Ginseng (Asian)

Common Names

  • 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.

Although extensive research has been performed with Panax ginseng showing that it exhibits a wide range of biological activities, scientists are still not exactly sure how it works. The active ingredients are called ginsenosides. These substances 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. Ginsenosides may also have anti-cancer activity: when they are directly applied to melanoma cells in the laboratory, these cells stop growing and multiplying. In addition, ginseng can prevent some 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 ginseg can lower blood cholesterol and triglyceride levels. In humans, clinical trials suggest that ginseng can reduce muscle injury and inflammation after exercise.

Purported Uses

  • 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 in humans 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 trials support this use, although the long-term effects of P. ginseng are still not known.
  • To treat sexual dysfunction
    One clinical trial supports the use of P. ginseng for male erectile dysfunction.
  • To improve strength and stamina
    Clinical trials do not support this use.

Patient Warnings

  • Use of Panax ginseng should be stopped at least one week before surgery.

Do Not Take If

  • You have hormone-sensitive disease such as estrogen-dependent cancer (It is suspected, but not known, that Panax ginseng may have estrogen-like activity).
  • 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).

Side Effects

  • Dry mouth
  • Tachycardia (fast heart rate)
  • Nausea
  • Vomiting
  • Diarrhea
  • Insomnia
  • Nervousness
  • 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.
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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, also cultivated for its medicinal properties. 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. Ginsenosides 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 increase the hypoglycemic effects of insulin and sulfonylureas as well as reduce insulin resistance in type II diabetic patients (5), and enhance immune response (19) (21). 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 also has anticancer potential. In vitro studies indicate that ginsenosides have antiproliferative effects (25) (26). Data from epidemiological studies 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 of Korean subject indicate an association between consumption of a Panax ginseng extract with reduction in the incidence of all cancers (11) (12). Larger, well-designed studies are needed.

Because ginseng was shown to have estrogenic effects (23), patients with hormone-sensitive cancers should avoid it until definitive data are available. Panax ginseng should not be confused with American ginseng or Siberian ginseng, which have different medicinal properties.

Purported Uses

  • Angina
  • Diabetes
  • Health maintenance
  • AIDS
  • Immunostimulation
  • Pain
  • Sexual dysfunction
  • Strength and stamina

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 exerts its effects in part by blocking the nuclear translocation of the protein ß-catenin in colon cancer cells, most of which turn cancerous via activation of the Wnt/ß-catenin signaling pathway (25); Rp1 reduces breast cancer cell proliferation by decreasing the stability of the insulin like growth factor 1 receptor (IGF-1R) protein in breast cancer cells (26).


Ginseng use should be discontinued at least one week before surgery (16).


Panax ginseng has estrogenic activity. Patients with hormone-sensitive cancer should avoid taking it (23).

Adverse Reactions

  • Dry mouth, tachycardia, nausea, vomiting, diarrhea, insomnia, and nervousnesshave 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).

Herb-Drug Interactions

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).
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)


  1. Huang KC. The Pharmacology of Chinese Herbs, 2nd ed. New York: CRC Press; 1999.

  2. Attele AS, Wu JA, Yuan CS. Ginseng pharmacology: multiple constituents and multiple actions. Biochem Pharmacol 1999;58:1685-93.

  3. Cui Y, Shu XO, Gao YT, et al. Association of ginseng use with survival and quality of life among breast cancer patients. Am J Epidemiol 2006;163:645-53.

  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.

  5. 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.

  6. Jiang X, Williams KM, Liauw WS, et al. Effect of St John’s wort and ginseng on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects. Br J Clin Pharmacol. 2004 May;57(5):592-9.

  7. Brinker F. Herb Contraindications and Drug Interactions. 3rd ed. Sandy (OR): Eclectic Medical Publications; 2001.

  8. Shin HR, Kim JY, Yun TK, Morgan G, Vainio H. The cancer-preventive potential of panax ginseng: a review of human and experimental evidence. Cancer Causes Control 2000;11:565-76.

  9. Cheng TO. Panax (ginseng) is not a panacea. Arch Intern Med 2000;160:3329.

  10. Nah JJ, Hahn JH, Chung S, et al. Effect of ginsenosides, active components of ginseng, on capsaicin-induced pain-related behavior. Neuropharmacology 2000;39:2180-4.

  11. Cabral de Oliveira AC, et al. Protective effects of panax ginseng on muscle injury and inflammation after eccentric exercise. Comp Biochem Physiol C Toxicol Pharmacol 2001;130:369-77.

  12. Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care. JAMA 2001;286:208-16.

  13. Engelberg D, McCutcheon A, Wiseman S. A case of ginseng-induced mania. J Clin Psychopharmacol 2001;21:535-6.

  14. Vogler BK, Pittler MH, Ernst E. The efficacy of ginseng. A systematic review of randomised clinical trials. Eur J Clin Pharmacol 1999;55:567-75.

  15. Inoue M, Wu CZ, Dou DQ, et al. Lipoprotein lipase activation by red ginseng saponins in hyperlipidemia model animals. Phytomedicine. 1999 Oct;6(4):257-65.

  16. Lee Y, Jin Y, Lim W, et al. A ginsenoside-Rh1, a component of ginseng saponin, activates estrogen receptor in human breast carcinoma MCF-7 cells. J Steroid Biochem Mol Biol. 2003 Mar;84(4):463-8.

  17. 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.

  18. Chen JK, Chen TT. Chinese Medical Herbology and Pharmacology. California: Art of Medicine Press; 2004.

  19. 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.

  20. Mateo-Carrasco H, Gálvez-Contreras MC, Fernández-Ginés FD, Nguyen TV. Elevated liver enzymes resulting from an interaction between Raltegravir and Panax ginseng: a case report and brief review. Drug Metabol Drug Interact. 2012;27(3):171-5.

  21. Sen A. Orobuccolingual dyskinesia after long-term use of black cohosh and ginseng. J Neuropsychiatry Clin Neurosci. 2013 Fall;25(4):E50.

  22. Norelli LJ, Xu C. Manic Psychosis Associated With Ginseng: A Report of Two Cases and Discussion of the Literature. J Diet Suppl. 2014 Apr 1. [Epub ahead of print]

  23. Lee J, Lee E, Kim D, Lee J, Yoo J, Koh B.Studies on absorption, distribution and metabolism of ginseng in humans after oral administration. J Ethnopharmacol. 2009 Feb 25;122(1):143-8.

  24. Park KS, Park KI, Kim JW, Yun YJ, Kim SH, Lee CH, Park JW, Lee JM. Efficacy and safety of Korean red ginseng for cold hypersensitivity in the hands and feet: a randomized, double-blind, placebo-controlled trial. J Ethnopharmacol. 2014 Dec 2;158 Pt A:25-32.

  25. Yigit M, Cevik E. A rare cause of pulmonary embolism: panax. Am J Emerg Med. 2015 Feb;33(2):311.e1-2.

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