||Asian Ginseng (English)|
Araliaceae (Plant Family)
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,
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
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
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;
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,
Clinical applications: rehabilitation; to increase stamina and well-being,
particularly in the elderly. German Commission E monograph describes ginseng as
"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
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.
|Dosage Ranges and Duration of
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
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
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
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
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.
|Regulatory and Compendial
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.
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
Blumenthal M, Riggins C. Popular Herbs in the U.S. Market: Therapeutic
Monographs. Austin, Tex: The American Botanical Council; 1997.
Cheng TO. Ginseng-warfarin interaction. ACC Curr J Rev. 2000;9(1):84.
Choi HK, Seong DH, Rha KH. Clinical efficacy of Korean red ginseng for
erectile dysfunction. Int J Impotence Res. 1995;7:181-186.
D'Angelo L, et al. A double-blind, placebo-controlled clinical study on the
effect of a standardized ginseng extract on psychomotor performance in healthy
volunteer. J Ethnopharmacol. 1986;16:15-22.
Dega H, Laporte JL, Frances C, Herson S, Chosidow O. Ginseng as a cause for
Stevens-Johnson Syndrome? Lancet. 1996;347:1344.
De Smet PAGM, Keller K, Hänsel R, Chandler RF, eds. Adverse Effects of
Herbal Drugs. Berlin: Springer-Verlag; 1997:1.
Ding DZ, Shen TK, Cui YZ, et al. The effects of red ginseng on the congestive
heart failure and its mechanism [in Chinese]. Chung Kuo Chung His I Chieh Ho
Tsa Chih. 1995;15(6):325-327.
Dorling E. Do ginsenosides influence the performance? Results of a
double-blind study. Notabene medici. 1980;10:241-246.
Foster S. Asian Ginseng. Austin, Tex: The American Botanical Council;
Gross D, Krieger D, Efrat R, Dayan M. Ginseng extract G115 for the treatment
of chronic respiratory diseases. Schweizerische Zeitschrift fur Ganzheits
Huang KC. The Pharmacology of Chinese Herbs. Boca Raton, Fla: CRC
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
Kim YR, Lee SY, Shin BA, Kim KM. Panax ginseng blocks morphine-induced
thymic apoptosis by lowering plasma corticosterone level. Gen Pharmacol.
Kowalchik C, Hylton W, eds. Rodale's Illustrated Encyclopedia of
Herbs. Emmaus, Pa: Rodale Press; 1998.
McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products
Association's Botanical Safety Handbook. Boca Raton, Fla: CRC Press;
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.
Quiroga HA, Imbriano AE. The effect of Panax ginseng extract on
cerebrovascular deficits. Orientacion Medica. 1979;1208:86-87.
Quiroga HA. Comparative double-blind study of the effect of Ginsana Gii5 and
Hydergin on cerebrovascular deficits. Orientacion Medica.
Schulz V, Hänsel R, Tyler V. Rational Phytotherapy: A Physicians' Guide to
Herbal Medicine. 3rd ed. Berlin: Springer; 1998.
Sun XB, Matsumoto T, Yamada H. Purification of immune complexes clearance
enhancing polysaccharide from the leaves of Panax ginseng, and its
biological activities. Phytomedicine. 1994;1:225-231.
Takahashi M, Tokuyama S. Pharmacological and physiological effects of ginseng
on actions induced by opioids and psychostimulants. Meth Find Exp Clin
Tang W, Eisenbrand G. Chinese Drugs of Plant Origin: Chemistry,
Pharmacology, and Use in Traditional and Modern Medicine. New York, NY:
You JS, Hau DM, Chen KT, Huang HF. Combined effects of ginseng and
radiotherapy on experimental liver cancer. Phytotherapy Research.
Copyright © 2000 Integrative Medicine
CommunicationsThis publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein.