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Ginseng

 

Natural Standard Monograph, Copyright © 2013 (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, 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 L.), CVT-E002, dae-jo-hwan (DJW), dammarane-type glycosides, dammarane-type tetracyclic triterpenoid saponins, dammarane-type triterpene ketone (panaxadione), 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, jenseng, jen-shen, jinpi, kao-li-seng, Korean ginseng, Korean red ginseng (KRG), Kraftwurzel (German), limonene, magnesium, malonylginsenoside Ra3, maltol, man root, manganese, memory enhancer, minjin, molybdenum, mountain ginseng, 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 vietnamensis (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), sanchi ginseng, sang, 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, 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 ( Eleutherococcus senticosus ) 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 ( Panax quinquefolius L.) 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 L., 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 (KHSM) injection, 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 L.), 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, Schisandra fruit, Ophiopogon japonicus), 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 monograph. In Russia, Siberian ginseng (Eleutherococcus senticosus) was promoted as a cheaper alternative to ginseng, as it was believed to have identical benefits. However, it is void of the ginsenosides contained in Panax spp. Other species may be referred to as ginseng as well, but they are from a different family or genus; examples include 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 review.

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 C.A.Mey.) and American ginseng (Panax quinquefolius L.). Panax species should not be confused with Siberian ginseng (Eleutherococcus senticosus), which is from a different botanical family.
  • The word "ginseng" is derived 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 diverse 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 conditions such as coronary heart disease and chronic obstructive pulmonary disease (COPD).
  • American ginseng (Panax quinquefolius L.) has been used as a folk remedy by many Native American tribes, as a mild stimulant and digestive aid and for diverse ailments, including headache, female infertility, fever, and earache.  
  • Ginseng has been used traditionally as a treatment for cancer and, in modern times, has been suggested as a cancer preventative.
  • The primary active ingredients of Panax are ginsenosides. When purchasing ginseng products, most experts recommend looking for a product labeled as Panax ginseng, 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* 

Hyperglycemia (high blood sugar levels; healthy individuals) 

Several studies report that American ginseng (Panax quinquefolius L.) lowers blood sugar when fasting and after meals. These results are promising, especially as ginseng does not seem to cause hypoglycemia. Further research is needed to evaluate the long-term effectiveness of ginseng in managing blood glucose levels.

B 

Immune system enhancement 

Limited research suggests that ginseng may stimulate the immune system. Ginseng may increase clearance of bacterial infections treated with antibiotics and improve the immune response to influenza immunization (flu shot). 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 

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 in treatment of Alzheimer's disease. More well-designed trials are needed before a conclusion can be made.

C 

Aplastic anemia (blood disorder) 

Preliminary 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. Panax notoginseng is not commonly used or available in the United States. More research is needed in this area.

C 

Attention-deficit hyperactivity disorder (ADHD) 

Preliminary 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 patients with bad breath caused by the bacterium Helicobacter pylori has been investigated in preliminary research. Additional studies are needed in this area.

C 

Birth outcomes (anoxemic encephalopathy) 

Preliminary clinical research has been conducted in this area. However, more research is needed.

C 

Blood clotting disorders (idiopathic thrombocytopenic purpura) 

The effect of a Chinese medical preparation consisting mainly of ginseng saponins on idiopathic thrombocytopenic purpura (ITP) has been investigated. Early results suggest it is safe and effective. Further clinical trials are required before conclusions can be made.

C 

Cancer (chemotherapy adjunct) 

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

C 

Cancer prevention 

Preliminary 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 (weakening and enlargement of heart muscle) 

Based on limited research, shenmai injection (Panax ginseng, Schisandra fruit, and Ophiopogon japonicus) may have therapeutic effects in patients with dilated cardiomyopathy. Additional studies are needed before a conclusion can be made.

C 

Cardiovascular conditions 

American ginseng (Panax quinquefolius L.) has antioxidant activity due to its ginsenoside content. Its saponins have shown beneficial effects on low-density lipoprotein (LDL, or "bad") cholesterol in laboratory studies. Ginseng preparations have been used to treat complications of cardiac bypass surgery. Preliminary studies suggest that shenmai (Panax ginseng, Schisandra fruit, and Ophiopogon japonicus) may be beneficial for other cardiovascular disorders. Additional research is needed in this area.

C 

Chronic hepatitis B 

Early evidence suggests that shenmai injection (Panax ginseng, Schisandra fruit, and Ophiopogon japonicus) may help improve liver function, although it did not improve liver fibrosis indices in patients with chronic hepatitis B. More research is needed in this area to define the effect of ginseng alone on liver function.

C 

Congestive heart failure 

Panax ginseng has been used together with digoxin to treat congestive heart failure, with no clear benefit. Shenmai injection (Panax ginseng, Schisandra fruit, and Ophiopogon japonicus) has also been used to treat this condition. Studies on the effect of ginseng alone are needed.

C 

Coronary artery disease 

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

C 

Dementia 

Preliminary 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 

Preliminary 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 

Exercise performance 

There are many anecdotal reports from China of the effectiveness of Panax ginseng for exercise performance, but the scientific evidence is inconclusive. Panax ginseng is the herbal supplement most used by athletes in China. Additional research is needed before a conclusion can be made.

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 

Preliminary evidence in infants with perianal abscess or fistula-in-ano suggests that treatment with a ginseng and tang-kuei ten combination (GTTC) may speed recovery. Further research is needed before a conclusion can be made.

C 

Heart disease (present at birth) 

Based on preliminary research, an injection of Panax ginseng in children undergoing heart surgery may limit gastrointestinal injury and inhibit inflammatory responses. More well-designed trials are needed before a conclusion can be made.

C 

High blood pressure 

Preliminary evidence indicates that ginseng may be effective in treating high blood pressure, but evidence from well-conducted clinical trials is still lacking. It is not clear what constitutes a safe or effective dose. Additional studies are needed in this area.

C 

High cholesterol 

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

C 

HIV (adjunct) 

Early research has examined the effects of highly active antiretroviral therapy (HAART), with or without ginseng, in patients 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 

Intracranial pressure 

Preliminary research on xuesaitong (XST, a preparation of Panax notoginseng) injection suggests that it may help to decrease intracranial pressure and benefit coma patients. Further research is needed in this area.

C 

Kidney disorders 

Hemorrhagic fever with renal syndrome is an immune response to hantavirus infection. Multi-ingredient preparations containing ginseng have been suggested to improve quality of life in patients with chronic kidney failure. More research is needed in this area.

C 

Liver protection 

Evidence to support the use of American (Panax quinquefolius L.) or Asian (Panax ginseng) ginseng to prevent liver damage is lacking. Compound K, a ginseng metabolite, has been investigated. Further research is needed in this area.

C 

Menopausal symptoms 

Evidence suggests that Panax ginseng may be moderately effective in relieving postmenopausal 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) 

In patients treated with hochu-ekki-to, which contains ginseng and several other herbs, MRSA in the urine has been reported to decrease after 10 weeks of treatment. Further research on ginseng alone is necessary to make a firm conclusion.

C 

Myocardial infarction 

Ginseng in combination with other herbs has been examined in patients 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 

Neurological disorders 

Evidence suggests that patients with neurological 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 

Obesity 

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

C 

Osteoarthritis 

Preliminary research suggests that the combination of Panax notoginseng (Burk.) F.H.Chen, Rehmannia glutinosa Libosch, and Eleutherococcus senticosus, may be effective for reducing pain and improving physical function in patients with osteoarthritis. More studies are needed on the effect of ginseng alone before a conclusion can be made.

C 

Postoperative recovery (breast cancer) 

Limited research has been carried out on the effect of ginseng on postoperative recovery in breast cancer patients. Some data suggest a faster recovery of hemoglobin and immune cell ratios. Further research is required before conclusions can be made.

C 

Pregnancy (intrauterine growth retardation) 

Preliminary research suggests that Panax ginseng saponins may be useful in treating intrauterine growth retardation. Further research is required in this area.

C 

Premature ejaculation 

Early research suggests that a topical herbal combination product containing Panax ginseng may be effective in the treatment of premature ejaculation. Additional research is needed before a conclusion can be made.

C 

Pulmonary conditions 

Preliminary research has examined the effect of combination products containing ginseng on lung function in burn victims and those with chronic obstructive pulmonary disease (COPD). Other studies have investigated the use of shenmai injection (Panax ginseng, Schisandra fruit, and Ophiopogon japonicus) to treat respiratory failure, primarily in COPD patients. Further research on the effect of ginseng alone is needed before a conclusion can be made.

C 

Quality of life 

There is some evidence that Panax ginseng or American ginseng (Panax quinquefolius L.) improves quality of life, although the effects may not be long-lasting unless ginseng is consumed continually. 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. However, clinical studies have found that ginseng may improve fatigue and well-being, which are commonly associated with radiation treatments. Further research is required before conclusions can be made.

C 

Recovery from surgery (transcatheter arterial chemoembolization) 

Early research has examined the effects of ginseng on postembolization syndrome following transcatheter arterial chemoembolization (TACE) in patients with advanced liver cancer. Additional studies are needed before a conclusion can be made.

C 

Sexual arousal (in women) 

Study suggests that ArginMax® (a combination of Panax ginseng, L-arginine, Ginkgo biloba, damiana, multivitamins, and minerals) improves sexual function in menopausal women and women who lack interest in sexual activity. Korean red ginseng extracts taken by mouth 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 

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

C 

Sleep 

Research suggests that ginseng may promote better 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 alleviating 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 (sanqi), and Dryobalanops may prevent recurrent stroke in patients with ischemic cerebrovascular disease. Further studies of the effect of ginseng alone are required.

C 

Tonsillitis 

Based on early research, sho-saiko-to-ka-kikyo-sekko, a formulation consisting of ginseng and eight other herbs, may reduce the incidence of acute tonsillitis. More well-designed trials are needed before a conclusion can be made.

C 

Type 2 diabetes 

Several studies report that American ginseng (Panax quinquefolius L.) may reduce blood lipid, fasting blood sugar, and blood sugar levels following meals in patients with type 2 diabetes. Additional research is needed in this area.

C 

Upper respiratory tract infections (children) 

Based on early research, American ginseng (Panax quinquefolius L.) root extract is considered safe and well tolerated in children for the treatment of upper respiratory tract infections. Additional studies are needed before a conclusion can be made.

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 as the result of a viral infection). More in-depth and reliable studies are needed before a conclusion can be made.

C 

Well-being 

Several studies investigated the effect of Panax ginseng as a tonic for healthy older individuals suffering from fatigue. G115® extract, alone or in combination with multivitamins and trace elements, appeared to alleviate symptoms of fatigue and stress, thereby enhancing well-being. Further research is needed in this area.

C 

Wrinkle prevention 

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

C 

 

*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 (circulatory insufficiency of the extremities), adrenal tonic, aerobic fitness, aggression, aging, AIDS/HIV, air pollution protection, alcoholism, allergy, altitude (mountain) sickness, amnesia, analgesia, anemia, angiogenesis, anorexia, antibacterial, anticonvulsant, antifungal, anti-infective, anti-inflammatory, antioxidant, antipsychotic, anxiety, aphrodisiac, appetite stimulant, arrhythmia, asthma, atherosclerosis, autoimmune disorders, bile flow stimulant, bleeding disorders, breast enlargement, burns, childbirth, choleretic, chronic bronchitis, chronic cough, chronic fatigue syndrome, CNS disorders, colitis, deep venous thrombosis (prevention), demulcent, depression, dialysis, diuretic, dizziness, drug addiction, dysentery, dyspepsia, dyspnea, earache, emesis, emphysema, endocrine disorders, energy, expectorant, fever, fibromyalgia, frequent urination, gastritis, gastrointestinal motility, gynecological disorders, H. pylori infection, hair tonic, hangover remedy, head injury (severe intractable), headaches, hemolytic anemia, hepatitis, herpes, hoarse voice, hypercholesterolemia, improvement of blood supply, improving resistance to disease, infertility, influenza, insomnia, irritability, ischemia-reperfusion injury prevention (cerebral), ischemic stroke, jaundice, Kaposi's sarcoma, learning, leukemia, low back pain, lumbar disc herniation, malaise, memory, metabolic disorders, migraine, mood enhancement, morphine tolerance, muscle weakness, myocardial injury, nausea, neuralgia, neurasthenia, neuroblastoma, neurodegenerative diseases, nosebleeds, osteoporosis, ovulation disorders, palpitations, Parkinson's disease, peptic ulcers, physical work capacity, pneumonia, postherpetic neuralgia, postoperative recovery (general), prolapse, Pseudomonas infection in cystic fibrosis, psycho-asthenia, qi-deficiency and blood-stasis syndrome in heart disease (Eastern medicine), rehabilitation, rheumatism, salivary stimulant, scar healing (acne), sciatica, sedative, spleen disorders, stimulant, sweating, thirst, thrombosis, toxicity, tuberculosis, ulcers, upper respiratory tract infections (general), vein clots, vomiting, weight loss, 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 Araliaceae family.
  • Allergic reactions to Korean red ginseng and cross-reactions with other members of the Araliaceae family have been reported. Anaphylaxis-like symptoms, with breathing problems, low blood pressure, and rash, have occurred after ingestion of Panax ginseng syrup.

Side Effects and Warnings

  • Panax ginseng or American ginseng (Panax quinquefolius L.) is likely safe when used in healthy individuals in suggested doses for a short period. Shenmai injection (Panax ginseng, Schisandra fruit, and Ophiopogon japonicus) has been used for two weeks without serious adverse effects.
  • Agranulocytosis, followed by life-threatening bacterial infection and, in one case, death, has been reported in patients taking an over-the-counter ginseng-containing combination product that was later shown to contain phenylbutazone and aminopyrine, known inducers of agranulocytosis. Independently reported severe drops in white blood cell counts may be due to similar contamination.
  • Asthma and rhinitis due to occupational exposure to ginseng dust has been reported.
  • Ginseng may cause agitation, amenorrhea, breast symptoms (pain, enlargement, nipple enlargement, breast enlargement in men), breathing problems, cerebral arteritis (reversible), chest pain, decreased heart rate, delayed ejaculation, depression, diarrhea, dizziness, drowsiness, dry mouth, enhanced blood alcohol clearance, enhanced sexual performance/responsiveness, erectile dysfunction, estrogen-like effects, excitability, extremely high fever, euphoria, eye disturbances (pupil dilation, difficulty focusing), feeling of well-being, flushing, gastrointestinal symptoms (abdominal pain, bloating, constipation, diarrhea, discomfort, nausea, vomiting), headache, heartburn, hives, increased motor and cognitive efficiency, impotence, increased libido, irritability, jaundice, light protection/sensitization, liver toxicity, loss of appetite, mania, migraine, muscle and joint pain, neonatal androgenization (after maternal use), neonatal intoxication and death, nervousness, nosebleeds, palpitations, perioperative effects, rapid heartbeat, restlessness, sedation, seizures, skin reactions (dermatitis, eczema, rash, skin eruptions, rose spots, pruritus, mild pain and burning, Stevens-Johnson syndrome), sleep disorders (e.g., trouble falling or staying asleep), teratogenic effects (in animals), throat irritation, transient ischemic attack following high blood pressure crisis, tremulousness, vaginal bleeding, vertigo, or worsened symptoms of schizophrenia.
  • Ginseng may cause low or high blood pressure. Caution is advised in patients taking drugs, herbs, or supplements that 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 lower blood sugar levels. Caution is advised in patients 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 increased or decreased effects or potentially serious adverse reactions. Patients using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
  • Use cautiously in patients with sleep disorders, as ginseng may cause insomnia.
  • Use cautiously in patients 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 patients with mental health disorders, such as schizophrenia or depression, or in those taking medication for these disorders, as ginseng has caused mania or depression.
  • Use cautiously in patients taking opiates, as ginseng has antagonized the effects of morphine and cocaine.
  • 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 Panax ginseng cautiously in patients using alcohol, as ginseng reduced blood concentration of alcohol (ethanol) and enhanced blood alcohol clearance.
  • Use cautiously in patients 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 perioperative period, as ginseng is known to have an effect on the perioperative period. Anesthetists should inquire about a patient's use of ginseng.
  • Use suggested amounts cautiously in children, due to inadequate safety evidence.
  • Avoid in patients with bleeding disorders or those taking drugs, herbs, or supplements that may increase the risk of bleeding, as ginseng may increase the risk of bleeding. Dosing adjustments may be necessary.
  • Avoid use of large amounts of ginseng extract in infants.
  • Avoid in patients with known allergy or hypersensitivity to Panax species, their constituents, or to other members of the Araliaceae family. Allergic reactions to Korean red ginseng and cross-reactions with other members of the Araliaceae family have been reported. Anaphylaxis-like symptoms have occurred after ingestion of Panax ginseng syrup.
  • Avoid in patients who are pregnant or breastfeeding. Although not well studied in humans, ginseng may have teratogenic and embryotoxic effects.

Pregnancy and Breastfeeding

  • Avoid in pregnant or breastfeeding women, due to a lack of available scientific evidence and safety information.
  • 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 systematically 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. Although not well studied in humans, the ginsenoside Rb1 may cause birth defects in animals.

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. Patients 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 patients 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 cause increased or decreased effects or potentially serious adverse reactions. Patients 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, Alzheimer's agents, analgesics, anesthetics, antianxiety agents, antiarrhythmics, antiasthmatics, antibiotics, antidepressants (monoamine oxidase inhibitors (MAOIs)), antiemetics, antifungals, antihistamines, anti-inflammatories, antilipemics, antineoplastics, antiobesity agents, antiparasitics, antipsychotics, antiretrovirals, antiulcer agents, antivirals, caffeine, calcium channel blockers, cardiac glycosides, CNS depressants, CNS stimulants, corticosteroids, disulfiram, diuretics, hepatotoxins, immunosuppressants, impotence agents, influenza vaccine, metronidazole, opiates, phenytoin, photosensitizers, protease inhibitors, QT-prolonging drugs, radioprotective drugs, steroids, sympathomimetics, and vasodilators.

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 patients 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, Alzheimer's agents, analgesics, anesthetics, antiallergy agents, antiarrhythmics, antiasthmatics, antibacterials, antidepressants (monoamine oxidase inhibitors (MAOIs)), antiemetics, antihistamines, anti-inflammatories, antilipemics, antineoplastics, antiobesity herbs and supplements, antioxidants, antiparasitics, antipsychotics, antiulcer agents, antivirals, anxiolytics, aphrodisiacs, ashwagandha (Withania somnifera), caffeine, cardiac glycosides, cardiovascular agents, Carthamus tinctorius, dehydroepiandrosterone (DHEA), diuretics, epicatechin, Ginkgo biloba, glycyrrhiza, hepatotoxins, immunosuppressants, impotence herbs and supplements, mate, opioids, photosensitizers, radioprotective agents, radix Astragali, red clover, sedatives, steroids, stimulants, sympathomimetics, vasodilators, and vitamin C.

Authors

  • This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

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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  3. Biondo PD, Robbins SJ, Walsh JD, et al. A randomized controlled crossover trial of the effect of ginseng consumption on the immune response to moderate exercise in healthy sedentary men. Appl Physiol Nutr Metab 2008;33(5):966-975.
  4. Carabin IG, Burdock GA, Chatzidakis C. Safety Assessment of Panax Ginseng. International Journal of Toxicology 2000;19 (4).
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  8. Kim J, Chung SY, Park S, et al. Enhancing effect of HT008-1 on cognitive function and quality of life in cognitively declined healthy adults: a randomized, double-blind, placebo-controlled, trial. Pharmacol Biochem Behav 2008;90(4):517-524.
  9. Kim YS, Jin SH. Ginsenoside Rh2 induces apoptosis via activation of caspase-1 and -3 and up-regulation of Bax in human neuroblastoma. Arch Pharm Res 2004;27(8):834-839.
  10. Kimura Y, Okuda H, Arichi S. Effects of various ginseng saponins on 5-hydroxytryptamine release and aggregation in human platelets. J Pharm Pharmacol 1988;40(12):838-843.
  11. King ML, Adler SR, Murphy LL. Extraction-Dependent Effects of American Ginseng (Panax quinquefolium) on Human Breast Cancer Cell Proliferation and Estrogen Receptor Activation. Integrative Cancer Therapies 2006;5(3):236-243.
  12. Lee YJ, Jin YR, Lim WC, et al. Ginsenoside Rc and Re stimulate c-fos expression in MCF-7 human breast carcinoma cells. Arch Pharm Res 2003;26(1):53-57.
  13. McElhaney JE, Goel V, Toane B, et al. Efficacy of COLD-fX in the prevention of respiratory symptoms in community-dwelling adults: a randomized, double-blinded, placebo controlled trial. J Altern Complement Med 2006;12(2):153-157.
  14. Predy GN, Goel V, Lovlin R, et al. Efficacy of an extract of North American ginseng containing poly-furanosyl-pyranosyl-saccharides for preventing upper respiratory tract infections: a randomized controlled trial. CMAJ 2005;173(9):1043-1048.
  15. Rotem C, Kaplan B. Phyto-Female Complex for the relief of hot flushes, night sweats and quality of sleep: randomized, controlled, double-blind pilot study. Gynecol Endocrinol 2007;23(2):117-122.
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