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Supplements

ginseng (Panax)

What Is It?
Health Benefits
Forms

Dosage Information

Guidelines for Use

General Interaction

Possible Side Effects
Cautions

References
Evidence Based Rating Scale
 

What Is It?

For thousands of years in Asia, the ginseng herb has had a reputation as a tonic that can boost energy, combat the physical effects of stress, empower the immune system, and improve concentration. Its legendary properties, particularly as an aphrodisiac, were once so prized in China that only the emperor was allowed to gather the herb. Today, ginseng is promoted for these beneficial effects as well as for its antioxidant properties, and it is added to many everyday products such as orange juice and multivitamins.

The healing ingredients in Panax ginseng are concentrated in the root, or what traditional Chinese healers call the "man root" because its shape resembles a human. This classic form of ginseng, also known as Asian, Chinese or Korean ginseng is the most widely available and extensively studied form. (1, 2) Siberian ginseng (Eleutherococcus senticosus) and American ginseng (Panax quinquefolius) are botanical cousins with different effects.

A growth period of four to six years is necessary for full maturation of the plant's complex mixture of energizing compounds known as ginsenosides, panaxans (substances that reportedly lower blood sugar), and polysaccharides (complex sugar molecules that enhance the immune system).

High-quality ginseng root is expensive and must be properly cured to be of any therapeutic value. A recent analysis of products on the market revealed that some so-called ginseng supplements are devoid of active ingredients. Other examinations have found that the amount of active ginsenosides in different brands varies widely. Such ginseng products as chewing gum and soft drinks probably contain little, if any, of the constituents from the root.

Health Benefits

Panax ginseng is one of the most widely studied herbs and also one of the most economically important herbs in world trade. It has been used to treat a variety of conditions, from fatigue and infertility to cancer and diabetes, providing a broad range of nutritional and medicinal properties. Indeed the name “Panax” is derived from the Greek words for “all” (pan) and “cure” (akos). (3) Herbalists consider it to be an adaptogen—a natural herb that increases the body's resistance to stress, trauma, anxiety and fatigue.

Specifically, ginseng may help to:

Combat physical and mental fatigue. The energizing effects of Panax ginseng seem to result from a stimulant effect on the central nervous system during stress. Evidence of this effect has been shown in animal and human studies that demonstrate that ginseng leads to improved physical and mental performance. Several preliminary studies in the 1950s and 1960s provided the basis for researchers to further investigate these beneficial effects of ginseng. (4-8) For example, one study showed that Soviet soldiers taking ginseng ran faster than those taking a placebo. (6) In mice, ginseng has been shown in several studies to possess clear anti-fatigue properties, lengthening time to exhaustion by up to 183% during exercise. (7, 9-12) However, conflicting evidence exists in humans. In several human studies with ginseng, aerobic exercise performance was not enhanced. (13-15) A 1999 Cochrane Database review of 16 double-blind, randomized, placebo-controlled studies evaluating the use of ginseng root for physical performance, psychomotor performance, or cognitive function found a lack of compelling evidence in high-quality studies to confirm efficacy of ginseng for these uses. (16) Many of the more positive studies were carried out in Asia where higher doses tend to used; thus it is unclear whether the difference in outcomes is a result of dosage used or study quality. More research is needed.

Several studies have shown that Panax ginseng improves cognitive performance. An early study showed that radio operators taking ginseng worked faster and with fewer mistakes than those taking placebo. (7) In a double-blind study at a London hospital in 1982, a group of nurses were given ginseng or placebo for three consecutive days before switching to night duty. The ginseng treatment group reported better scores for competence, mood, general well-being and performance on tests for speed and coordination compared to the placebo group. (17) In another double-blind, crossover study, college students in Italy were given either ginseng or placebo before various psychomotor tests. Taking ginseng led to improved performance in attention, mental arithmetic skills, logical deduction, and reaction time compared to placebo. However, statistically significant superiority of the ginseng group over the placebo group was noted only in mental arithmetic. Interestingly, the ginseng group reported a greater sense of well-being throughout the trial than the placebo group. (18) A later study also found that taking ginseng improved abstract thinking, mental arithmetic skills, and reaction times in healthy, middle-aged adults. (19) However, the same Cochrane review noted above indicates a lack of compelling evidence or high-quality research supporting the use of ginseng to improve cognitive function. Of note, while Panax ginseng alone does not seem to improve memory, some evidence indicates that a combination of ginseng and ginkgo leaf extract can improve memory in otherwise healthy adults ages 38 to 66. (20, 21) More research is needed.

Reduce effects of stress. The adaptogenic properties of ginseng have been touted for providing relief from stress, but evidence has not been convincing. Some studies have shown that taking Panax ginseng improves self-rated quality of life. A 1996 study compared quality-of-life parameters in 501 adults experiencing stress from high physical and mental activity. Participants were given either a multivitamin with ginseng or a multivitamin alone daily for 12 weeks. By the end of the study, the ginseng group showed improved ratings for overall quality of life compared to the placebo group. (22) Other studies, however, showed no benefit of ginseng for improving quality of life. (23, 24) A 2003 review of studies clarified that while improvement of overall health-related quality of life cannot be solely attributed to ginseng, the herb did contribute to the improvement of some facets of quality of life, such as mood and well-being. (25) More research is needed.

Regulate diabetes. Some constituents of Panax ginseng have been shown to have hypoglycemic activity that is beneficial to patients with type 2 diabetes. (26-30) In one study of 36 patients with type 2 diabetes, taking 200 mg of ginseng for eight weeks reduced levels of fasting blood glucose (FBS) and Hemoglobin A1c, elevated mood, and improved psychophysical performance while helping to lower body weight. Placebo users did not alter their FBS. (31) However, results have not been convincing. A 1999 Cochrane Database review of 16 studies evaluating the use of ginseng for various conditions, including type 2 diabetes, found the trials were of small sample sizes and short duration, leading to a lack of compelling evidence to rate ginseng for this use. (32) More research is needed.

Treat male infertility. Male infertility is generally defined as a sperm count of less than 5 million sperm per ml, the presence of more than 50% abnormal sperm, and/or inability of the sperm to impregnate an egg in the laboratory. Studies in animals have shown that ginseng may stimulate the production of testosterone and the formation of sperm, suggesting the possibility of improved fertility in men. In animals, Panax ginseng has shown efficacy in promoting growth of the testes, increasing sperm formation, testosterone levels, sexual activity, and mating behavior in animals. (33, 34) Human studies are limited; however in a 1996 study of 36 infertile men, taking ginseng did increase sperm count, sperm motility, and testosterone levels. (35)

Treat Erectile Dysfunction. The vasodilating effects of ginseng have been shown to improve sexual function in men with erectile dysfunction (ED). In a 2002 double-blind, placebo controlled, crossover study of 45 patients with ED, taking 900 mg of ginseng three times daily significantly improved patient satisfaction, libido, rigidity, and tumescence compared with trazadone and with placebo. (36)

Relieve menopause symptoms. Some evidence has shown ginseng may help to relieve some symptoms of menopause. One study of 384 menopausal women compared the effects of a standardized ginseng extract to placebo. While relief of symptoms was only slightly better in the ginseng group than the placebo group, taking ginseng was associated with statistically significant improvements in mood and well-being. However, no statistically significant effects were reported for physiologic parameters, including symptoms such as hot flashes. (37) A small study also found that taking ginseng for 30 days improved quality of life and menopausal symptoms such as fatigue, insomnia, and depression in 12 postmenopausal women. (38) More research is needed.

Prevent cancer. Preliminary studies in animals and in three population studies have shown that regularly consuming ginseng reduces the risk for development of cancer, specifically liver, lung, ovarian, skin, and stomach cancers. (39-41) The studies were all carried out in Korea by the same research team, and it’s possible that other lifestyle differences among the ginseng users may have contributed to the apparent benefit. However, laboratory studies have shown that ginseng possesses anticancer effects, such as stimulating natural-killer cell activity, and anti-tumor activity. (42-45) More human trials are needed.

Resist the common cold. Preliminary evidence indicates that taking a specific Panax ginseng extract (G115) may increase the efficacy of influenza vaccination in preventing both colds and flu. In a study of 227 volunteers who took 100 mg of the ginseng extract or placebo daily for 12 weeks and who received influenza vaccination at week four, there were significantly fewer cases of subsequent colds or influenza in the ginseng group. (46) More research is needed.

Treat bronchitis. Some evidence indicates ginseng may help to reduce infection, relax inflamed bronchial smooth muscle and relieve coughing associated with bronchitis. (47) In a 2001 pilot study of 75 chronic bronchitis patients who were having acute bronchitis attacks, taking the specific Panax ginseng extract (G115) in conjunction with antibiotic therapy seemed to reduce bronchial bacterial counts more than antibiotic therapy alone. (48) More research is needed.

Forms

  • liquid
  • lozenge
  • pill
  • powder
  • tea 

Dosage Information

Use products standardized to contain at least 7% ginsenosides, the main active ingredient in ginseng.

  • For fatigue: 650 mg or twice daily has been used.

  • For stress: 100-200 mg two to three times daily has been used.

  • For diabetes: 200 mg daily has been used.

  • For infertility, male: 650 mg twice daily has been used.

  • For erectile dysfunction: 900 mg three times daily.

  • For menopause: 600 mg daily has been used

  • For cancer prevention: No standard dosage has been established.

  • For common cold: 100 mg daily, four weeks prior to flu vaccination and continued for eight weeks afterwards has been used.

  • For bronchitis: 100 mg twice daily for nine days in conjunction with antibiotic therapy has been used.

Guidelines for Use

Use products standardized to contain at least 7% ginsenosides, the main active ingredient in ginseng.

General Interaction

Because of a risk of unwanted interactions, consult a physician before taking ginseng along with MAO inhibitors (drugs primarily used to treat depression), antipsychotics, diabetes medications, heart disease medications, high blood pressure medications, diuretics (furosemide in particular), anti-coagulants, or oral corticosteroids.

Ginseng may increase the risk of over stimulation and stomach upset when taken with methylphenidate (Ritalin) and other nervous system stimulants. 

Possible Side Effects

Consuming large amounts of caffeine or other stimulants while taking ginseng can result in nervousness, sleeplessness, elevated blood pressure, and other complications. 

Note: For information on interactions with specific drugs, see our WholeHealthMD Drug/Nutrient Interactions Chart.

Cautions

Because the effects of long-term use of ginseng remain to be carefully researched, avoid using it for more than three months at a stretch. 

Ginseng is a stimulant, so avoid taking it at bedtime. 

Higher than commonly recommended doses may cause nervousness, insomnia, headache, skin eruptions, stomach upset, and increased menstrual bleeding and breast tenderness. If any of these reactions are present, reduce the dosage or stop taking the herb. 

Patients with an acute illness, such as uncontrolled high blood pressure, an irregular heart rhythm, or who are pregnant should avoid taking ginseng.

Ginseng may have estrogen-like effects. Patients with hormone dependent conditions e.g. breast and uterine cancers, uterine fibroids, endometriosis, should avoid it. 

References 

1. Leung AY, Foster S. Encyclopedia of common natural ingredients used in food, drugs and cosmetics. New York: John Wiley, 1996:277-281.
2. Shibata S, Tanaka O, Shoji J, et al. In Wagner H, Hikino H, Farnsworth NR, eds. Economic and medicinal plant research, vol 1. London: Academic Press, 1985:217-284.
3. Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Austin, TX: American Botanical Council; Boston: Integrative Medicine Communications; 2000.
4. Petkov W. [Pharmacology of the drug Panax ginseng.] Arzneimittelforschung. 1959;9:305-311.
5. Petkov W. [On the mechanism of action of Panax ginseng C.A. Mey: on the problem of a pharmacology of reactivity.2.] Arzneimittelforschung. 1961;11:288-295, 418-422.
6. Brekhman II, Dardymov IV. New substances of plant origin which increase nonspecific resistance. Annu Rev Pharmacol. 1969;9:419-430.
7. Brekhman II, Dardymov IV. Pharmacological investigation of glycosides from ginseng and Eleutherococcus. Lloydia 1969;32:46-51.
8. Petkov V. Effect of ginseng on the brain biogenic monoamines and 3’5’-AMP system. Experiments in rats. Arzneimittelforschung. 1978;28:388-393.
9. Sterner W, Kirchdorfer AM. Comparative work load tests on mice with standardized ginseng extract and a ginseng containing pharmaceutical preparation. Z Gerontol. 1970;3:307-312.
10. Saito H, Yoshida Y, Takagi K. Effect of Panax ginseng root on exhaustive exercise in mice. Jpn J Pharmacol. 1974;24:119-127.
11. Kaku T, Miyata T, Uruno T, et al. Chemico-harmacological studies on saponins of Panax ginseng. C.A. Meyer. II. Pharmacological part. Arzneimittelforschung. 1975;25:539-547.
12. Avakian EV Jr, Evonuk E. Effect of Panax ginseng extract on tissue glycogen and adrenal cholesterol depletion during prolonged exercise. Planta Med. 1979;36:43-48.
13. Morris AC, Jacobs I, McLellan TM, et al. No ergogenic effect of ginseng ingestion. Int J Sport Nutr 1996;6:263-71.
14. Engels HJ, Wirth JC. No ergogenic effects of ginseng (Panax ginseng C.A. Meyer) during grades maximal aerobic exercise. J Am Diet Assoc 1997;97:1110-5.
15. Allen JD, McLung J, Nelson AG, Welsch M. Ginseng supplementation does not enhance healthy young adult's peak aerobic exercise performance. J Am Coll Nutr 1998;17:462-6.
16. Vogler BK, Pittler MH, Ernst E. The efficacy of ginseng. A systematic review of randomized clinical trials. Eur J Clin Pharmacol. 1999 Oct;55(8):567-75.
17. Hallstrom C, Fulder S, Carruthers M. Effects of ginseng on the performance of nurses on night duty. Comp Med East West. 1982;6(4):277-282.
18. D’Angelo L, Grimaldi R, Caravaggi M, et al. A double-blind, placebo-controlled clinical study on the effect of a standardized ginseng extract on psychomotor performance in healthy volunteers. J Ethnopharmacol. 1986;16:15-22.
19. Sorensen H, Sonne J. A double-masked study of the effects of ginseng on cognitive functions. Curr Ther Res 1996;57:959-68.
20. Wesnes KA, Ward T, McGinty A, Petrini O. The memory enhancing effects of a Ginkgo biloba/Panax ginseng combination in healthy middle-aged volunteers. Psychopharmacology (Berl) 2000;152:353-61.
21. Scholey AB, Kennedy DO. Acute, dose-dependent cognitive effects of Ginkgo biloba, Panax ginseng and their combination in healthy young volunteers: differential interactions with cognitive demand.
Hum Psychopharmacol 2002;17:35-44.

22. Caso MA, Vargas RR, Salas VA, Begona IC. Double-blind study of a multivitamin complex supplemented with ginseng extract.
Drugs Exp Clin Res 1996;22:323-9.
23. Cardinal BJ, Engels HJ. Ginseng does not enhance psychological well-being in healthy, young adults: results of a double-blind, placebo-controlled randomized clinical trial. J Am Diet Assoc. 2001;101:655-60.
24. Ellis JM, Reddy P. Effects of Panax ginseng on quality of life. Ann Pharmacother. 2002;36:375-9.
25. Coleman CI, Hebert JH, Reddy P. The effects of Panax ginseng on quality of life. J Clin Pharm Ther. 2003 Feb;28(1):5-15.
26. Kimura M, Waki I, Chujo T, et al. Effects of hypoglycemic components in ginseng radix on blood insulin level in alloxan diabetic mice and on insulin release from perfused rat pancreas. J Pharmacobiodyn. 1981;4:410-417.
27. Kimura M, Waki I, Tanaka O, et al. Pharmacological sequential trials for the fractionation of components with hypoglycemic activity in alloxan diabetic mice from ginseng radix. J Pharmacobiodyn. 1981;4:402-9.
28. Waki I, Kyo H, Wasuda M, et al. Effects of a hypoglycemic component of ginseng radix on insulin biosynthesis in normal and diabetic animals. J Pharmacobiodyn. 1982;5:547-554.
29. Konno C, Sugiyama K, Kano M, et al. Isolation and hypoglycaemic activity of panaxans A, B, C, D and E, glycans of Panax ginseng roots. Planta Med. 1984;50:434-6.
30. Ng, TB, Yeung HW. Hypoglycemic constituents of Panax ginseng. Gen Pharmacol. 1985;16:549-552.
31. Sotaniemi EA, Haapakoski E, Rautio A. Ginseng therapy in non-insulin-dependent diabetic patients. Diabetes Care. 1995 Oct;18(10):1373-5.
32. Vogler BK, Pittler MH, Ernst E. The efficacy of ginseng. A systematic review of randomised clinical trials. Eur J Clin Pharmacol. 1999 Oct;55(8):567-75.
33. Kim C, Choi H, Kim CC, et al. Influence of ginseng on mating behavior of male rats. Am J Chin Med. 1976;4:163-8.
34. Nocerino E, Amato M, Izzo AA. The aphrodisiac and adaptogenic properties of ginseng. Fitoterapia. 2000;71(Suppl 1):S1-5.
35. Salvati G, Genovesi G, Marcellini L, et al. Effects of Panax Ginseng C.A. Meyer saponins on male fertility. Panminerva Med. 1996 Dec;38(4):249-54.)
36. Hong B, Ji YH, Hong JH, et al. A double-blind crossover study evaluating the efficacy of Korean red ginseng in patients with erectile dysfunction: a preliminary report. J Urol 2002;168:2070-3.
37. Wiklund IK, Mattsson LA, Lindgren R, Limoni C. Effects of a standardized ginseng extract on quality of life and physiological parameters in symptomatic postmenopausal women: a double-blind, placebo-controlled trial. Swedish Alternative Medicine Group. Int J Clin Pharmacol Res. 1999;19(3):89-99.
38. Tode T, Kikuchi Y, Hirata J, et al. Effect of Korean red ginseng on psychological functions in patients with severe climacteric syndromes. Int J Gynaecol Obstet 1999;67:169-74.
39. Yun TK, Choi SY. Non-organ specific cancer prevention of ginseng: a prospective study in Korea. Int J Epidemiol 1998;27:359-64.
40. Shin HR, Kim JY, Yun TK, et al. The cancer-preventive potential of Panax ginseng: a review of human and experimental evidence. Cancer Causes Control 2000;11:565-76.
41. Yun TK. Panax ginseng – a non-organ-specific cancer preventive? Lancet Oncol. 2001;2:49-55.
42. Lee KD, Huemer RP. Antitumoral activity of Panax ginseng extracts. Jpn J Pharmacol. 1971;21:299-302.
43. Yun TK, Yun YS, Han IW. Anticarcinogenic effect of long-term oral administration of red ginseng on newborn mice exposed to various chemical carcinogens. Cancer Detect Prev. 1983;6:515-525.
44. Liu WK, Xu SX, Che CT. Anti-proliferative effect of ginseng saponins on human prostate cancer cell line. Life Sci. 2000;67:1297-1306.
45. Kim HS, Lee EH, KO SR, et al. Effects of ginsenosides Rg3 and Rh2 on the proliferation of prostate cancer cells. Arch Pharm Res. 2004;27:429-435.
46. Scaglione F, Cattaneo G, Alessandria M, Cogo R. Efficacy and safety of the standardized Ginseng extract G115 for potentiating vaccination against the influenza syndrome and protection against the common cold. Drugs Exp Clin Res 1996;22:65-72.
47. Tamaoki J, Nakata J, Kawatani K, et al. Ginsenoside-induced relaxation of human bronchial smooth muscle via release of nitric oxide. Br J Pharmacol 2000;130:1859-64.
48. Scaglione F, Weiser K, Alessandria M. Effects of the standardized ginseng extract G115 (Reg.) in patients with chronic bronchitis: A nonblinded, randomized, comparative pilot study. Clin Drug Invest 2001;21:41-5.

Evidence Based Rating Scale

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.

 

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Date Published: 04/18/2005
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