Ginseng (Asian)

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Ginseng (Asian)

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Ginseng (Asian)

Common Names

  • Chinese ginseng
  • Ren shen
  • Korean ginseng
  • Red ginseng

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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

Data on Panax ginseng for various conditions are limited. Larger high quality studies are needed.

The active ingredients in P. ginseng are called ginsenosides, which show both stimulatory and inhibitory activity in animal nervous systems. Other animal studies suggest certain ginsenosides may stimulate the immune system or that ginseng may have antitumor effects. Although a few studies in humans suggest this effect may also occur, additional studies are needed.

In one study, Korean individuals who consumed ginseng extract had a decreased risk of all types of cancers. However, use of ginseng did not relieve fatigue in advanced cancer patients or surgical menopause symptoms in women with gynecologic cancers. Although ginseng may help improve markers for some conditions like heart disease or diabetes, these studies are also limited and additional trials for safety and effectiveness are needed.

Because ginseng was shown to have estrogenic effects, patients with hormone-sensitive cancers should consult their physicians before using it.

Purported uses and benefits
  • To treat angina
    Lab studies suggest ginseng can increase nitric oxide, a vasodilator. However, clinical trials have not been conducted to determine if it is useful in treating angina.
  • To treat diabetes
    Small studies suggest ginseng may help increase the effect of insulin and reduce insulin resistance in type 2 diabetes, but larger high-quality studies are needed.
  • To stimulate the immune system
    Data suggests ginseng can stimulate some aspects of the immune system, but studies are limited and more research is necessary.
  • To treat sexual dysfunction
    Although ginseng has been used for erectile dysfunction, a large review determined the effect may be small and the quality of evidence for most studies is low.
  • To improve strength and stamina
    Evidence is lacking to support this use.
Patient Warnings
  • Use of Panax ginseng should be stopped at least 1 week before surgery.
  • Recommended doses of P. ginseng should not be exceeded, and products that aren’t standardized should be avoided.
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, aspirin, or other blood thinners: P. ginseng may decrease their effects or increase side 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.
Side Effects
  • Dry mouth
  • Fast heart rate
  • Nausea, vomiting
  • Diarrhea
  • Insomnia
  • Nervousness

Case reports

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.

Special Point

Panax ginseng should not be confused with American ginseng or Siberian ginseng, which have different medicinal properties. It should also not be confused with Panax notoginseng which also has different properties, and is a key ingredient in the TCM formula Yunnan baiyao.

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For Healthcare Professionals

Brand Name
Ginsana®, G115®, Ginsai®
Scientific Name
Panax ginseng
Clinical Summary

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 medicinal effects of P. ginseng. They have both stimulatory and inhibitory effects on the CNS, alter cardiovascular tone, and increase humoral and cellular-dependent immunity (2).

Studies in humans are limited. Although ginseng has been used in the treatment of erectile dysfunction (4), the effect may be trivial and the quality of evidence for most studies is low (46). Other preliminary data suggest it can be helpful for type II diabetic patients (5), but more studies are needed.

Small studies suggest ginseng may enhance immune functioning in various populations (19) (21) (47) or benefit patients with prehypertension or hypertension (42). It may also 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 also been investigated for potential anticancer properties. Ginsenosides exhibit 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). Small randomized studies suggest safety and effectiveness of ginseng for reducing genotoxicity and improving quality of life in patients with epithelial ovarian cancer (43), but did not find benefit against fatigue in advanced cancer patients (44). It also did not relieve surgical menopause symptoms in women with gynecologic cancers (48).

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 (Panax quinquefolius) or Siberian ginseng (Eleutherococcus senticosus), which have different medicinal properties. It should also not be confused with Panax notoginseng which also has different properties (52), and is a key ingredient in the TCM formula Yunnan baiyao.

Purported uses and benefits
  • Angina
  • Diabetes
  • Immunostimulation
  • Sexual dysfunction
  • Strength, stamina
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 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 protein in breast cancer cells (26).

Warnings
  • Ginseng use should be discontinued at least 1 week before surgery (16).
  • Recommended doses of P. ginseng should not be exceeded, and products that aren’t standardized should be avoided, especially when combined with anticoagulants or some CYP450 substrates (51).
Adverse Reactions

Dry mouth, tachycardia, nausea, vomiting, diarrhea, insomnia, and nervousness (1)

Case reports

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).

Herb-Drug Interactions

Insulin and sulfonylureas: In humans, P. ginseng may increase the hypoglycemic effect of insulin and sulfonylureas (5).
Antiplatelets: P. ginseng may increase aspirin bioavailability (49).
Anticoagulants: Studies on whether P. ginseng can antagonize the effects of anticoagulants are mixed (6) (7) (8) (50) (51). Clinical relevance needs further assessment.
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).
CYP3A4 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).

Dosage (OneMSK Only)
References
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  4. de Andrade E, de Mesquita AA, Claro Jde A, et al. Study of the efficacy of Korean Red Ginseng in the treatment of erectile dysfunction. Asian J Androl. Mar 2007;9(2):241-244.
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  6. Lee SH, Ahn YM, Ahn SY, et al. Interaction between warfarin and Panax ginseng in ischemic stroke patients. J Altern Complement Med. Jul 2008;14(6):715-721.
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  24. Bilgi N, Bell K, Ananthakrishnan AN, et al. Imatinib and Panax ginseng: A potential interaction resulting in liver toxicity. Ann Pharmacother. 2010 May;44(5):926-8.
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  31. Kakisaka Y, Ohara T, Tozawa H, et al. Panax ginseng: A newly identified cause of gynecomastia. Tohoku J Exp Med. 2012;228(2):143-5.
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