Taxonomic Class

Araliaceae

Common Trade Names

Multi-ingredient preparations : Bio Star, Cimexon, Energy Rise, Fast Lane Herb Tea, Gincosan, Ginsana, Ginsatonic, Ginseng Action, Neo Ginsana

Common Forms

No standards exist for ginseng despite availability of chromatographic assays for ginsenosides and ginseng polysaccharides.

Capsules : 100 mg, 250 mg, 500 mg

Extract : 2 oz root extract (in alcohol base)

Root powder : 1 oz, 4 oz

Tea bags : 1,500 mg ginseng root

Also available as a cream, eye gel, nutrition bar, and oil. The root is available in bulk by the pound.

Source

The most common species is Panax quinquefolius, commonly known as American or Western ginseng. Sought after most commonly for its root, the plant's other characteristics (wild or cultivated) and the shapes of the root make it more valuable. Traditionally, ideal plants are at least 6 years old. Panax ginseng is known as the Asian, Korean, or Japanese ginseng. Asian ginseng usually undergoes treatment, such as drying and curing, before it is sold; the American variety undergoes less manipulation and carries less distinction.

Chemical components

Ginseng is composed primarily of ginsenosides, also known as panaxosides. About 12 major panaxosides have been isolated but are found in only minute quantities and are difficult to purify on a large scale. Other components of the plant isolated for pharmacologic effects include a volatile oil, beta-elemine, sterols, flavonoids, peptides, vitamins (B 1 , B 2 , B12 panthotenic acid, nicotinic acid, and biotin), fats, polyacetylenes, minerals, enzymes, and choline.

Actions

Several pharmacologic effects have been noted that vary with dose and duration of treatment. The panaxosides, found in the root, are thought to be the pharmacologically active agents. Although they are similar in

structure, sometimes these compounds exert opposing pharmacologic effects. For example, ginsenoside Rb-1 has analgesic, anticonvulsant, antipsychotic, and CNS depressant effects; stress ulcer-preventing action; and acceleration of glycolysis and nuclear RNA synthesis. Ginsenoside Rg-1 has antifatigue, CNS stimulating, hypertensive, and stress ulcer-aggravating activities. These opposing features form the basis for the theory that ginseng serves to "balance bodily functions."

Another example of these opposing actions is that Rg and Rg-1 enhance cardiac performance, whereas Rb depresses cardiac function. Other ginsenosides have shown antiarrhythmic activity similar to that of verapamil and amiodarone. Oral ginseng was found to reduce cholesterol and triglyceride levels, decrease platelet adhesiveness, impair coagulation, and increase fibrinolysis in cholesterol-fed rats. Ginsenosides may reduce stress by acting on the adrenal gland.

Hypoglycemic activity in rodents has been documented, but the mechanism of action has not been proved . Extracts of ginseng have shown antioxidant activity on human erythrocytes in a laboratory model and prevented the development of morphine tolerance in rats. Some studies in animals have documented ginseng's anti-inflammatory and antiviral activities and its hepatoprotective effects at low doses (destruction at high doses) in a rat model, whereas others found that tumors in mice were suppressed by components of ginseng.

Reported Uses

Ginseng is popularly claimed to minimize or reduce thymus gland activity. Other claims include its use as an antidepressant, an aphrodisiac, a demulcent (soothes irritated or inflamed internal tissues and organs), a diuretic, a sedative, and a sleep aid. Short-term use of the herb may improve concentration, healing, stamina, stress resistance (adaptogenic), vigilance, and work efficiency; long-term use is claimed to improve well-being in elderly patients with debilitated or degenerative conditions. Few claims have supporting data from animal studies and fewer still have data from human studies.

Although studies conducted in humans were mostly small and poorly designed, results suggest that ginseng has several beneficial effects. Improvement in appetite, emotional lability, sleep, and work efficiency in animals and humans indicates the ginseng's ability to enhance physical and mental performance. Ginseng may also indirectly exhibit corticosteroid-like effects.

Ginseng decreased fasting blood glucose and hemoglobin Ale levels in both diabetic and nondiabetic patients such that some diabetics were free of insulin therapy for the duration of the study . The herb has also been shown to be beneficial in patients with hepatic dysfunction, hyperlipidemia, and impaired cognitive function.

Dosage

Dosages vary with the disease state; usually, 0.5 to 2 g of dry ginseng root P.O. daily or 200 to 600 mg of ginseng extract P.O. daily in one or two equal doses.

For improved well-being in debilitated elderly patients, 0.4 to 0.8 g of root daily P.O. on a continual basis.

Adverse Reactions

CNS: headache, insomnia, nervousness.

CV: chest pain, hypertension, palpitations.

EENT: epistaxis.

GI: diarrhea, nausea, vomiting.

GU: impotence, mastalgia, vaginal bleeding.

Skin: pruritus, rash (with ginseng abuse).

Interactions

Antidiabetic agents, insulin: Increased hypoglycemic effect. Use together

cautiously.

MAO inhibitors (hypericin, parnate, phenelzine, selegiline, tranylcypromine): Adverse reactions include headache, mania, and tremor. Avoid administration with ginseng.

Contraindications And Precautions

Avoid using ginseng in pregnant or breast-feeding women; effects are unknown. Use cautiously in patients with CV disease, diabetes, hypertension, or hypotension and in those who are also receiving steroid therapy.

Special Considerations

Monitor the patient for signs and symptoms of ginseng abuse syndrome. This syndrome occurs when large doses of the herb are taken concomitantly with other psychomotor stimulants, such as tea and coffee. Symptoms include depression, diarrhea, edema, euphoria, hypertension, insomnia, loss of appetite, rash, and restlessness. The existence of this syndrome is debatable.

Monitor the diabetic patient for signs and symptoms of hypoglycemia. Advise him to monitor his blood glucose level closely until effects are known.

Advise the patient not to take ginseng for a prolonged period.

Instruct the patient with preexisting medical conditions to check with his health care provider before taking ginseng.

Urge the patient to watch for unusual symptoms (diarrhea, insomnia, nervousness, palpitations) because of the risk of ginseng toxicity.

Advise the pregnant or breast-feeding patient to consult a health care provider before taking ginseng because safety has not been established.

Points of Interest

Ginseng has been given a positive evaluation from the German Commission.

It is estimated that 6 million people in the United States use ginseng regularly. In oriental cultures, it has been used for its medicinal properties for more than 2,000 years.

Although it was abundant in eastern North America, American ginseng is now considered threatened because of aggressive harvesting for commercial sales.

Commentary

Public interest in ginseng has been increasing. Although the herb appears to have promising uses, additional human efficacy, toxicity, and interactions data are needed. Ginseng has an interesting and unique pharmacologic profile, but ingestion of the plant is not without risk, despite its use for centuries.