Scientific Name: Panax Ginseng
Other Names: Asian Ginseng, Chinese Ginseng, Ginseng, Panax, Guigai, Japanese Ginseng, Korean Ginseng, Ninjin, Oriental Ginseng, Panax schinseng, Red Ginseng, Seng

Who is this for?

Uses

NOTE: Panax ginseng is different from American ginseng and Eleuthero (formerly called Siberian ginseng). They are not interchangeable.

Ginsengs are best known as "adaptogens", which are substances that may help individuals cope with physical and emotional stress. As a part of traditional Chinese medicine for thousands of years, Panax ginseng has been used to treat almost every possible ailment from anxiety to cancer. Currently, it is used extensively in Oriental countries as an everyday tonic to maintain overall health as well as to treat several illnesses, including heart conditions.

In Western herbal medicine, Panax ginseng's possible ability to regulate the immune system has been studied for potential effectiveness in preventing colds, flu, and some forms of cancer. In clinical studies, Panax ginseng has been shown to lower blood levels of both sugar and cholesterol. Therefore, it may help treat type 2 diabetes and high cholesterol. Its other potential uses are not as well defined, however. In separate studies of laboratory animals and humans, Panax ginseng showed a relaxing effect on muscles in the lungs. The resulting airway expansion may help to relieve asthma symptoms and other lung conditions that result from constricted airways. In other studies, a combination of Panax ginseng and gingko is believed to have boosted memory and thinking processes. Early results from laboratory study may show that chemicals in orally dosed Panax ginseng promote the growth of blood vessels, which could be valuable in treating extensive injuries. All of these possible effects continue to be studied.

When it is applied to the skin, Panax ginseng may increase the production of both collagen and blood vessels. Collagen is a protein that makes up most of the connective tissues that support skin. Because collagen production generally decreases as individuals get older, collagen supplementation may prevent or improve signs of aging such as wrinkles and age lines. Topical Panax ginseng creams and lotions are also used to treat acne scars and skin wounds. Additionally, Rg1 and other chemicals in Panax ginseng seem to promote angiogenesis--the growth of new blood vessels when taken by mouth. While angiogenesis allows tumors to spread, it also helps wounds to heal and restores blood flow to injured tissue.

Both topical and oral forms of Panax ginseng are used to treat erectile dysfunction (ED) in men. One large study also found that taking Panax ginseng orally improved male fertility by increasing numbers, quality, and movement of sperm. Although the exact reasons that Panax ginseng may enhance male fertility are not completely known, chemicals in Panax ginseng are believed to activate the body system that increases production of certain hormones. Whether Panax ginseng increases testosterone levels in the blood is uncertain, however. Nevertheless, due to proposed hormonal activation, Panax ginseng frequently is added to sports drinks or supplements as a way to enhance athletic performance, even though no evidence supports this use.

Through the same activation of hormone production, chemicals in Panax ginseng are thought to exert an effect similar to the female hormone, estrogen. In some laboratory studies, Panax ginseng accelerated the growth of estrogen-dependent breast cancer cells, perhaps by activating estrogen receptors. Other laboratory and animal studies suggest that Panax ginseng may increase blood levels of substances that the body converts into estrogen. Results of a recent chemical analysis show that some of Panax ginseng's possible estrogenic effects may be due to a fungus that frequently contaminates Panax ginseng roots. Whether Panax ginseng can help to relieve menopause symptoms and conditions worsened by low estrogen levels is not yet known. Much more research is needed to understand more clearly Panax ginseng's possible estrogen-like effects.

An intoxication-like syndrome has been seen in a few newborn babies who were given Panax ginseng or whose mothers took it while pregnant or breast-feeding. One documented case of an infant's death which was attributed to Panax ginseng intoxication has been reported. Small children and babies should not be given Panax ginseng; pregnant and breast-feeding women should also avoid taking it.

Women with hormone-dependent conditions such as endometriosis, uterine fibroids, and cancers of the breast, ovaries, or uterus should not take Panax ginseng due to its possible estrogenic effects. Men with prostate cancer should also avoid taking Panax ginseng.

In clinical studies of both humans and animals, Panax ginseng has slowed the rate and decreased the force of heartbeats. It has also reduced blood pressure in some cases. All of these effects may worsen some heart conditions. Individuals with any kind of heart disease should not take Panax ginseng without supervision from a healthcare professional.

Precautions

Individuals with diabetes should avoid taking large amounts of Panax ginseng because it can lower blood sugar levels, potentially resulting in hypoglycemia (blood sugar that is too low). Indications that blood sugar may be too low include shakiness, sweating, confusion, distorted speech, and loss of muscle control. If not corrected, low blood sugar can lead to unconsciousness and even death.

Taking Panax ginseng by mouth may cause or worsen insomnia.

Occasionally, Panax ginseng roots harvested from wild plants are contaminated with potentially dangerous molds. If whole Panax ginseng root is purchased, it should be clean, firm, and mold-free. Commercial Panax ginseng products should be made from cultivated root, which has not been found to contain molds.

What side effects should I watch for?

Note: Most side effects from Panax ginseng have been reported in individuals who took high doses or who took Panax ginseng continually for long periods of time.

Major Side Effects

Infants given Panax ginseng may develop a condition resembling alcohol intoxication that has lead to at least one reported death of a newborn.

Rarely, taking Panax ginseng by mouth has been associated with cases of non-infectious hepatitis.

In other rare reports, Panax ginseng may have caused inflammation of blood vessels in the brain--a condition that could result in headaches or strokes.

One case has been reported of an individual who developed anaphylaxis-like symptoms shortly after ingesting a small amount of Panax ginseng syrup. Anaphylaxis is a potentially life-threatening allergic reaction that may involve the development of a rash or hives, a sudden fall in blood pressure, swelling of the mouth and throat, or unconsciousness.

In very rare cases, Panax ginseng may have caused a very serious skin reaction called Stevens-Johnson Syndrome. A doctor should be contacted right away if a high fever, swollen eyelids, blisters in the mouth, or red marks on the skin develop while Panax ginseng is taken.

Less Severe Side Effects

Other side effects associated with taking Panax ginseng are generally mild and temporary. They usually fade away after a few days and they may include:

• Blood pressure changes
• Breast pain
• Diarrhea
• Dizziness
• Headache
• Heart rate changes
• Insomnia
• Itching
• Loss of appetite
• Mood changes
• Nervousness

A few individuals have experienced itchy rashes after taking or applying Panax ginseng preparations or touching Panax ginseng plants.

What interactions should I watch for?

Prescription Drugs

In studies, Panax ginseng has been shown to increase the time blood needs to clot. When it is taken with antiplatelet or anticoagulant drugs, the effect of the drug may be increased, possibly resulting in uncontrolled bleeding.

• Antiplatelet agents include clopidogrel and Ticlid
• Anticoagulants include heparin and warfarin

Some drugs used for asthma, heart problems, or other reasons can affect heart rhythm. Because Panax ginseng can change the force and rate of heart beats, it can increase the risk of side effects from drugs such as:

• albuterol
• clonidine
• theophylline and related drugs for asthma
• Viagra

In case reports, tests for blood levels of the heart drug digoxin have been altered when Panax ginseng is taken at the same time as digoxin. Individuals who decide to take Panax ginseng while also taking digoxin may need more frequent tests to measure digoxin levels in the blood.

Panax ginseng may interfere with insulin and oral drugs for diabetes, such as:

• Actos
• Avandia
• glimepiride
• glipizide
• glyburide
• Glyset
• metformin
• Prandin
• Precose

Panax ginseng is believed to affect levels of neurotransmitters, chemicals that carry messages from nerve cells to other cells. Antipsychotic drugs used to treat mental disorders such as schizophrenia also alter the levels of neurotransmitters. If Panax ginseng and antipsychotic drugs are taken at the same time, the effectiveness of the drug may be changed, so it is best to avoid using Panax ginseng while taking drugs such as:

• chlorpromazine
• fluphenazine (Prolixin)
• olanzapine (Zyprexa)
• prochlorperazine (Compazine)
• Risperdal
• Seroquel

Because it is broken down by certain enzymes in the liver, Panax ginseng may possibly interfere with the use of prescription drugs that are processed by the same enzymes. Some of these drugs are:

• Allergy drugs such as fexofenadine
• Antifungal drugs such as itraconazole and ketoconazole
• Cancer drugs such as etoposide, paclitaxel, vinblastine, or vincristine
• Drugs for high cholesterol such as lovastatin
• Oral contraceptives

In reported cases, the risk of side effects such as headache, insomnia, and shakiness increased when Panax ginseng was taken with antidepressants known as MAO inhibitors. Drugs in this class include:

• Marplan
• Nardil
• selegiline (Eldepryl, Emsam, Zelapar)
• tranylcypromine

Because it is a non-specific central nervous system stimulant, Panax ginseng may increase the effects and the side effects of prescription drugs that also stimulate the central nervous system. Used mainly to treat attention-deficit hyperactivity disorder, narcolepsy, and obesity; stimulant drugs can raise heart rate and blood pressure. They include:

• amphetamine salts (Adderall)
• dextroamphetamine (Dexedrine)
• methylphenidate (Concerta, Methlyn, Ritalin)
• phentermine (Adipex-P, Ionamin)

Panax ginseng's possible stimulant effect could interfere with drugs for insomnia, such as Lunesta, Rozerem, Sonata, and zolpidem.

Non-prescription Drugs

Panax ginseng may decrease the ability of blood to clot after an injury. Aspirin can also delay clotting, so Panax ginseng should not be taken orally at the same time as aspirin.

Stimulants may be included in non-prescription drugs that are used for increasing energy, losing weight, raising mental alertness, or treating colds or asthma. If Panax ginseng is taken by mouth at the same time as one of these products is being used, the central nervous system may be over stimulated, possibly resulting in insomnia, irritability, and increased blood pressure. Individuals who are not sure whether the non-prescription drugs they take contain stimulants should ask a doctor or pharmacist before taking Panax ginseng.

Herbal Products

Theoretically, if Panax ginseng is used with other herbs that affect blood clotting, bleeding may occur. Some of the most common herbal products that might inhibit blood clotting are:

• Danshen
• Devil's Claw
• Eleuthero
• Garlic
• Ginger (in high amounts)
• Ginkgo
• Horse Chestnut
• Papain
• Red Clover
• Saw Palmetto

If Panax ginseng is taken at the same time as other herbs that also affect the heart, potentially dangerous changes in heart function may result. Some herbal products with heart effects are:

• European Mistletoe
• Ginger (in large doses)
• Hawthorn
• Motherwort
• Pleurisy Root
• Squill

Because Panax ginseng may decrease blood sugar levels, taking it with other blood sugar-lowering herbal products may result in hypoglycemia--blood sugar that is too low. Herbals that may reduce blood sugar include:

• Fenugreek
• Ginger (in high amounts)
• Kudzu

Certain herbal products are stimulants that may result in side effects if they are taken with Panax ginseng. These herbal products include ephedra (which has been withdrawn from the market), guarana, and mate. Taken together with Panax ginseng, any one of these herbals may cause insomnia, irritability, nervousness, and other side effects.

Foods

Caffeine increases the central nervous system stimulation effect of Panax ginseng. The combination may cause excessive nervousness and irritability, along with other signs of over-stimulation. Caffeinated beverages such as coffee, soft drinks, and tea should be limited when taking Panax ginseng.

Some interactions between herbal products and medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how Panax ginseng interacts with drugs, other herbals, and foods and the severity of those interactions, please use our Drug Interactions Checker to check for possible interactions.

Should I take it?

Closely related, American ginseng and Panax ginseng plants look similar. Panax ginseng plants generally are larger than American ginseng plants, however. Additionally, Panax ginseng and American ginseng contain different chemical substances. Mature plants of both ginseng types have three to seven short stems each containing five leaves. One tall central stem bears a cluster of tiny yellow flowers followed by small red berries.

Although the berries, flowers, leaves, and stems of Panax ginseng all may have some medical properties, it is the roots that are used almost exclusively in medicine. Generally bigger in diameter than American ginseng's roots, those of Panax ginseng usually have a sweetish smell. Little or no smell is associated with American ginseng roots. Typically, fresh roots of Panax ginseng are a slightly darker tannish color, as opposed to a yellow or cream color for the roots of American ginseng. Unlike the quicker-growing American ginseng, cultivated Panax ginseng roots are not large enough to harvest until the plants are at least 7 years old. Wild Panax ginseng grows even more slowly. Thought to be more effective than cultivated roots, wild Panax ginseng roots that can be proved to be very old are extremely expensive--sometimes selling for thousands of dollars a pound. The name "red ginseng" refers to a method of preserving Panax ginseng roots by steaming them under pressure. Popular especially in Japan, processing by steam is thought to increase the amounts of some active components of Panax ginseng.

Panax ginseng and American ginseng also differ in some important chemical aspects. The most notable difference is that Panax ginseng has higher levels of a steroid-like chemical (ginsenoside) known as Rg1 and lower levels of another ginsenoside--Rb1. Both Rg1 and Rb1 have some similar effects--both are believed to enhance memory, for example. However, Rb1 may have more stress-relieving effects; while Rg1 have more impact on the immune system.

In North America, Panax ginseng is known mainly as a dietary supplement. In Oriental countries, however, it has multiple uses. Panax ginseng is used to flavor drinks and foods, it is an ingredient in some soft drinks and chewing gum, and it is included in vitamin tablets. Small children may be given a Panax ginseng root to chew while teething. Powdered Panax ginseng may be added to cooked foods or coffee. In cosmetics, Panax ginseng is used as a scent and a coloring agent.

Dosage and Administration

Panax ginseng is available in a large number of different oral dosage forms that include capsules, dried root powder, fresh root, liquid extracts, and teas. It may be found as a single ingredient or in many different combination products. Many Panax ginseng products are standardized to contain 7% of the active ingredients known as ginsenosides. Standardization by the manufacturer should assure the same amount of active ingredient in every batch of the commercial preparation. The U.S. Food and Drug Administration does not require standardization of herbal products, so not every Panax ginseng product sold in the United States may contain the same active ingredients. Additionally, the amounts of active chemicals in Panax ginseng vary greatly according to how the plants are grown, harvested, processed, and stored. Panax ginseng products may be extended with other types of ginseng that are less expensive to produce.

For improving or maintaining general health, a commonly recommended daily dose of oral Panax ginseng is 500 mg (0.5 gram) to 3000 mg (3 grams) of fresh root or 200 mg (0.2 grams) to 600 mg (0.6 grams) as dried root powder in capsules. Doses for other conditions differ widely depending on the type of product being used and the condition being treated. If Panax ginseng is used, the directions on the package that is purchased should be followed.

Panax ginseng tea may be made by soaking about 3000 mg (3 grams) of chopped fresh root or 1500 mg (1.5 grams) of dried root powder in about 5 ounces of boiling water for 10 minutes to 15 minutes and then straining out the solid particles. Panax ginseng tea may have a strong taste, so it is often sweetened, flavored, or mixed with other herbals before drinking.

Many sources recommend that the oral use of Panax ginseng be interrupted for 2 weeks to 3 weeks after it has been taken continuously for 3 months.

Summary

Taken most commonly as an adaptogen or general tonic to help the body resist stress, Panax ginseng has been studied for improving memory, treating asthma, and enhancing immune function. It may also help to reduce levels of blood sugar and blood cholesterol. Either orally or topically, it may treat erectile dysfunction and improve the appearance of aging skin. Panax ginseng may also help to relieve some types of male infertility. Its possible estrogenic effects need further investigation.

Risks

Individuals who have heart conditions or cancers of the breast, ovaries, prostate, or uterus should not take Panax ginseng. Pregnant women, infants, and young children should also avoid taking it. Individuals who have diabetes or insomnia should monitor their conditions carefully if they decide to take Panax ginseng.

Side Effects

Rarely, newborn babies who are given Panax ginseng have developed an intoxication-like condition, which could be severe. In adults, a few cases of hepatitis or inflamed blood vessels in the brain have been attributed to taking it. Panax ginseng may lead to heart rate changes that could worsen heart conditions. One case of possible severe allergy to Panax ginseng resulted in breathing problems, low blood pressure, and sudden appearance of a rash. More often, Panax ginseng is associated with milder and temporary side effects such as diarrhea, insomnia, and nervousness.

Interactions

Panax ginseng may interfere with many prescription drugs, non-prescription products, and herbals, including:

• albuterol
• caffeine
• Central nervous system stimulants
• Drugs and herbals that affect blood clotting
• Drugs and herbals used for the treatment of diabetes
• Drugs for insomnia
• Drugs used to treat schizophrenia
• MAO inhibitors
• theophylline and related drugs for asthma
• Viagra

Last Revised October 17, 2007

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Last Revised October 17, 2007

Note: The above information is not intended to replace the advice of your physician, pharmacist, or other healthcare professional. It is not meant to indicate that the use of the product is safe, appropriate, or effective for you.

In general, herbal products are not subject to review or approval by the U.S. Food and Drug Administration (FDA). They are not required to be standardized, meaning that the amounts of active ingredients or contaminants they contain may vary between brands or between different batches of the same brand. Not all of the risks, side effects, or interactions associated with the use of herbal products are known because few reliable studies of their use in humans have been done.

This information is provided for your education only. Please share this information with your healthcare provider and be sure that you talk to your doctor and pharmacist about all the prescription and non-prescription medicines you take before you begin to use any herbal product.

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