- Chinese ginseng
- ren shen
- Korean ginseng
- red ginseng
For Patients & Caregivers
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 ginseng are called ginsenosides, which show definite activity in the nervous systems of animals, with both stimulatory and inhibitory effects. Certain ginsenosides are able to stimulate the immune system in mice. They may also have anti-cancer activity. In addition, ginseng can prevent tumors in mice, including ovarian, lung, liver, and skin cancers. Some studies suggest that this effect may also occur in humans. In one study, Korean individuals who consumed ginseng extract had a decreased risk of all types of cancers.
Other experiments have suggested that ginseng may increase the production of nitric oxide, a vasodilator, in the heart, lung, and kidneys. In addition, studies in animals showed that ginseng can lower blood 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 Some laboratory studies show that ginseng can increase the synthesis of nitric oxide, a vasodilator, but clinical trials have not been conducted to determine if ginseng is useful in treating angina.
- To treat diabetes Ginseng may help to increase the effect of insulin as well as reduce insulin resistance in type II diabetic patients.
- To treat HIV and AIDS Research shows that P. ginseng stimulates certain aspects of the immune system, and although one small clinical trial supports this use, more research is necessary.
- To stimulate the immune system Clinical data support this use, but the long-term effects of P. ginseng 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 (MAOIs) (If combined with MAOIs, Panax ginseng can cause manic-like symptoms).
- You are taking insulin or sulfonylureas (Panax ginseng may increase their effect, causing a drop in blood sugar).
- You are taking warfarin or other blood thinners (Panax ginseng may lessen their effects).
- You are taking Raltegravir (Panax ginseng may increase its effects).
- Dry mouth
- Tachycardia (fast heart rate)
- In a case report, a young man with no history of mental illness became manic following chronic consumption of 250 mg of Panax ginseng capsules three times a day. His symptoms resolved when he stopped taking the herb.
- Gynecomastia (developing breasts) has been reported in a 12-year-old boy after ingesting ginseng extract for body building.
- A 46-year-old woman developed orobuccolingual dyskinesia (OBLD) that interfered with her speech, tongue-biting and eating difficulties, following consumption of a formula containing black cohosh and ginseng. Her symptoms resolved after discontinuing use of the formula.
- Perioperative bleeding was reported in a 72-year-old woman following cardiac surgery due to severe coagulopathy induced by high oral intake of ginseng before surgery.
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), has the potential to increase the hypoglycemic effects of insulin and sulfonylureas as well as reduce insulin resistance in type II diabetic patients (5), to enhance immune response (19) (21); and to benefit patients with pre-hypertension and hypertension (42). It was also shown to improve menopausal symptoms, and may positively affect cardiovascular health in postmenopausal women (30). Data from randomized clinical trials indicate that ginseng helps alleviate idiopathic chronic fatigue (33), and may alleviate 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 show improved survival and quality of life with ginseng use, in breast cancer patients (3); and inverse association between ginseng consumption and reduction in the 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
Ginsenosides have been shown responsible for many of ginseng’s effects, including analgesic effects when administered parenterally (12). Animal studies suggest that the ginsenoside Rb1 improves the release of acetylcholine and enhances post-synaptic uptake of choline (2). Ginsenosides also compete for binding sites on GABA receptors in vitro. They prolong drug-induced sleeping time in mice and exhibit additional depressant effects on the central nervous system (2). Ginseng may improve nitric oxide synthesis in endothelium of the heart, lung, kidneys, and in the corpus cavernosum (13).
Oral intake of ginseng was shown to reduce muscle injury and inflammation following exercise in humans, marked by reductions in the levels of creatine kinase, beta-glucuronidase, and glucose-6-phosphate dehydrogenase (G6PDH) (14). In animal studies, ginseng saponins lowered total plasma cholesterol and triglyceride levels (15).
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 its 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 the 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 have been reported following consumption of ginseng (1).
- A 26-year-old male with no history of mental illness became manic following chronic consumption of 250 mg panax ginseng capsules three times a day. His symptoms, including irritability, insomnia, flight of ideas, and rapid speech, resolved following discontinuation of supplement (17).
- Gynecomastia has been reported in a 12-year-old boy after ingesting ginseng extract for body building (31).
- A 46-year-old woman developed orobuccolingual dyskinesia (OBLD) that interfered with her speech, tongue-biting and eating difficulties, following consumption of a formula containing black cohosh and ginseng. Her symptoms resolved after discontinuing use of the formula (34).
- Two cases of ginseng-associated manic psychosis have been reported (35).
- Pulmonary embolism has been reported in a 41-year-old woman after taking panax pills (40).
- Perioperative bleeding was reported in a 72-year-old woman following cardiac surgery due to severe coagulopathy induced by high oral intake of ginseng before surgery (45).
Insulin and sulfonylureas: P. ginseng may increase the hypoglycemic effect of insulin and sulfonylureas (5).
Anticoagulants: P. ginseng may antagonize the effects of anticoagulants (6) (7) (8).
Monoamine oxidase inhibitors (MAOIs): P. ginseng may cause manic-like symptoms when combined with MAOIs (9).
Imatinib: P. ginseng may increase risk of hepatotoxicity (24).
Cytochrome P450 (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).