quality of life) may improve after four weeks of therapy, although
C

differences appear to attenuate with continued use. Additional study is necessary in
this area before a firm conclusion can be reached.

Sense of well-being

Several studies have examined the effects of ginseng (with or without multivitamins)

on overall well-being in healthy and ill patients, when taken for up to 12 weeks. Most
C
trials are not high quality, and results are mixed. However, it remains inconclusive if

ginseng is beneficial in this area for anybody.

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on overall well-being in healthy and ill patients, when taken for up to 12 weeks. Most
trials are not high quality, and results are mixed. However, it remains inconclusive if
ginseng is beneficial in this area for anybody.

Viral myocarditis

Poorly described research in patients treated with Shenmai and Shengmai injection

(a ginseng preparation), report that there may be some related cardiac improvement.
C
More in-depth and reliable studies are needed before a clear conclusion can be

drawn.

*Key to grades: A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C:
Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F:
Strong scientific evidence against this use (it likely does not work).




The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly
tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are
potential y serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses
that are not listed below.

Adaptogen, adrenal tonic, aerobic fitness, aging, aggression, Alzheimer's disease, allergy,
anemia, antidepressant, anti-inflammatory, antioxidant, antitumor, anxiety, aphrodisiac,
aplastic anemia, appetite stimulant, asthma, atherosclerosis, attention-deficit hyperactivity
disorder (ADHD), bleeding disorders, breast cancer, breast enlargement, breathing difficulty,
bronchodilation, burns, chemotherapy support, chronic fatigue syndrome, cold limbs, colitis,
convulsions, diabetic nephropathy (kidney disease), digestive complaints, diuretic (water pill),
dizziness, dysentery, estrogen-like activity, female sexual function, fever, gynecology-related
disorders, fibromyalgia, hangover, headaches, heart damage, hepatitis/hepatitis B infection,
herpes, HIV, H. pylori infection in stomach ulcers, human lung adenocarcinoma, improved
memory and thinking after menopause, influenza, insomnia, ischemic brain injury, kidney
disease, learning, liver diseases, liver health, long-term debility, low sperm count, male
infertility, malignant tumors, migraine, morphine tolerance, neuralgia (pain due to nerve
damage or inflammation), neuroprotective, neurosis, organ prolapse, oxygen absorption, pain
relief, palpitations, physical work capacity, premature ejaculation, prostate cancer,
Pseudomonas infection in cystic fibrosis, psycho-asthenia, prostate cancer, qi-deficiency and
blood-stasis syndrome in heart disease (Eastern medicine), recovery from radiation,
rehabilitation, sedative, senile dementia, sexual arousal, sexual symptoms, spontaneous
sweating, stomach cancer, stomach upset, stress, strokes, surgical recovery, upper
respiratory tract infection, vomiting, weight loss.




The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and
supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be
made differently, with variable ingredients, even within the same brand. The below doses may not apply to al
products. You should read product labels, and discuss doses with a qualified healthcare provider before starting

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therapy.

Adults (18 years and older)
Capsules containing 100-200 milligrams of a standardized ginseng extract (4% ginsenosides)
taken by mouth once or twice daily has been used in studies for up to 12 weeks. 0.5 to 2
grams of dry ginseng root, taken daily by mouth in divided doses, has also been used. E.
senticosus dry extract at a dose of 300 milligrams per day was used in a small study for eight
weeks to improve quality of life in elderly patients. A proprietary ginseng root extract (Cold-FX,
CV Technologies Inc., Edmonton, AB) has been studied in athletes for 28 days at a dose of
400 milligrams per day. Higher doses are sometimes given in studies or under the supervision
of a qualified healthcare provider. Many different doses are used traditionally. Practitioners
sometimes recommended that after using ginseng continuously for two to three weeks, people
should take a break for one or two weeks, and that long-term dosing should not exceed 1
gram of dry root daily.
A decoction of 1 to 2 grams added to 150 milliliters of water, taken by mouth daily has been
used; a 1:1 (grams per milliliter) fluid extract taken as 1 to 2 milliliters by mouth daily has been
used; 5 to 10 milliliters (approximately 1 to 2 teaspoons) of a 1:5 (grams per milliliter) tincture
taken by mouth daily has been used. Practitioners sometimes recommended that after using
ginseng continuously for two to three weeks, people should take a break for one or two
weeks.

Children (younger than 18 years)
There is not enough scientific information available to recommend the safe use of ginseng in
children.



The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of
strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a
medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare
provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies
People with known allergy to plants in the Araliaceae family should avoid ginseng.

Side Effects and Warnings
Ginseng has been well tolerated by most people in scientific studies when used at
recommended doses, and serious side effects appear to be rare.
Based on limited evidence, long-term use may be associated with skin rash or spots, itching,
diarrhea, sore throat, loss of appetite, excitability, anxiety, depression, or insomnia. Less
common reported side effects include headache, fever, dizziness/vertigo, blood pressure
abnormalities (increases or decreases), chest pain, difficult menstruation, heart palpitations,
rapid heart rate, leg swelling, nausea/vomiting, or manic episodes in people with bipolar
disorder.
Based on human research, ginseng may lower blood sugar levels. This effect may be greater
in patients with diabetes than in non-diabetic individuals. Caution is advised in patients with
diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood
sugar. Serum glucose levels may need to be monitored by a healthcare provider, and
medication adjustments may be necessary.

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There are anecdotal reports of nosebleeds and vaginal bleeding with ginseng use, although
scientific study is limited in this area. There is also evidence in humans of ginseng reducing
the effectiveness of the "blood thinning" medication warfarin (Coumadin®). Caution is advised
in patients with bleeding disorders or taking drugs that may affect the risk of bleeding or blood
clotting. Dosing adjustments may be necessary. Several cases of severe drops in white blood
cell counts were reported in people using a combination product containing ginseng in the
1970s, and may have been due to contamination.
Ginseng may have estrogen-like effects, and has been associated with reports of breast
tenderness, loss of menstrual periods, vaginal bleeding after menopause, breast enlargement
(reported in men), difficulty developing or maintaining an erection, or increased "sexual
responsiveness." Avoid use of ginseng in patients with hormone sensitive conditions, such as
breast cancer, uterine cancer, or endometriosis.
Ginseng may produce manic symptoms, based on a case report.
A severe life-threatening rash known as Stevens-Johnson syndrome occurred in one patient
and may have been due to contaminants in a ginseng product. A case report describes liver
damage (cholestatic hepatitis) after taking a combination product containing ginseng. High
doses of ginseng have been associated with rare cases of temporary inflammation of blood
vessels in the brain (cerebral arteritis), abnormal dilation of the pupils of the eye, confusion, or
depression.
There is preliminary evidence that ginseng may increase the QTc interval (thus increasing the
risk of abnormal heart rhythms) and decrease diastolic blood pressure two hours after
ingestion in healthy adults.

Pregnancy and Breastfeeding
Ginseng has been used traditionally in pregnant and breastfeeding women. Animal studies
and preliminary human research suggest possible safety, although safety has not been clearly
established in humans. Therefore, ginseng use cannot be recommended during pregnancy or
breastfeeding. There is a report of neonatal death and the development of male
characteristics in a developing baby girl after exposure of a pregnant mother to ginseng.
Many tinctures contain high levels of alcohol and should be avoided during pregnancy.



Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs,
or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or
traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs,
herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs
Research in humans suggests that American ginseng may reduce the anticoagulant (blood
thinning) effects of warfarin (Coumadin®). In addition, based on limited animal research, and
anecdotal reports of nosebleeds and vaginal bleeding in humans, ginseng may increase the
risk of bleeding when taken with other drugs that increase the risk of bleeding. Examples
include aspirin, anticoagulants ("blood thinners") such as heparin, anti-platelet drugs such as
clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®,
Advil®) or naproxen (Naprosyn®, Aleve®). In contrast, there is a case of the effectiveness of
the "blood thinner" warfarin (Coumadin®) being reduced when taken at the same time as
ginseng, with effects on levels of the blood test used to measure warfarin effects being altered

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(decreased "INR").
Based on human research, ginseng may lower blood sugar levels. This effect may be greater
in patients with diabetes than in non-diabetic individuals. Caution is advised when using
medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or
insulin should be monitored closely by a qualified healthcare provider. Medication adjustments
may be necessary.
Headache, tremors, mania, or insomnia may occur if ginseng is combined with prescription
anti-depressant drugs called monoamine oxidase inhibitors (MAOIs) such as isocarboxazid
(Marplan®), phenelzine (Nardil®), and tranylcypromine (Parnate®).
Based on case reports, ginseng may alter the effects of blood pressure or heart medications,
including calcium channel blockers such as nifedipine (Procardia®). There is preliminary
evidence that ginseng may increase the QTc interval (thus increasing the risk of abnormal
heart rhythms) and decrease diastolic blood pressure two hours after ingestion in healthy
adults. Therefore, caution is advised with other medications that may alter QTc. There is a
reported case of decreased effects of the diuretic drug furosemide (Lasix®) when used with
ginseng. A Chinese study reports that the effects of the cardiac glycoside drug digoxin
(Lanoxin®) may be increased when used with ginseng in patients with heart failure. Do not
combine ginseng with heart or blood pressure medications without first consulting a qualified
healthcare provider.
There is limited laboratory evidence that ginseng may contain estrogen-like chemicals, and
may affect medications with estrogen-like or estrogen-blocking properties. This has not been
well demonstrated in humans.
In theory, ginseng may interfere with the way the body processes certain drugs using the
liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be
increased in the blood and may cause increased effects or potentially serious side effects. A
pharmacist should be consulted before taking and herbs or supplements.
The analgesic effect of opioids may be inhibited by ginseng. Ginseng may interact with
sedatives.
Many tinctures contain high levels of alcohol, and may cause nausea or vomiting when taken
with metronidazole (Flagyl®) or disulfiram (Antabuse®). In a preliminary study, ginseng was
reported to increase the removal of alcohol from the blood, although this has not been well
substantiated.

Interactions with Herbs and Dietary Supplements
Based on human research, ginseng may lower blood sugar levels. This effect may be greater
in patients with diabetes than in non-diabetic individuals. Caution is advised when using herbs
or supplements that may also lower blood sugar. Blood glucose levels may require monitoring,
and doses may need adjustment.
Headache, tremors, mania, and insomnia may occur if ginseng is combined with supplements
that have monoamine oxidase inhibitor (MAOI) activity or that interact with MAOI drugs.
Based on case reports, ginseng may raise or lower blood pressure. Use caution if combining
ginseng with other products that can affect blood pressure.
There is preliminary evidence that ginseng may increase the QTc interval (thus increasing the
risk of abnormal heart rhythms) and decrease diastolic blood pressure two hours after
ingestion in healthy adults. Therefore, caution is advised with other agents that may cause
abnormal heart rhythms.

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Based on limited animal research and anecdotal reports of nosebleeds and vaginal bleeding
in humans, ginseng may increase the risk of bleeding when taken with herbs and supplements
that are believed to increase the risk of bleeding. Multiple cases of bleeding have been
reported with the use of Ginkgo biloba, some cases with garlic, and fewer cases with saw
palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this
has not been proven in most cases.
In theory, ginseng may decrease the effects of diuretic herbs like horsetail or licorice. Ginseng
may interact with sedatives.
In theory, ginseng may interfere with the way the body processes certain herbs or
supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of
other herbs or supplements to be too high in the blood. It may also alter the effects that other
herbs or supplements possibly have on the P450 system such as cat's claw or echinacea.
There is limited laboratory evidence that ginseng may contain estrogen-like chemicals, and
may affect agents with estrogen-like or estrogen-blocking properties. This has not been
demonstrated in humans.



This information is based on a systematic review of scientific literature edited and peer-
reviewed by contributors to the Natural Standard Research Collaboration
(www.naturalstandard.com).



Natural Standard developed the above evidence-based information based on a thorough systematic review of the
available scientific articles. For comprehensive information about alternative and complementary therapies on the
professional level, go to www.naturalstandard.com. Selected references are listed below.


1.
Allen JD, McLung J, Nelson AG, et al. Ginseng supplementation does not enhance healthy young adults' peak aerobic
exercise performance. J Am Coll Nutr 1998;17(5):462-466. View Abstract
2.
Anderson GD, Rosito G, Mohustsy MA, et al. Drug interaction potential of soy extract and Panax ginseng. J Clin
Pharmacol 2003;43(6):643-648. View Abstract
3.
Awang DV. Maternal use of ginseng and neonatal androgenization. JAMA 1991;266(3):363. View Abstract
4.
Cardinal BJ, Engels HJ. Ginseng does not enhance psychological wel -being in healthy, young adults: results of a double-
blind, placebo-control ed, randomized clinical trial. J Am Diet Assoc 2001;101(6):655-660. View Abstract
5.
Cicero AF, Derosa G, Bril ante R, et al. Effects of Siberian ginseng (Eleutherococcus senticosus maxim.) on elderly quality
of life: a randomized clinical trial. Arch Gerontol Geriatr Suppl 2004;(9):69-73. View Abstract
6.
Coleman CI, Hebert JH, Reddy P. The effects of Panax ginseng on quality of life. J Clin Pharm Ther 2003;28(1):5-15.
View Abstract
7.
Hartley DE, Elsabagh S, File SE. Gincosan (a combination of Ginkgo biloba and Panax ginseng): the effects on mood and
cognition of 6 and 12 weeks' treatment in post-menopausal women. Nutr Neurosci 2004;7(5-6):325-333. View Abstract
8.
Hartz AJ, Bentler S, Noyes R, et al. Randomized controlled trial of Siberian ginseng for chronic fatigue. Psychol Med
2004;34(1):51-61. View Abstract
9.
Hong B, Ji YH, Hong JH, et al. A double-blind crossover study evaluating the efficacy of korean red ginseng in patients
with erectile dysfunction: a preliminary report. J Urol 2002;168(5):2070-2073. View Abstract
10. Jiang X, Wil iams KM, Liauw WS, et al. Effect of St John's wort and ginseng on the pharmacokinetics and
pharmacodynamics of warfarin in healthy subjects. Br J Clin Pharmacol 2004;57(5):592-599. View Abstract
11. Kabalak AA, Soyal OB, Urfalioglu A, et al. Menometrorrhagia and tachyarrhythmia after using oral and topical ginseng. J
Womens Health (Larchmt ) 2004;13(7):830-833. View Abstract
12. Ohya T, Usui Y, Okamoto K, et al. Management for fistula-in-ano with Ginseng and Tang-kuei Ten Combination. Pediatr
Int 2004;46(1):72-76. View Abstract

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13. Vogler BK, Pittler MH, Ernst E. The efficacy of ginseng. A systematic review of randomised clinical trials. Eur J Clin
Pharmacol 1999;55(8):567-575. View Abstract
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