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Ginseng

 

Natural Standard Monograph, Copyright © 2014 (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 health care professional before making decisions about therapies and/or health conditions.

Related Terms

  • 2-Furanmethanol, 20-(R)-R, (20S)-protopanaxadiol-3-O-(6-O-malonyl-beta-D-glucopyranosyl(1-->2)-beta-D-glucopyranoside-20-O-beta-D-xylopyranosyl(1-->3)-beta-D-glucopyranosyl(1-->6)-beta-D-glucopyranoside, 20-(S)-Re, 28-glu-oleanolic acid ester, acetylenic alcohol, acidic polysaccharides, adenosine, aglycones, Allheilkraut (German), alpha-maltosyl-beta-D-fructofuranoside, aluminum, American ginseng (AG), American wild ginseng, antioxidants, Araliaceae (family), Asian ginseng, Asian red ginseng, Asiatic ginseng, calcium, capsaicin 4-O-(6-O-beta-D-xylopyranosyl)-beta-D-glucopyranoside, capsaicin 4-O-beta-D-glucoside, ceramide, chikusetsu ginseng, chikusetsusaponin IV, chikusetsusaponin IVa, chikusetsusaponin-L8, chitinolytic enzymes, chosen ninjin, citral, class I chitinase, cobalt, copper, CPPQ (coarse polysaccharide from Panax quinquefolius), CVT-E002, dae-jo-hwan (DJW), dammarane-type glycosides, dammarane-type triterpene ketone (panaxadione), dammarane-type tetracyclic triterpenoid saponins, dwarf ginseng, fatty acids, five-fingers, five-leaf ginseng, G115®, ginsan, ginsenan PA (phagocytosis-activating polysaccharide), ginseng acidic polysaccharide, ginseng radix, ginseng saponins, ginseng tetrapeptide, Ginsengwurzel (German), ginsenoside, ginsenoside F1, ginsenoside F2, ginsenoside F3, ginsenoside F4, ginsenoside Ia, ginsenoside R0, ginsenoside Ra1, ginsenoside Ra2, ginsenoside Rb1, ginsenoside Rb2, ginsenoside Rb3, ginsenoside Rc, ginsenoside Rd, ginsenoside Rd2, ginsenoside Re, ginsenoside Rf, ginsenoside Rg1, ginsenoside Rg2, ginsenoside Rg3, ginsenoside Rg5, ginsenoside Rg6, ginsenoside Rh1, ginsenoside Rh2, ginsenoside Rh3, ginsenoside Rh4, ginsenoside Rk1, ginsenoside Rk3, ginsenoside Ro, ginsenoside Rs3, ginsenoside Rs4, ginsenoside Rs5, ginsenosides compound (shen-fu), GTTC (ginseng and tang-kuei ten combination), hakusan (Japanese), hakushan, higeninjin, hong shen (Chinese), hua qi shen (Chinese), hungseng, hungsheng, hunseng, insam (Korean), iron, Japanese rhizome, jenseng, jen-shen, jinpi, kao-li-seng, king herb, Korean ginseng, Korean red ginseng (KRG), Kraftwurzel (German), limonene, magnesium, malonylginsenoside Ra3, maltol, manganese, man root, memory enhancer, minjin, molybdenum, mountain ginseng, mountain ginseng pharmacopuncture, nhan sam (Vietnamese), ninjin (Japanese), ninzin, niuhan, North American ginseng, notoginseng, notoginsenoside, notoginsenoside-Fe, notoginsenoside R1, notoginsenoside R2, notoginsenoside R4, oleanolic acid, ophioponins, Oriental ginseng, otane ninjin (Japanese), panajaponin, panax de Chine (French), Panax ginseng, Panax ginseng C.A.Mey., Panax notoginseng, Panax psuedoginseng, Panax quinquefolium (common misspelling), Panax spp., Panax trifolius L., Panax vietamensis (Vietnamese ginseng), panaxadial, panaxans, panaxatriol, panaxosides, panaxydol, panaxynol, panaxytriol, pannag (Hebrew), peptidoglycans, phenolic compounds, phosphorus, polyacetylenes, polyacetylenic compounds, poly-furanosyl-pyranosyl-saccharides, poly-hydroxyl octadecenoic acid, potassium, protopanaxadiol ginsenosides, protopanaxatriol, protopanaxatriol saponins, protopanaxatriol (PPT)-type ginsenosides, quinqueginsin, racine de ginseng (French), Re, red ginseng, renshen, ribonucleases, rozu (Japanese), Romanian ginseng, Rumanian ginseng, sang, sanchi ginseng, san-pi, sanqi, saponins, schinsent, sei yang sam, seng, sesquiterpenoids, shanshen, shen-fu (Chinese), shenghaishen, shenlu, shen-sai-seng, shenshaishanshen, siyojin, sodium, sterol glucosides, stress-buster, sun ginseng, superoxide dismutase, t'ang-sne, tartar root, terpineol, tienchi ginseng, to-kai-san, trilinolein, triperpenoid saponins, triterpenoids, true ginseng, tyosenninzin, vanadium, vanillic acid, Vietnamese ginseng, vitamins, volatile oil, Western ginseng, Western sea ginseng, white ginseng, wild ginseng, woodsgrown (wild-stimulated) ginseng root, xi shen, xi yang shen, yakuyo ninjin, yakuyo ninzin, yang shen, yeh-shan-seng, yuan-seng, yuansheng, zhuzishen, zinc.
  • Siberian ginseng synonyms: Acanthopanax senticosus, ci wu jia, ciwujia, devil's bush, devil's shrub, eleuthera, eleuthero, eleuthero ginseng, eleutherococ, Eleutherococci radix, Eleutherococcus, phytoestrogen, shigoka, touch-me-not, ussuri, ussurian thorny pepperbush, wild pepper, wu-jia, wu-jia-pi.
  • American ginseng synonyms: Amerikan ginseng (Turkish), Amerikanischer Ginseng (German), amerikkalainen ginseng (Finnish), anchi ginseng, Aralia quinquefolia Decne. & Planch. (botanical synonym), Araliaceae (family), Canadian ginseng, CVT-E 002®, five fingers, five-leafed ginseng, garantoquen, ginseng, ginseng d'Amérique (French), ginsenosides poly-furanosyl-pyranosyl-saccharides, man-root, man's health, North American ginseng, Occidental ginseng, Ontario ginseng, Panax quincefolius, Panax quinquefolius, red berry, redberry, sang, shang (traditional Chinese medicine (TCM)), tartar root, western ginseng, wild American ginseng, Wisconsin ginseng, xi yang shen (TCM, Chinese).
  • Panax ginseng synonyms: Aralia (botanical synonym), Aralia ginseng Mey., Araliaceae (family), Asian ginseng, Asiatic ginseng, Chinese ginseng, G115®, Gincosan, Ginsai®, ginseng asiatique (French), ginseng radix, ginseng root, ginsengjuuri (Finnish), guigai, Japanese ginseng, jintsam, Korean ginseng, Korean Panax ginseng, Korean red, Korean red ginseng, kuhuang shenmai injection (KHSM), ninjin (Japanese), Oriental ginseng, Panax, Panax ginseng C.A.Mey., Panax schinseng, Panax schinseng Nees, Panax spp., radix ginseng rubra, red ginseng, ren shen (TCM), renshen (TCM), renxian, sang, schinsent, seng, shen, shengmai, shengmai chenggu capsule, shengmai injection (SI), shengmai san (SMS), shengmai-san, shengmaisan, shengmaiyin, shenmai, shenmai huoxue decoction (SMHXD), shenmai injection (SMI), white ginseng.
  • Selected products: AD-fX®, ArginMax® (Panax quinquefolius L., Panax ginseng, and other ingredients), Bu zhong yi qi wan (Panax ginseng root and other ingredients), CKBM (Panax ginseng, Schisandra chinensis, fructus Crataegi, Ziziphus jujube, and processed Saccharomyces cerevisiae), Cold-fX® (polyfuranosyl-pyranosyl-saccharides from the root of Panax quinquefolius), Gericomplex® (Panax ginseng and a vitamin/mineral complex), Gincosan® (standardized GK501® Ginkgo biloba and the standardized G115® ginseng extract), Ginsana® (standardized G115® ginseng extract), GURU™ energy drink (Ginkgo biloba, Echinacea, Panax ginseng, and guarana), Memory Enhancer® (Panax ginseng and other ingredients), Phyto-Female Complex (standardized extracts of black cohosh, dong quai, milk thistle, red clover, American ginseng, chaste tree berry), sheng mai san (radix ginseng and other ingredients), sheng mai yin (ginseng root, winter wheat (Ophiopogon japonicus) root tuber, Chinese magnoliarine (Schisandra chinensis) fruit), shengmai yin (Panax ginseng, Schizandra fruit, Ophiopogon), shi-quan-da-bu-tang (Rehmannia glutinosa, Paeonia lactiflora, Ligusticum wallichii, Angelica sinensis, Glycyrrhiza uralensis, Poria cocos, Atractylodes macrocephala, Panax ginseng, Astragalus membranaceus, and Cinnamomum cassia), sho-saiko-to (Asian ginseng root extract, schisandra fruit extract, ginger root extract, and other ingredients).
  • Note: This review is focused on Panax ginseng species. Kaempferia parviflora is referred to as Thai ginseng and is in the ginger family. It is not related to Panax ginseng and is not included in this bottom line. In Russia, Siberian ginseng has been advertised as a cheaper type of ginseng with identical benefits. However, it lacks the the same effects as the Panax ginseng. Other species may be referred to as ginseng as well, but they are different. Examples include: Eleutherococcus senticosus (Siberian ginseng), Pseudostellaria heterophylla (prince ginseng), Angelica sinensis (female ginseng, or dong quai), Withania somnifera (Indian ginseng or ashwagandha), Pfaffia paniculata (Brazilian ginseng), Lepidium meyenii (Peruvian ginseng or maca), and Gynostemma pentaphyllum (southern ginseng or jiaogulan). These species are not covered in this bottom line.

Background

  • The term ginseng refers to several species of the genus Panax of the Araliaceae family. The two most commonly used ginseng species are Asian ginseng (Panax ginseng) and American ginseng (Panax quinquefolius). Panax species should not be confused with Siberian ginseng (Eleutherococcus senticosus), which is from a different plant family.
  • The word "ginseng" comes from ren-shen, the Chinese word for the plant, which means "essence of the earth in the form of a man" or "man-root," referring to the root's human-like shape.
  • Panax ginseng has been used in traditional Chinese medicine (TCM) for more than 2,000 years. Its uses include increasing appetite and strength, enhancing memory and physical performance, reducing fatigue and stress, and improving overall quality of life. Shengmai (also called shenmai) is a combination of Panax ginseng, Schisandra fruit, and Ophiopogon japonicus that has also been used in TCM to treat heart and respiratory diseases.
  • American ginseng has been used as a folk remedy by many Native American tribes, as a mild stimulant, digestive aid, and for ailments such as headache, female infertility, fever, and earache.  
  • Ginseng has been used traditionally to treat cancer and, in modern times, to prevent cancer. Evidence supports ginseng use in decreasing cold symptoms, and improving mental performance.
  • The primary active parts of ginseng are ginsenosides. When purchasing ginseng products, experts suggest products labeled as Panax ginseng and standardized to 4-7% ginsenosides.

Evidence

 

Uses based on scientific evidence 

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 professional.

Grade* 

Immune enhancer 

Limited research suggests that ginseng may stimulate the immune system. In several studies, Cold-fX® (American ginseng) lacked an effect on the frequency of colds, but decreased cold duration and improved cold symptoms. Additional research is needed in this area.

B 

Mental performance 

Several studies suggest that Panax ginseng may improve mental performance in healthy individuals. Further studies are needed in this area.

B 

Adaptogen (ability to adapt to the environment) 

Some studies have explored the effect of ginseng on promoting sleep and coping with stress. Additional research is needed before a conclusion can be made.

C 

Alzheimer's disease 

Available evidence suggests that ginseng may have some beneficial effects for Alzheimer's disease. More well-designed trials are needed before a conclusion can be made.

C 

Aplastic anemia 

Early research suggests that shenmai (Panax ginseng, Schisandra fruit, and Ophiopogon japonicus) and an herbal mixture containing Panax notoginseng may be useful in the treatment of aplastic anemia, a bone marrow disorder that results in decreased red blood cells. Panax notoginseng is not commonly used or available in the United States. More research is needed in this area.

C 

ADHD 

Early research examined the effects of an herbal mixture containing American ginseng and Panax ginseng on attention-deficit hyperactivity disorder (ADHD) in children. Additional studies are needed before a conclusion can be made.

C 

Bad breath 

The effect of ginseng in people with bad breath caused by the bacterium Helicobacter pylori has been investigated. Additional studies are needed in this area.

C 

Birth outcomes (brain damage due to lack of oxygen) 

Early research has been conducted on shenmai (Panax ginseng, Schisandra fruit, and Ophiopogon japonicus) for this condition. However, more research is needed.

C 

Blood clotting disorders 

Early evidence showed that a Chinese medical preparation consisting mainly of ginseng saponins is safe and effective for idiopathic thrombocytopenic purpura (ITP), a disease in which the immune system destroys platelets. Further clinical trials are required before conclusions can be made.

C 

Cancer (used with chemotherapy) 

Limited research suggests that injections of shenmai (Panax ginseng, Schisandra fruit, and Ophiopogon japonicus) may benefit people undergoing therapy for cancer. Anticancer effects have been reported for various types of ginseng. Additional research on the effect of ginseng alone is needed.

C 

Cancer prevention 

Early studies suggest that Panax ginseng, especially ginseng powder or extract, may reduce the risk of various organ cancers. Additional trials are necessary before a clear conclusion can be reached.

C 

Cardiomyopathy 

Based on limited research, shenmai injection (Panax ginseng, Schisandra fruit, and Ophiopogon japonicus) may have useful effects in people with dilated cardiomyopathy, a disease of the heart muscle. Additional studies are needed before a conclusion can be made.

C 

Chronic hepatitis B 

Early evidence suggests that shenmai injection (Panax ginseng, Schisandra fruit, and Ophiopogon japonicus) may improve liver function, although it lacked an effect on widespread liver scar tissue in people with chronic hepatitis B. More research is needed on ginseng alone.

C 

Coronary artery (heart) disease 

Early studies suggest that Panax ginseng may aid in the treatment of chest pain and other signs and symptoms of coronary artery disease. Shengmai injection (Panax ginseng, Schisandra fruit, and Ophiopogon japonicus) has also been used in Chinese medicine to treat people with this condition. Further research is needed in this area.

C 

Dementia 

Early studies have found positive effects of Panax ginseng in the treatment of elderly individuals with symptoms of senile dementia. Additional research is needed before a conclusion can be made.

C 

Diabetic nephropathy 

Early evidence suggests a beneficial effect of Panax notoginseng on diabetic nephropathy (kidney disease). Panax notoginseng is not commonly used or available in the United States. Additional studies are needed in this area.

C 

Fatigue 

Several studies evaluating exercise performance, cognitive performance, or mental performance have found that Panax ginseng supplements may help prevent fatigue. Further research is needed in this area.

C 

Fistula 

Early evidence in infants with a collection of pus near the anus or an abnormal anal opening (fistula) suggests that treatment with a ginseng and tang-kuei ten combination (GTTC) may speed recovery. Further research is needed on ginseng alone.

C 

Heart attack 

Ginseng, in combination with other herbs, has been examined in people who have suffered a heart attack, with some evidence of benefit. Additional studies of ginseng alone are needed before a conclusion can be made.

C 

Heart disease (general) 

Ginseng preparations have been used to treat complications of cardiac bypass surgery. There is evidence that ginseng, in combination with other treatments, may benefit people with heart valve disease, chest pain, and other heart disorders. Additional research is needed in this area.

C 

Heart disease (present at birth) 

Based on early research, an injection of Panax ginseng in children undergoing heart surgery may limit injury to the stomach and intestins and reduce inflammatory responses. More well-designed trials are needed before a conclusion can be made.

C 

Heart failure 

Panax ginseng has been used with digoxin to treat congestive heart failure, with a lack of clear benefit. Shenmai injection (Panax ginseng, Schisandra fruit, and Ophiopogon japonicus) and red ginseng have also been used to treat this condition. Studies on the effect of ginseng alone are needed.

C 

High blood pressure 

Early evidence shows that ginseng may lower blood pressure. Additional studies are needed in this area.

C 

High cholesterol 

Early studies have investigated the effect of Panax ginseng in treating high cholesterol, with mixed results. Additional studies are needed in this area.

C 

HIV 

Early research has examined the effects of ginseng in combination with highly active antiretroviral therapy (HAART) in people with HIV. Although there appears to be some benefit in adding ginseng to HAART, additional research is needed before a conclusion can be made.

C 

Hyperglycemia (high blood sugar levels; healthy people) 

Several studies report that American ginseng lowers both fasting blood sugar and blood sugar after meals. Other research showed that blood sugar levels were raised after using Asian ginseng. Further research is needed in this area.

C 

Intracranial pressure 

Early research on xuesaitong injection, a preparation of Panax notoginseng, suggests that it may help to decrease intracranial pressure (pressure inside the skull) and benefit people in a coma. Further research is needed in this area.

C 

Kidney disorders 

Hemorrhagic fever with renal syndrome is an immune response to hantavirus infection. Combination products containing ginseng have been suggested to improve quality of life in people with this disorder or in those with chronic kidney failure. More research is needed in this area.

C 

Liver protection 

Evidence to support the use a compound of American (Panax quinquefolius L.) or Asian (Panax ginseng) ginseng to prevent liver damage is lacking. Further research is needed in this area.

C 

Lung disease 

Early research has examined the effect of combination products containing ginseng on lung function in burn victims and those with chronic obstructive pulmonary disease (COPD), a type of lung disease. Further research on the effect of ginseng alone is needed before a conclusion can be made.

C 

Menopause 

Evidence suggests that Panax ginseng may be effective in relieving menopause symptoms, such as depression and anxiety. However, the findings are unclear. Further research is needed before a conclusion can be made.

C 

Methicillin-resistant Staphylococcus aureus (MRSA) 

Hochu-ekki-to, which contains ginseng and several other herbs, has been used to treat MRSA, a type of bacterial infection. Further research on ginseng alone is necessary to make a firm conclusion.

C 

Nervous system disorders 

Evidence suggests that people with nervous system disorders may experience improved cognitive function when taking Panax ginseng alone or in combination with other products. Further research is needed in this area.

C 

Osteoarthritis 

Early research suggests that the combination of Panax notoginseng, Rehmannia glutinosa, and Eleutherococcus senticosus, may be effective for reducing pain and improving physical function in people with osteoarthritis. More studies are needed on the effect of ginseng alone.

C 

Pregnancy (slowed growth in womb) 

Early research suggests that Panax ginseng saponins may be useful in treating slowed growth of baby in the womb. Further research is required in this area.

C 

Quality of life 

There is some evidence that Asian or American ginseng taken long-term improves quality of life. Further research is required.

C 

Radiation therapy side effects 

Evidence regarding the use of Panax ginseng or American ginseng as a radioprotective agent is inconclusive. Further research is required before conclusions can be made.

C 

Recovery from surgery (breast cancer) 

Limited research has been carried out on the effect of ginseng on recovery after surgery for breast cancer. Some data suggest a faster recovery. Further research is required before conclusions can be made.

C 

Recovery from surgery (liver cancer) 

Early research has examined the effects of ginseng on adverse effects following transcatheter arterial chemoembolization (TACE), an invasive chemotherapy treatment for advanced liver cancer. Additional studies are needed before a conclusion can be made.

C 

Sexual arousal (in women) 

Limited research has shown that ArginMax® (a combination of Panax ginseng, L-arginine, Ginkgo biloba, damiana, multivitamins, and minerals) improves sexual health in menopausal women and women who lack interest in sexual activity. Korean red ginseng extracts may improve sexual arousal in menopausal women. Further research, including investigation of the effect of ginseng alone, is required.

C 

Sexual function / libido / erectile dysfunction 

Early evidence suggests that ginseng, including red ginseng, may be effective in treating erectile dysfunction and early ejaculation. Ginseng may also improve the number and movement of sperm. Additional research is needed in this area.

C 

Sleep 

Research suggests that ginseng may improve sleep in healthy individuals. Additional studies are needed before a conclusion can be made.

C 

Stress 

Limited research suggests that ginseng, in combination with other agents, may aid in easing stress. Well-designed studies of the effect of ginseng alone are needed before a conclusion can be made.

C 

Stroke prevention 

A combination of Salvia miltiorrhiza, Panax notoginseng, and Dryobalanops may prevent recurrent stroke in people with ischemic cerebrovascular disease, a disorder in which blood clots that prevent blood from getting to the brain. Further studies of the effect of ginseng alone are required.

C 

Tonsillitis 

Sho-saiko-to-ka-kikyo-sekko, a treatment consisting of ginseng and eight other herbs, may reduce the incidence of acute tonsillitis (swelling of the tonsils). More well-designed trials are needed before a conclusion can be made.

C 

Type 2 diabetes 

Several studies report that American ginseng may reduce blood lipids, fasting blood sugar, and post-meal blood sugar levels following meals in people with type 2 diabetes. Limited research has shown that ginseng lacks an effect on the factors that cause diabetes. Additional research is needed in this area.

C 

Viral myocarditis 

Limited research suggests that shenmai or shengmai injection (Panax ginseng, Schisandra fruit, and Ophiopogon japonicus) may lead to improvement of viral myocarditis, inflamed heart muscle caused by a viral infection. Well-designed studies of the effect of ginseng alone are needed before a conclusion can be made.

C 

Well-being 

Several studies showed that Panax ginseng alone or in combination with multivitamins alleviated symptoms of fatigue and stress in healthy older individuals suffering from fatigue. However effects of ginseng were lacking on the well-being of healthy young adults. Further research is needed in this area.

C 

Weight loss 

Limited research has been conducted on the use of ginseng for treatment of obesity and weight loss. Additional studies are needed in this area.

C 

Wrinkle prevention 

In early research, a red ginseng extract containing a mixture of Torilus fructus and Corni fructus improved facial wrinkles. More well-designed studies are needed before a conclusion can be made.

C 

Exercise performance 

Overall, evidence for ginseng in improving exercise performance is lacking. However, ginseng is still commonly used by athletes in China. Additional research is needed in this area.

D 

 

*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).

For full grading rationale, click here.

Uses based on tradition or theory 

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified health care professional

Acrocyanosis (poor circulation causing blue hands and feet), adrenal tonic, aggression, aging, air pollution protection, alcoholism, allergy, altitude (mountain) sickness, amnesia, anemia, angiogenesis (new blood vessel formation), antibacterial, antifungal, antioxidant, antipsychotic, anxiety, appetite stimulant, autoimmune disorders, bile flow stimulant, bone loss, breast enlargement, burns, chronic cough, chronic fatigue syndrome, colitis (colon inflammation), common cold/upper respiratory tract infection, demulcent (soothing effects), depression, dialysis, dizziness, drug addiction, dysentery, earache, endocrine disorders, expectorant (loosens mucus), fever, fibromyalgia (body pain), frequent urination, gastritis (inflamed stomach lining), graft-versus-host disease, gynecological disorders, H. pylori infection, hair tonic, head injury, headache, herpes, hoarse voice, improvement of blood supply, improving urine flow, infertility, influenza, inflammation, low back pain, mental disorders, metabolic disorders, mood enhancement, muscle weakness, nausea, nosebleeds, pain relief, Parkinson's disease, prolapse, Pseudomonas infection in cystic fibrosis, qi-deficiency and blood-stasis syndrome in heart disease (Eastern medicine), recovery after surgery (general), rehabilitation, rheumatism, saliva production, scar healing (acne), sedative, seizure, spleen disorders, stomach motility disorders, stroke recovery, sweating, thirst, toxicity, tuberculosis, ulcers, vein clots (prevention), vomiting, wound healing.


Safety

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 professional before starting a new therapy. Consult a healthcare professional immediately if you experience side effects.

Allergies

  • Avoid with known allergy or hypersensitivity to Panax species, their constituents, or to other members of the same plant family.
  • Allergic reactions to Korean red ginseng and other members of its plant family have been reported. Anaphylaxis symptoms, including breathing problems, low blood pressure, and rash, have occurred after ingestion of Panax ginseng syrup.

Side Effects and Warnings

  • Panax ginseng or American ginseng is likely safe when used in healthy individuals in suggested doses for a short time. Shenmai injection (Panax ginseng, Schisandra fruit, and Ophiopogon japonicus) has been used for two weeks without serious adverse effects except for a report of anaphylactic shock (severe allergic reaction).
  • Ginseng is possibly safe when combined with other herbs in some marketed preparations, although maximum doses and maximum duration are not well described.
  • Ginseng may cause low or high blood pressure. Caution is advised in people taking drugs, herbs, or supplements that raise or lower blood pressure.
  • Ginseng may lower blood sugar levels. Caution is advised in people with diabetes or hypoglycemia and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Ginseng may interfere with the way the body processes certain drugs, herbs, or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may change in the blood and may cause altered effects or potentially serious adverse reactions. People using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
  • Because ginseng contains estrogen like chemicals, the effects of other agents believed to have estrogen-like properties may be altered.
  • Use cautiously in people with sleep disorders, as ginseng may cause insomnia.
  • Use cautiously in people using agents that may increase the risk of abnormal heart rhythms.
  • Use cautiously in those using light-sensitizing agents or those with fair skin, as high doses of ginseng may have a light-sensitizing effect.
  • Use cautiously in people with mental health disorders, such as schizophrenia or depression, or in those taking medication for these disorders, as discontinuing prescribed medications and staring ginseng may result in mania or depression.
  • Use cautiously in combination with phenelzine for depression, as combination with ginseng may induce mania.
  • Use cautiously in people taking opiates, as ginseng has decreased the effects of morphine.
  • Use cautiously in individuals prone to seizures. According to case reports, seizures following heavy consumption of energy drinks, which may contain ginseng, have been reported.
  • Use Korean ginseng cautiously in individuals who have "heat" disorders, such as ulcers, high blood pressure, tension headaches, and symptoms associated with high stress levels, as well as those with symptoms of nervousness, mental imbalance, inflammation, or fever.
  • Use cautiously in people with immune disorders or those using immunosuppressants, as ginseng has immune-stimulating effects and, theoretically, may interfere with the effects of immunosuppressants.
  • Use cautiously during the period before, after, and during surgery, as ginseng may have an effect during that time.
  • Use cautiously in children due to inadequate safety evidence.
  • Ginseng may increase the risk of bleeding. Avoid in people with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.
  • Avoid in people with known allergy or sensitivity to Panax species, their components, or to other members of the same plant family. Allergic reactions to Korean red ginseng and other members of its plant family have been reported.
  • Avoid in people who are pregnant or breastfeeding due to reports of adverse effects.
  • Ginseng may cause absence of menstruation, agranulocytosis (bone marrow failure), agitation, asthma, breast symptoms (pain, enlargement, nipple enlargement, breast enlargement in men), breathing problems, chest pain, decreased or increased heart rate, delayed ejaculation, depression, dizziness, drowsiness, dry mouth, enhanced sexual performance/responsiveness, erectile dysfunction, excitability, fever, euphoria, eye disturbances (pupil dilation, difficulty focusing), flushing, gastrointestinal symptoms (abdominal pain, bloating, constipation, diarrhea, discomfort, heartburn, loss of appetite, nausea, vomiting), headache, immune-stimulating effects, impotence, increased motor and cognitive efficiency, inflammation of the brain arteries (reversible), insomnia, irritability, jaundice, light protection/sensitization, liver toxicity, migraine, muscle and joint pain, neonatal androgenization (after maternal use, developing male characteristics in the infant), neonatal intoxication and death, nervousness, restlessness, runny nose, skin reactions (dermatitis, eczema, rash, skin eruptions, rose spots, itching, mild pain and burning, hives, Stevens-Johnson syndrome), sleep disorders (trouble falling or staying asleep), throat irritation, temporary loss of blood flow to the brain after a high blood pressure crisis, and trembling.

Pregnancy and Breastfeeding

  • Avoid in pregnant or breastfeeding women, due to a lack of available scientific evidence and safety information. Limited study in humans showed a lack of adverse effects on pregnancy, however non-human studies showed that ginseng may damage the developing baby before birth.
  • Ginseng does not appear to interfere with normal embryonic development or cause birth defects. However, the safety of ginseng during pregnancy and breastfeeding has not been evaluated. Chinese tradition suggests that ginseng not be used during pregnancy and breastfeeding. A number of reports caution against its use in pregnant and breastfeeding women.

Interactions

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 professional before starting a new therapy.

Interactions with Drugs

  • Ginseng may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
  • Ginseng may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. People taking insulin or drugs for diabetes by mouth should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Ginseng may affect blood pressure. Caution is advised in people taking drugs that raise or lower blood pressure.
  • Ginseng may interfere with the way the body processes certain drugs (such as midazolam or diclofenac) using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may change in the blood and may altered effects or potentially serious adverse reactions. People taking any medication should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
  • Because ginseng may contain estrogen-like chemicals, the effects of other agents believed to have estrogen-like properties may be altered.
  • Ginseng may also interact with ACE inhibitors; alcohol; agents for allergy, anxiety, asthma, cancer, cholesterol, depression, inflammation, obesity, psychosis, vomiting, ulcers and viral, fungal, or parasitic infections; agents that affect the heart, nervous, or immune systems; agents that cause sensitivity to light; agents that control heart rhythm; agents that damage the liver; agents that dilate blood vessels; agents that increase sex drive; agents that protect against radiation; Alzheimer's agents; antibiotics; caffeine; calcium channel blockers; cardiac glycosides; disulfiram; diuretics; hypnotics; impotence agents; influenza vaccine; metronidazole; numbing agents; opiates; pain relievers; phenelzine; phenytoin; protease inhibitors; sedatives; or steroids.

Interactions with Herbs and Dietary Supplements

  • 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, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
  • 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 may change in the blood. It may also alter the effects that other herbs or supplements potentially may have on the P450 system.
  • Ginseng may lower blood sugar levels. 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.
  • Ginseng may affect blood pressure. Caution is advised in people taking herbs or supplements that may raise or lower blood pressure.
  • Because ginseng may contain estrogen-like chemicals, the effects of other agents believed to have estrogen-like properties may be altered.
  • Ginseng may also interact with acupuncture; alcohol; herbs and supplements for allergy, anxiety, asthma, cancer, cholesterol, depression, inflammation, obesity, psychosis, vomiting, ulcers and viral, fungal, or parasitic infections; herbs and supplements that affect the heart, nervous, and immune systems; herbs and supplements that cause sensitivity to light; herbs and supplements that control heart rhythm; herbs and supplements that damage the liver; herbs and supplements that dilate blood vessels; herbs and supplements that increase sex drive; herbs and supplements that protect against radiation; Alzheimer's herbs and supplements; antibacterials; antioxidants; ashwagandha (Withania somnifera); astragalus; caffeine; cardiac glycosides; Carthamus tinctorius; dehydroepiandrosterone (DHEA); diuretics; epicatechin; Ginkgo biloba; glycyrrhiza; guarana; hypnotics; impotence herbs and supplements; mate; numbing herbs and supplements; opioids; pain relievers; red clover; sedatives; steroids; stimulants; or vitamin C.

Authors

Selected References

Natural Standard developed the above evidence-based information based on a 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.

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  2. Barton DL, Soori GS, Bauer BA, et al. Pilot study of Panax quinquefolius L. (American ginseng) to improve cancer-related fatigue: a randomized, double-blind, dose-finding evaluation: NCCTG trial N03CA. Support Care Cancer 2010;18(2):179-187.
  3. Chen J, Yao Y, Chen H, et al. Shengmai (a traditional Chinese herbal medicine) for heart failure. Cochrane Database Syst Rev 2012;11:CD005052.
  4. Gagnier JJ, Moher D, Boon H, et al. Randomized controlled trials of herbal interventions underreport important details of the intervention. J Clin Epidemiol 2011;64(7):760-9
  5. Hugel HM, Jackson N, May BH, et al.Chinese herbs for dementia diseases. Mini.Rev Med Chem 2012;12(5):371-379.
  6. Jia Y, Zhang S, Huang F, et al. Could ginseng-based medicines be better than nitrates in treating ischemic heart disease? A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2012;20(3):155-166.
  7. Kwon KR, Kim H, Kim JS, et al. Case series of non-small cell lung cancer treated with mountain Ginseng pharmacopuncture. J Acupunct.Meridian.Stud. 2011;4(1):61-68.
  8. Liu ZL, Liu ZJ, Liu JP, et al. Herbal medicines for viral myocarditis. Cochrane Database Syst Rev 2012;11:CD003711.
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  10. Kakisaka Y, Ohara T, Tozawa H, et al. Panax ginseng: a newly identified cause of gynecomastia. Tohoku J Exp Med 2012;228(2):143-145.
  11. Kim S, Shin BC, Lee MS, et al. Red ginseng for type 2 diabetes mellitus: a systematic review of randomized controlled trials. Chin J Integr.Med 2011;17(12):937-944.
  12. Mateo-Carrasco H, Galvez-Contreras MC, Fernandez-Gines FD, et al. Elevated liver enzymes resulting from an interaction between Raltegravir and Panax ginseng: a case report and brief review. Drug Metabol.Drug Interact. 2012;27(3):171-175.
  13. Shin SK, Kwon JH, Jeong YJ, et al. Supplementation of cheonggukjang and red ginseng cheonggukjang can improve plasma lipid profile and fasting blood glucose concentration in subjects with impaired fasting glucose. J Med Food 2011;14(1-2):108-113.
  14. Shou C, Li J, and Liu Z. Complementary and alternative medicine in the treatment of menopausal symptoms. Chin J Integr.Med 2011;17(12):883-888.
  15. Zeng Y, Song JX, and Shen XC. Herbal remedies supply a novel prospect for the treatment of atherosclerosis: a review of current mechanism studies. Phytother.Res 2012;26(2):159-167.
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