American ginseng stimulates convalescence, rehabilitation, stamina and strength through actions that are similar to those of its more famous Asian cousin, Panax ginseng. In Asian countries, ginseng is regarded as the king of herbs and is added to many everyday items, including beverages. The Chinese associated ginseng with longevity, virility, strength, and wisdom as early as 1 A.D., according to written accounts. As long as the roots are five or six years old, at which time they contain suitable amounts of active plant chemicals, American ginseng is considered similar enough to Asian ginseng chemically to be used interchangeably.

Ginseng can be difficult to cultivate. It is susceptible to blights, needs loamy, high-humus soil, and prefers 70% shade. This difficulty made it a good export crop early on in American history, because it was plentiful here. In 1718, American ginseng brought five dollars a pound in Canton, China. In 1773, 55 tons of American ginseng were sold to the Chinese. By 1824, 380 tons were exported. Even Daniel Boone traded ginseng.

Ginseng is classified as an adaptogen and antioxidant. Adaptogens increase physiological resistance to stressors. Antioxidants function similarly, reducing the negative consequences of free radicals. Modern research shows that ginseng improves resistance to bacterial, viral, emotional, cognitive, muscular, metabolic, and cardiovascular stressors, and suggests a plethora of ginseng or ginseng constituent actions. While the elderly take it to diminish debility from age-related illness, others take it to enhance physical and cognitive performance. Ongoing studies are looking into ginseng for the treatment of cancer, diabetes, cardiovascular disease, non–AIDS related immune system depression, infertility, aging, and depression.

According to alternative medicine practitioners, American and Asian ginsengs are indicated in stress, fatigue, convalescence and diabetes, and Siberian ginseng in stress, fatigue, atherosclerosis, and impaired kidney function. Confusion regarding which ginseng to use for stress, fatigue, and convalescence (American, Asian, or Siberian) stems from the suggestion that active components in one type are superior to those in another type, e.g., ginsenosides versus eleutherosides. Such superiority has not been demonstrated. Early Russian studies indicated that Siberian ginseng's positive effects exceed those of Asian ginseng's. These results are supported by empirical reports, but are challenged by investigators who question the validity of the studies and the quality of the Siberian ginseng preparation. At this time, all three ginsengs are regarded as adaptogens, all three share contraindication and side effect profiles, and despite qualitative differences, each is used for similar indications. Cost, standardization, and the reputation of the manufacturer may be the deciding points in determining which product to use.

After two years' growth the leaves are five-lobed and palmate; after a few more years, leaflets develop on prongs. Stem grows from a tap root and can reach up to 16 inches in height. Small, greenish-white flowers grow in clusters and produce red berries with two seeds.

Light beige, variably thick, gnarled root can appear similar in shape to the human body, and has offshoots with long stringy hairs that can look like arms and legs. The root is harvested at 4 to 6 years' age; age is determined by the numbers of wrinkles on the neck of the root. The crude drug is prepared from the lateral root and root hairs.

• Roots

Dried root contains ginsenosides (Rb1 as marker); polysaccharide glycans (quinquefolan A, B, and C)

White ginseng (dried, peeled) is prepared as liquid extracts, powders, or capsules.

Traditional:

• Adaptogen
• Bitter tonic
• Restorative
• Alterative

Clinical applications:

• Diabetes
• Ulcer
• Edema
• Cancer
• Hypercholesterolemia
• Infertility
• Fatigue
• Frequent colds or viral illness
• Rehabilitation after acute illness
• To increase stamina and well being

American ginseng reduces stress and fatigue and improves physical and mental function. In studies in humans, American ginseng improves cholesterol ratios, increases blood alcohol clearance, reduces liver toxicity, improves psychomotor performance, helps control asthma, lowers blood sugar levels, and regulates blood pressure and adrenocorticotropic hormone. Studies in humans also indicate that American ginseng may be used as adjunctive therapy in the treatment of diabetic neuropathy, reactive depression, psychologically-induced impotence, and psychological disorders in children. Many of these studies involve other species of ginseng, in particular, Panax ginseng (Asian ginseng). However, while further study is needed for clarification, the two species do exert similar actions.

Non-insulin-dependant diabetes is perhaps the condition most often used to study the effects of constituents specific to American ginseng. The polysaccharide glycans, quinquefolans A, B, and C are hypoglycemic in mice. Ginsenoside Rb1 reduces concentrations of islet insulin to practically nothing.

White ginseng standardized to 0.03% ginsenosides, designated as Rb1. The recommended dose is: 1 to 2 g fresh root, 0.6 to 2 g dried root, or 200 to 600 mg liquid extract daily. Healthy persons using American ginseng for enhanced physical or mental performance or to improve resistance to stressors should take these doses in cycles of 15 to 20 days followed by two-week breaks.

For rehabilitation after an illness, the elderly should take 0.5 g bid for three months; or, take 0.5 g bid for one month, followed by a two-month break, and repeat cycle if desired.

American ginseng is not considered to have side effects when used at the recommended daily dose.

The American Herbal Products Association (AHPA) rates American ginseng as class 2d: 2d indicates that specific restrictions apply; hypertension is the specific restriction.

Similar contraindications to those for Asian ginseng may be applicable to American ginseng: patients with acute illness, cardiovascular disease, diabetes, or blood pressure disorders should use caution when taking ginseng. Pregnant women should not take ginseng because its safety during pregnancy has not been determined.

American ginseng is currently on the United Plant Savers (UpS) at-risk list, meaning that the species is endangered due to overharvesting or lack of habitat. Wisconsin currently produces the most ginseng, which is still sent primarily to China. In 1905 the state passed a law that made it illegal to dig ginseng roots until after they've been allowed to set seed (August 1). Poaching roots and spreading fungus from cultivated to wild crops are as much of a threat to the species as is overharvesting.

There have been reports of a possible interaction between ginseng and phenelzine (Jones and Runikis 1987). This interaction has resulted in symptoms ranging from manic-like episodes to headache and tremulousness. While the mechanism for this suspected interaction remains unclear, it is thought that ginsenosides inhibit cyclic AMP phosphodiesterase and affect cortical steroid secretion. This activity may explain the psychoactive effects of ginsenosides either alone or in combination with monoamine oxidase inhibitors.

There is a case report of an interaction between ginseng and warfarin in a 47-year-old heart valve replacement patient (Cheng 2000; Janetsky and Morreale 1997). Within two weeks of adding ginseng to his medication regimen, his INR declined from 3.1 to 1.5. Upon discontinuing the ginseng, his INR value rose to 3.3 over a two week period. INR values should be monitored carefully in patients taking ginseng with warfarin. Studies confirming this interaction have not been performed and the mechanism remains unclear.

The U.S. FDA classifies ginseng as a dietary supplement. In Germany, ginseng root is approved with nonprescription status, and in the United Kingdom it is licensed on the General Sale List.

Bahrke M, Morgan P. Evaluation of the ergogenic properties of ginseng. Sports Medicine. 1994;18:229-248.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998.

Blumenthal M, Riggins C. Popular Herbs in the U.S. Market: Therapeutic Monographs. Austin, Tex: The American Botanical Council; 1997.

Chen X, et al. The effects of Panax quinquefolium saponin (PQS) and its monomer ginsenoside on heart. Chung Kuo Chung Yao Tsa Chih. 1994;19:617-20, 640.

Cheng TO. Ginseng-warfarin interaction. ACC Curr J Rev. 2000;9(1):84.

Foster S. Herbal Renaissance: Growing, Using and Understanding Herbs in the Modern World. Salt Lake City, Utah: Gibbs-Smith; 1993.

Huang KC. The Pharmacology of Chinese Herbs. Boca Raton, Fla: CRC Press; 1993.

Janetsky K, Morreale A. Probable interaction between warfarin and ginseng. Am J Health-Syst Pharm. 1997;54:692-693.

Jones BD, Runikis AM. Interaction of ginseng with phenelzine [letter]. J Clin Psychopharmacol. 1987;7(3):201-202.

Kowalchik C, Hylton W, eds. Rodale's Illustrated Encyclopedia of Herbs. Emmaus, Pa: Rodale Press; 1998.

Kwan CY. Vascular effects of selected antihypertensive drugs derived from traditional medicinal herbs. Clin Exp Pharmacol Physiol. 1995;(suppl 1):S297-S299. Review.

Li J, et al. Panax quinquefolium saponins protect low density lipoproteins from oxidation. Life Sci. 1999;64:53-62.

McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, Fla: CRC Press; 1996.

Murphy LL, et al. Effect of American ginseng (Panax quinquefolium) on male copulatory behavior in the rat. Physiol Behav. 1998;64:445-450.

Murray M. The Healing Power of Herbs: The Enlightened Person's Guide to the Wonders of Medicinal Plants. Rocklin, Calif: Prima Publishing; 1995.

Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press; 1996.

Oshima Y. Isolation and hypoglycemic activity of quinquefolans A, B, and C, glycans of Panax quinquefolium roots. J Nat Prod. 1987;50:188-190.

Schulz V, Hänsel R, Tyler V. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine. 3rd ed. Berlin: Springer; 1998.

Thornton L. The ethics of wildcrafting. The Herb Quarterly. 1998:41-46.

Waki I. Effects of a hypoglycemic component of Ginseng radix on insulin biosynthesis in normal and diabetic animals. J Pharmacobiodyn. 1982;5:547-554.

Yuan CS, et al. Modulation of American ginseng on brainstem GABAergic effects in rats. J Ethnopharmacol. 1998;62:215-222.