Ginseng has been used as a medicinal herb for at least 5,000 years in the Far East.1 It was introduced to the rest of the world in the early 18th century after the emperor of China ordered French missionary Pierre Jartoux to compile an atlas of the region. An exhausted Jartoux was given ginseng as a tonic and wrote to his superiors in Europe, raving about the herb’s restorative powers.2 Ginseng now enjoys vast popularity ($60 million annual sales in the United States).3 Ginseng is loosely translated as “the wonder of the world”—an apt description indeed.2
To be medicinally useful plants, ginseng needs to be at least six years old.4 This free-growing herb thrives in rich forested soil and produces a large, slow-growing fleshy root system, with projections at least 2-3 inches long and 0.5-1 inch thick.2 These root sections range in color from yellow to a light brown.5 The above-ground portion of the plant is approximately 12 inches tall, growing three leaves that are divided into smaller leaflets.2
Background
Ginseng is prized for its root structure. The herb’s seven major species are defined by their geographic habitat. Asian or Far Eastern ginseng (Panax ginseng) is better studied than American ginseng but requires more processing before use.1 The root is dried before processing and then sold in various forms.
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Researchers generally classify ginseng as a tonic with an overall stimulant effect. However, when the chemical components are fractionated, it appears the active compound contains both stimulant and sedative effects, giving rise to the ancient Chinese terminology that is translated as “balance.”4 Most studies have focused on ginseng’s ability to improve stamina, cognition, immune function, and overall feelings of well-being.5
Technical information
The major chemical components of ginseng are the ginsenosides, which are of the triterpene saponin classification. These compounds are found primarily in the root of the plant, hence the focus on that structure for commercial use.4 Most study compounds use an extract of the root with a 5% concentration of these ginsenosides.1
There is some speculation that ginseng’s healthful effects are attributable to a mechanism involving the hypothalamic-pituitary-adrenal axis and the immune system. Animal models support the theory that ginseng enhances phagocytosis, natural killer cells, and the upregulation of interferon. These actions stimulate vasodilatation and increase resistance to exogenous stress, which in turn affects hypoglycemic activity.5
Panax is derived from the Greek panakos, meaning a panacea, so it is not surprising that the list of physical ailments ginseng is purported to remedy is a lengthy one. Studies have some conflicting results, but the outcomes have generally been positive in the small clinical trials that have been conducted.
Metabolically, ginseng was tested in adult non-insulin-dependent diabetics. Those taking a daily 200-mg dose had improved markers of glycemic control, including fasting glucose levels and reduced glycosylated hemoglobin levels.5
A comprehensive summary of trials evaluating the effect of a standardized ginseng product 400 mg/day on concentration, memory, or subjective experience failed to show either a positive or negative effect. These trials involved healthy adults, both men and women. Effect on physical performance also failed to show a significant change in healthy adults.5
However, a study aimed at examining immunostimulatory capabilities in healthy adults did show a reduced incidence of colds or flu over general population statistics. The 12-week trial also demonstrated higher serum antibody titer, increased helper T-cell numbers, and enhanced chemotaxis.5
Perhaps ginseng’s best-known claim of late is its purported enhancement of sexual performance in men. There is evidence that ginseng does improve erectile function in some men via its regulatory action on nitric oxide and stimulation of vasodilatation.3
Safety and side effects
Because of the wide variety of ginseng formulations available, interpretation of documented adverse effects and drug interactions can be difficult. Adding to this difficulty is the fact that the precise amount of ginseng in these products may not be provided on the label.5
Ginseng is generally well tolerated in most individuals, and its adverse effects (nausea, diarrhea, euphoria, insomnia, headaches, hypertension, hypotension, mastalgia, and vaginal bleeding) are mild and reversible.5
Given its tonic effect, ginseng should not be used in persons with hypertension or ischemic heart disease.1 Safety has not been established in pregnant or lactating women, so usage in this population should be discouraged. Research indicates ginseng products are physically well tolerated but should be monitored when used in combination with warfarin, oral hypoglycemic agents, insulin, and phenelzine.5
No dosing standardization exists for ginseng, despite numerous studies and trials. While ginseng is available in many forms, including teas, tinctures, and whole root, the typical dosing format is powder-filled capsules at 200-500 mg daily for adults.1 A tea made from the dry root is considered therapeutic at a dose of 0.5-2 g of steeped root per day. Most patients take ginseng for long periods. A two-week ginseng-free period every two to three weeks is recommended for some individuals.5
Cost
Generally, daily consumption of ginseng in any form will cost $15-$20 per month.5
Summary
Though it does not appear to be the miracle herb its name suggests, ginseng is definitely a plant with potential. Safety and efficacy trials are under way around the world, and updated information is continuously available. With the data collected so far, it would seem that although ginseng does not show drastic improvements in the indicated conditions, use of the herb would not be detrimental.
References
1. Skidmore-Roth L. Mosby’s Handbook of Herbs & Natural Supplements. 3rd ed. St. Louis, Mo.: Elsevier Mosby; 2006:492-497.
2. Botanical.com. Ginseng. Available at www.botanical.com/botanical. Accessed October 10, 2007.
3. American Botanical Council. Ginseng root. Available at www.herbalgram.org. Accessed October 10, 2007.
4. Fetrow CW, Avila JR. Professional’s Handbook of Complementary & Alternative Medicines. 3rd ed. Springhouse, Pa.: Springhouse Corp; 2001:338-342.
5. Kiefer D, Pantuso T. Panax ginseng. Am Fam Physician. 2003;68:1539-1542.
