The British Herbal Compendium (BHC) advises against use of ginseng along with caffeine-containing beverages, 13 Likely based on the suggestion that ingestion of caffeine along with long term consumption (13 weeks) of large doses (3 grams daily) of ginseng may lead to hypertension 19; however, this last account, which attributed a variety of side effects to ginseng use – the so-called Ginseng Abuse Syndrome – has been soundly discredited on the basis of serious methodological flaws and failure to assess the potential influence of accompanying medication. 20
Two reports of interaction between ginseng and phenelzine, a monoamine oxidase inhibitor, are cited in the WHO monograph on Asian ginseng 2 and claimed responsible for headache and tremor. Another publication attributes an apparent manic reaction to Asian ginseng alone, in a 35-year-old woman with prior episodes of depression 21; however, the implicated ginseng product was apparently no analyzed, nor was the possible effect of the patient’s withdrawal from he accustomed antidepressant medicatin (lithium carbonate and amitriptyline) assessed. The clinical significance of these claimed interactions is yet to be properly evaluated. There has been 1 case report which associates Asian ginseng use with decreased anticoagulant effect of warfarin (Coumadin). 22 A clear resolution of this ginseng case report is difficult, particularly because there has been widespread acceptance of ginseng being an anti-platelet medicinal. The case is also complicated by the fact that the patient was also taking other medications. In any event, the patient’s blood status was restored following withdrawal of ginseng. A subsequent in vivo study in rats found neither pharmacodynamic nor pharmacokinetic interactions of single-dose or steady-state ginseng upon warfarin. 23 Until this situation is clarified, patients on coumarin anti-coagulants should either refrain from consuming ginseng or have bleeding times regularly monitored.
There is no indication of any interaction of ginseng with laboratory tests. 2
Information on the relationship between substances and disease is provided for general information, in order to convey a balanced review of the scientific literature. In many cases the relationship between a substance and a disease is tentative and additional research is needed to confirm such a relationship.
Other Common Names: Chinese ginseng, Korean ginseng, schin-seng, ren shen (man root).
Panax ginseng is found in China, Korea, Japan and Russia.
Ginseng root consists of the dried main root, lateral root and rootlets of P. ginseng.
The biologically active ingredients of Panax species are mainly a group of dammarane-type triterpenoid glycosides often referred to as saponins and termed ginsenosides, or panaxosides (in Russia); of the more than 30 ginsenosides, one, ginsenoside Ro is an oleanolic acid derivative.
The ginsenoside content of dried ginseng root varies with the age, season of harvest and method of processing. ‘Red’ ginseng is steamed unpeeled before drying to give a reddish caramel-colored product. ‘White’ Asian ginseng (Chinese or Korean) is the peeled or unpeeled root which has been dried in the sun. The ginsenoside profile is somewhat altered and microbial load considerably reduced by steaming.
The content of ginsenosides in American ginseng is considerably greater than that of Asian ginseng. Leaves and roots of the different ginseng species show significantly different patterns of composition of the main 8 ginsenosides. 4 The most abundant ginsenoside in both American and asian ginseng root is ginsenoside Rb1, which is reported to have sedative effect. Ginsenoside Rg1, held to exert a mild stimulant effect 5 , exist at considerably lower levels in American ginseng. The Rb1:Rg1 ratio in American ginseng is usually around 10, whereas the ratio for Asian ginseng is generally between 1 and 3. 6 American ginseng is devoid of ginsenosides Rf and Rg2 and contains pseudoginsenoside F11 virtually absent from Asian ginseng. 7
Scientific Name: Panax quinquefolius L.
Other Common Name: Western ginseng
P. quinquefolias is abundant in parts of eastern North America, from Quebec to western Manitoba in Canada, and south to northern Florida, Alabama and Oklahoma. 8 Today most cultivation of American ginseng is in the provinces of Ontario and British Columbia, in Canada, and in the state of Wisconsin in the U.S. The plant is now considered a threatened, rare or endangered species in many regions due to overharvesting.
Asian and American ginsengs differ little in appearance, being perennial herbs that grow up to about 2ft. tall. A single stalk rising from the root bears 3 to 5 leaves, each mature leaf having 5 leaflets, with the basal pair being considerably smaller than the upper leaflets; Sanchi ginseng leaves have seven leaflets. The flowering stalk, 3 to 8 in. long, produces pale yellowish-green flowers and eventually bright red “berries” (drupes) encasing 2-3 white seeds, after about three years growth. The leaves are bright green in summer and turn yellow in autumn. The tick fleshy roots are cream to pale yellowish-buff in color. Older roots are usually forked or branched producing the characteristic human-body-like shapes. Fresh roots have a strong taste that is bitter and sweet and a typical strong smell that fades on storage. 9
Other Ginseng Species
While 11 species and 1 variety of Panax are currently recognized 10, only P. ginsengand P. quinquefolius are significant items of commerce in the West; P. notoginseng (Burkill) F.H. Chen (Tienchi or Sanchi ginseng) is popular in Asia, where it is used as a hemostatic agent, for other blood-regulating purposes, and also as a cardiotonic treatment. Inappropriately, at least 20 non-Panax species have also been promoted as ‘ginseng’, the most notable being eleuthero or ‘Siberian ginseng’ 11, Eleutherococcus senticosus (Rupr. & Maxim.) Maxim.; like Panax species, eleuthero is a member of the Araliaceae plant family, but has totally different chemical composition from those of the true ginsengs. A perennial vine growing in southern Asia (Gynostemma pentaphyllumMakino, Cucurbitaceae), marketed in the U.S. as ‘Southern ginseng’, is the only non-Panax plant found to contain ginsenosides, the characteristic ginseng compounds. 12
While numerous studies have confirmed the safety of ginseng, and no significant toxicity has been reported, it is held that excessive use can have stimulant effects resulting in sleeplessness, increased blood pressure or other side effects. 13, 14, 15 There has been a case report of severe headache accompanied by nausea, vomiting and chest tightness, in a 28-year-old-woman following ingestion of a large quantity of a rice wine (22% alcohol) extract of Asian ginseng root slices. 16 It was suggested that high doses of ginseng could cause cerebral arteritis. The toxic dose for ethanolic extract of ginseng in humans is not known.
The German Commission E reports no known side effects. 17 Asian ginseng (Panax ginseng) is categorized as a Class 2d herb in the American Herbal Product Association’s Botanical Safety Handbook , 14 with the specific restriction against use by hypertensive patients. No such restriction applies to American ginseng (Panax quinquefolius).
The British Herbal Compendium 13contraindicates ginseng during pregnancy, a caution not consistent with traditional use in Asia 14, where ginseng consumption in pregnancy is very popular; such consumption has long been a part of Chinese tradition and believed to provide energy for both mother and child. 18
Chronic Respiratory Diseases: Ginseng extract was used in the treatment of chronic respiratory disease in individuals on home oxygen treatment. Patients were given 200 mg twice daily of Panax ginseng and were evaluated every month and a half. The study found increased respiratory strength, improved oxygenation and walking distance increased. Researchers concluded that ginseng taken twice daily helped improve oxygenation and pulmonary function in patients with severe chronic pulmonary function. 24Hypoglycemia: Ginseng may have an effect on newly diagnosed non-insulin dependent diabetic patients (NIDDM) and healthy individuals.
A study done in 1995 gave newly diagnosed diabetic patients 100 or 200 mg of an Asian ginseng extract of unspecified composition for 8 weeks. Researchers found that ginseng enhanced mood and psychophysical performance. This may have resulted in positive changes in diet, physical activity and weight. In the 200 mg ginseng group there was enhanced physical activity, improved glycated hemoglobin and aminoterminalpropeptide concentration. Overall, researchers concluded that ginseng may aid in the management of NIDDM. 25
In a study on healthy subjects without diabetes, subjects were given 2 or 3 g of ginseng at different intervals prior to oral glucose. The trial showed glycemia was lower than placebo over the last 45 minutes of ginseng dosing. Results indicated that American ginseng decreased postprandial glycemia in healthy non-diabetic subjects. 26
In another study, non-diabetic subjects were given 3 g of American ginseng or placebo 40 minutes prior to or with a 25 g dose of oral glucose. Fasting blood samples were taken at various minutes after the glucose administration. The results showed when ginseng was taken at least 40 minutes before a glucose challenge, there were reductions in postprandial glycemia. 27
Erectile dysfunction: A study compared the effectiveness of 300 mg of Korean red ginseng to placebo and 25 mg of trazodone for the treatment of erectile dysfunction. Ginseng was shown to be 60% effective and the placebo and trazodone groups were 30% effective. Ginseng was shown to be superior to placebo and trazodone in treatment of erectile dysfunction. 28 Cancer: Natural products such as ginseng may reduce risk of cancer development.
In a study done on 4,634 people over 40 years, consumers of Asian ginseng had a decreased risk for cancer compared with non-ginseng consumers. There was a decreased risk associated with the frequency and dosing of ginseng. Overall, results indicate that Panax ginseng may have a non-specific preventative effect against cancer. 29
Ginseng has been documented to increase cell division and the synthesis of protein RNA, DNA in bone marrow cells. Ginseng combined with radiotherapy may aid in recovery of liver cancer tumors. The study found when 0.5 ml of ginseng was combined with radiotherapy in mice there was enhanced recovery of the destroyed liver cells. 30
One small study has reported enhanced blood alcohol clearance in 14 healthy male volunteers, used as their own controls. 31 A hot water extract (100o C for 8 h.) of Korean panax ginseng (3g/65kg body weight) was given along with 25% alcohol (72g/65kg body weight), over a period of 45 min.; the control group, tested 1 week before the treated group, took no ginseng. Blood alcohol level in the test group, determined 40 min. after the last drink, was, on the average, 35% lower than their control values; on individual bases 11 of 14 test subjects ranged from 32-51% lower and 3 between 14 and 18%. These findings are consistent with a mechanism of enhanced alcohol dehydrogenase and aldehyde dehydrogenase activity 32, 33 , but the effect may also be aided by activation of components of other elements of the ethanol oxidizing system31 .
Traditionally, it has been used as a tonic for invigoration and fortification in times of fatigue and debility or declining capacity for work and concentration, as also during convalescence. It is also claimed to improve mental and physical performance, enhancing endurance and promoting resistance to infection, as well as countering nervous debility. Asian ginseng was also reputed to improve vision and to be an aphrodisiac. 9
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