Ginseng is recommended to help the body recover from disease, and to improve mental and physical performance. Benefits attributed to it from over 2,000 years of use have been discussed in numerous studies. In Asian countries, ginseng is regarded as the king of herbs and is added to many every day items, including beverages. The Chinese have associated ginseng with longevity, virility, strength, and wisdom since at least 1 A.D., according to written accounts.

The scientific name given to ginseng by Swedish botanist Carl Linnaeus in 1753 uses the Greek words pan (all) and ax (akos; cure) to mean the root that cures all ills. More recently, ginseng is classified as an adaptogen and antioxidant. Adaptogens are substances that increase physiological resistance to stressors. Antioxidants function similarly, decreasing circulating free radicals and reducing their negative effects on the body. Modern research shows that ginseng increases the body's ability to fight against bacterial, viral, emotional, cognitive, muscular, metabolic, and cardiovascular stressors.

Elderly persons take ginseng to induce a feeling of well-being, increase stamina, and combat the negative physical and mental effects of recent or chronic age-related degenerative conditions. Younger persons take it to increase athletic strength and sexual virility and to improve intellectual performance. Ongoing studies are looking into the effects of ginseng as adjunctive therapy for cancer, diabetes, cardiovascular disease, non–AIDS related immune system disorders, male and female infertility, aging, menopause, and depression.

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.

The ginseng root is harvested at 4 to 6 years' age. Mature herbaceous plants bear five-lobed palmate leaves, which circle a stem that grows from a tap root and can reach up to 16 inches in height. At the fourth year, the plant produces a small, greenish-white umbel-shaped flower cluster at the junction of the leaves and stem. These produce red berries.

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. Age is determined by the numbers of wrinkles around the neck of the root. The crude drug is prepared from the lateral root and root hairs.

• Roots

Dried root contains at least 1.5% ginsenosides (Rg1 as marker); glycans (panaxans) up to 0.05% volatile oil; polysaccharide fraction DPG-3-2; peptides; and maltol.

White ginseng (dried, peeled) or red ginseng (unpeeled root steamed before drying) is prepared as aqueous, aqueous-alcohol, or alcohol liquid extracts, and as powders or capsules.

Traditional: adaptogen, tonic, restorative, alterative, anodyne, appetite-stimulant, aphrodisiac, antidepressant, cardiotonic, carminative, expectorant, hormone restorative, nervine, sedative, sialogogue, stimulant, stomachic.

Clinical applications: rehabilitation; to increase stamina and well-being, particularly in the elderly. German Commission E monograph describes ginseng as a "tonic to counteract weakness and fatigue, as a restorative for declining stamina and impaired concentration, and as an aid to convalescence." Also used to treat diabetes, ulcer, edema, cancer, hypercholesterolemia, infertility, fatigue, frequent colds or viral illness, menopause, and red blood cell depletion.

In 37 clinical studies published between 1968 and 1990, ginseng improved physical and cognitive performance, mood, or metabolism. Still other studies suggest a plethora of ginseng actions.

• Ginseng improves cholesterol ratios
• Elevates blood alcohol clearance
• Reduces liver toxicity
• Improves psychomotor performance
• Helps control asthma and chronic respiratory disease (200 mg per day improved respiratory strength, oxygenation capacity, and walking distance in chronic respiratory disease patients)
• Lowers blood sugar levels
• Regulates blood pressure and adrenocorticotropic hormone
• Enhances athletic stamina

Studies in humans also indicate that ginseng may be used as adjunctive therapy in the treatment of diabetic neuropathy, reactive depression, psychologically-induced impotence, and psychological disorders in children.

Asian ginseng stimulates the central nervous system, neurotransmitters, oxygen metabolism, and glycogen stores. Antidiabetic effects may be due to hypoglycemic actions of panaxans and ginseng polysaccharide fraction DPG-3-2. Virility may be related to increases in both male and female hormones in gonads. The beneficial effects of ginseng in treating cardiovascular disease may be due to decreases in serum levels of cholesterol, triglyceride, and fatty acids, and increases in high-density lipoprotein.

Studies in mice have shown that ginseng elevates antibody levels, improves cell-mediated immunity and natural-killer-cell activity, lymphocytes, phagocytosis, in vitro; stimulates interferon production in the spleen. Polysaccharides in leaves and roots enhance macrophage binding. Also in mice, ginseng extracts inhibit DMBA-, urethane-, and aflatoxin B1-induced tumors; injections of ginseng administered along with radiation prevent radiation-induced bone marrow death and increase liver cell recovery. Ginseng also stimulates red blood cell formation in bone marrow.

White or red ginseng standardized to 1.5% ginsenosides, designated as Rg1. The recommended dose is 1 to 2 g fresh root, or 0.6 to 2 g dried root, or 200 to 600 mg liquid extract daily. Healthy persons using 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.

The German Commission E cites no adverse effects with recommended daily dose. Agitation, addiction, changes in blood pressure, or "Ginseng Abuse Syndrome" are no longer associated with the normal use of ginseng. Adulterants, such as caffeine, are thought to cause these effects; NSAID adulterants may cause ginseng-associated Stevens–Johnson syndrome.

The American Herbal Products Association (AHPA) rates ginseng as a class 2d herb; 2d indicates that specific restrictions apply; in the case of ginseng, hypertension is the specific restriction.

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.

A study conducted with 45 patients with class IV cardiac function examined the effects of ginseng combined with digoxin for the treatment of congestive heart failure (CHF) (Ding et al. 1995). Patients were randomized into three groups of 15 to be treated with either digoxin alone, ginseng alone, or a combination of digoxin and ginseng. The hemodynamic and biochemical results obtained in the group receiving the combination of digoxin and ginseng were the most significant compared with patients receiving either digoxin alone or ginseng alone. The authors suggest that this herb acted synergistically with digoxin and was a safe and effective treatment for CHF patients.

Orally administered Panax ginseng may counter the effects of morphine in mice with morphine-induced immune suppression by lowering plasma corticosterone levels (Kim et al. 1999). Concomitant administration of ginseng total saponin (100 mg/kg po for 9 days) blocked the elevations in serum corticosterone levels associated with morphine (20 mg/kg subcutaneously for 4 days). In addition, it has been reported that ginseng blocks the analgesic effects of opioids and may offer a clinically useful option for the treatment of opioid dependence and abuse (Takahashi and Tokuyama 1998).

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 the ginseng root is approved with nonprescription status, and in the United Kingdom it is licensed on the General Sale List.

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