- Chinese ginseng
- Ren shen
- Korean ginseng
- Red ginseng
For Patients & Caregivers
Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.
How It Works
Panax ginseng may be effective in treating erectile dysfunction and diabetes. Whether it can improve strength and stamina remains unknown.
The active ingredients in P. ginseng are called ginsenosides, which show both stimulatory and inhibitory activity in animal nervous systems. Certain ginsenosides may stimulate the immune system in mice. Other animal studies suggest ginseng may prevent some types of tumors, including ovarian, lung, liver, and skin cancers. A few studies in humans suggest this effect may also occur. In one study, Korean individuals who consumed ginseng extract had a decreased risk of all types of cancers.
Other experiments suggest that ginseng may increase nitric oxide production in the heart, lung, and kidneys, and lower cholesterol and triglyceride levels. Clinical trials suggest that ginseng can reduce muscle injury and inflammation after exercise.
Because ginseng was shown to have estrogenic effects, patients with hormone-sensitive cancers should consult their physicians before using it.
To treat angina
Lab studies suggest ginseng can increase synthesis of nitric oxide, a vasodilator. However, clinical trials have not been conducted to determine if it is useful in treating angina.
To treat diabetes
Ginseng may help increase the effect of insulin and reduce insulin resistance in type 2 diabetes.
To treat HIV and AIDS
Research suggests ginseng stimulates certain aspects of the immune system, but studies are limited and more research is necessary.
To stimulate the immune system
Clinical data support this use, but the long-term effects are still not known.
To treat sexual dysfunction
A clinical trial showed benefits of P. ginseng for male erectile dysfunction.
To improve strength and stamina
Clinical trials do not support this use.
Do Not Take If
- You are taking monoamine oxidase inhibitors: If combined with MAOIs, Panax ginseng can cause manic-like symptoms.
- You are taking insulin or sulfonylureas: P. ginseng may increase their effects, causing a drop in blood sugar.
- You are taking warfarin or other blood thinners: P. ginseng may lessen their effects.
- You are taking raltegravir: P. ginseng may increase its effects.
- You are taking imatinib: A case report suggests P. ginseng use may increase the potential for liver toxicity with this drug.
- Dry mouth
- Fast heart rate
- Nausea, vomiting
Mania: In a young man with no history of mental illness following chronic consumption of 250 mg of Panax ginseng capsules three times a day. Symptoms resolved when he stopped taking the herb.
Swollen breast tissue: In a 12-year-old boy after ingesting ginseng extract for body building.
Uncontrolled facial movements: In a 46-year-old woman who developed speech and eating difficulties as well as tongue-biting, following consumption of a formula containing black cohosh and ginseng. Symptoms resolved after discontinuing use of the formula.
Perioperative bleeding: In a 72-year-old woman following cardiac surgery, due to impaired clotting ability caused by high oral intake of ginseng before surgery.
Liver toxicity: In a 26-year-old man with chronic myelogenous leukemia who was on long-term imatinib. He had no complications with this medication until daily ingestion of Panax ginseng via energy drinks for 3 months, after which he experienced right upper quadrant pain. It is thought the interaction of ginseng with this drug played some role.
For Healthcare Professionals
Panax ginseng is an herb native to East Asia and Russia. It is also cultivated for its medicinal properties and the root is widely used as a “Yang” tonic in traditional medicine (1). Patients take ginseng to improve athletic performance, strength, and stamina, and as an immunostimulant. Some use it to treat diabetes, cancer, HIV/AIDS, and a variety of other conditions. Ginsenosides, the saponin glycosides, are thought responsible for Panax ginseng’s medicinal effects. They have both stimulatory and inhibitory effects on the CNS, alter cardiovascular tone, and increase humoral and cellular-dependent immunity (2).
Ginseng has been used in the treatment of erectile dysfunction (4). It may also increase the hypoglycemic effects of insulin and sulfonylureas and reduce insulin resistance in type II diabetic patients (5). Other studies suggest it may enhance immune response (19) (21) or benefit patients with pre-hypertension or hypertension (42). In postmenopausal women, it may improve menopausal symptoms and markers for cardiovascular disease (30). Other data suggest ginseng helps alleviate idiopathic chronic fatigue (33) and cold hypersensitivity of hands and feet in women (39).
Ginseng has been investigated for its anticancer potential as well. Ginsenosides showed antiproliferative effects in vitro (25) (26). Epidemiological data in breast cancer patients show improved survival and quality of life with ginseng use (3), and reduced risk of endometrial cancer in breast cancer survivors (38). In addition, two case-controlled studies indicate a positive association between consumption and reduction in the incidence of all cancers (11) (12). Randomized studies show safety and effectiveness of ginseng for reducing genotoxicity and improving quality of life in patients with epithelial ovarian cancer (43), but did not find any benefit in alleviating cancer-related fatigue in advanced cancer patients (44).
Because ginseng was shown to have estrogenic effects (23), patients with hormone-sensitive cancers should consult their physicians before using it. Panax ginseng should not be confused with American ginseng or Siberian ginseng, which have different medicinal properties.
Mechanism of Action
Animal studies suggest ginsenosides prolong drug-induced sleeping time in mice and exhibit additional depressant effects on the CNS (2). In addition, the ginsenoside Rb1 improves acetylcholine release and enhances postsynaptic uptake of choline (2). In other animal studies, ginseng saponins lowered total plasma cholesterol and triglyceride levels (15). Ginseng may improve NO synthesis in endothelium of the heart, lung, kidneys, and in the corpus cavernosum (13).
In humans, oral intake of ginseng reduced post-exercise muscle injury and inflammation marked by reduced creatine kinase, beta-glucuronidase, and glucose-6-phosphate dehydrogenase (14).
Anticancer activity has also been observed in vitro with several ginsenosides. Differentiation of HL-60 (promyelocytic cells) was induced in ginsenosides Rh2- and Rh3-treated cells (2). Rg3 exerted effects in part by blocking the nuclear translocation of the protein ß-catenin in colon cancer cells, most of which turned cancerous via activation of the Wnt/ß-catenin signaling pathway (25). Rp1 reduced breast cancer cell proliferation by decreasing stability of the insulin like growth factor 1 receptor (IGF-1R) protein in breast cancer cells (26).
Dry mouth, tachycardia, nausea, vomiting, diarrhea, insomnia, and nervousness (1)
Mania: In a 26-year-old male with no history of mental illness following chronic consumption of 250 mg panax ginseng capsules 3 times a day. His symptoms, including irritability, insomnia, flight of ideas, and rapid speech, were resolved following supplement discontinuation (17). Two other cases of ginseng-associated manic psychosis were also reported (35).
Gynecomastia: In a 12-year-old boy after ingesting ginseng extract for body building (31).
Uncontrolled facial movements: In a 46-year-old woman who developed speech and eating difficulties as well as tongue-biting, following consumption of a formula containing black cohosh and ginseng. Symptoms resolved after discontinuing use of the formula (34).
Pulmonary embolism: In a 41-year-old woman after taking panax pills (40).
Perioperative bleeding: In a 72-year-old woman following cardiac surgery due to severe coagulopathy induced by high oral intake of ginseng before surgery (45).
Liver toxicity: In a 26-year-old man with chronic myelogenous leukemia who was on long-term imatinib. He had no complications with this medication until daily ingestion of Panax ginseng via energy drinks for 3 months, after which he experienced right upper quadrant pain. It is thought the interaction of ginseng with this drug played some role (24).
Insulin and sulfonylureas: In humans, P. ginseng may increase the hypoglycemic effect of insulin and sulfonylureas (5).
Anticoagulants: In humans, P. ginseng may antagonize the effects of anticoagulants (6) (7) (8).
MAOIs: In humans, P. ginseng may cause manic-like symptoms when combined with MAOIs (9).
Imatinib: A case report indicates that P. ginseng may increase risk of hepatotoxicity (24).
CYP 3A4 substrates: Certain ginsenosides can induce CYP3A4 and may increase the clearance of substrate drugs (28) (29). However, effects in humans may not be clinically significant (41).
Raltegravir: Elevated plasma levels of raltegravir, an antiretroviral drug, were reported in a patient following concurrent use of raltegravir and ginseng (32).