Ginseng
Panax ginseng describes the root from two species of plants, Asian ginseng (Panax ginseng) and American gin-seng (Panax
quinquefolius), popularly used for improv-ing stamina and providing a sense
of well-being. The terms red and white ginseng refer to how the root is
processed, not the species of origin. Red
ginseng roots are steam-cured prior to drying, while white ginseng is bleached and dried. Panax ginsengs contain
triterpenoid saponins called ginsenosides
(also called panaxosides), of which
up to 18 types are recognized as having differing and sometimes opposing
pharmacological properties.
Siberian ginseng (Eleutherococcus senticosus) should not
be confused with Panax ginseng. Although it belongs to the same plant family
(Araliaceae), it is a much larger, more abundant, and consequently less
ex-pensive plant. Like Panax ginseng, however, it is used as a tonic and
adaptogen, a nonmedical term meaning that it helps the body adapt to stress in
a variety of ways. Siberian ginseng does contain saponins (eleutherosides) but no ginsenosides. To date, in spite of its
popularity, there is little conclusive evidence of clinical efficacy.
Ginsenosides are thought to
be the active principles in Panax ginseng root. The various subtypes can have
op-posing pharmacological actions: Rg1 stimulates the cen-tral nervous system
(CNS) and elevates blood pressure, while Rb1 does just the opposite. Somehow
these mul-tiple ginsenoside constituents are thought to act in con-cert to provide
increased stamina. In addition, these compounds have antiplatelet aggregation
effects and antioxidant properties, and they may stimulate the im-mune system.
Despite the long popularity
of ginseng and its evident mild stimulatory effect, there is less conclusive
evidence for its clinical effectiveness than for many of the other herbs. In
regard to improving cognitive function, most studies have failed to prove a
consistent benefit. A recent investigation of ginseng’s effect on physical
stamina found that an 8-week course of therapy failed to improve aerobic work capacity. Ginseng has been studied
as a diabetic agent, with re-duced hemoglobin A1c levels and improved glucose
control being documented in a small trial. Although there is some intriguing
work with ginseng as a cancer preventive, there is not enough evidence to
suggest its clinical use at this time.
Ginseng is generally
considered safe for nonpregnant healthy adults; however, at sufficient doses,
ginseng may elevate blood pressure and cause insomnia, palpita-tions,
nervousness, and tremor in susceptible individu-als. These effects are
increased if caffeine or other stim-ulants are taken concurrently. Both Panax
and Siberian ginsengs should definitely be avoided in any patient with poorly
controlled hypertension. Dizziness, headache, diarrhea, and nausea have also
been re-ported. A controversial ginseng
abuse syndrome con-sisting of tremor, elevated blood pressure, insomnia,
and anxiety may also occur.
Diabetic patients have had
hypoglycemia on ginseng, so sugars must be monitored, and insulin or other
hypo-glycemic medication dosages may have to be reduced. The use of ginseng
with anticoagulants (e.g., warfarin) and antiplatelet drugs is to be avoided
because of the theoret-ical risk of increased bleeding. Also, coadministration
of ginseng with digoxin and MAOIs should be avoided.
Capsules of powdered root
(100, 250, and 500 mg) are available, and doses range from 200 to 600 mg per day. Ginseng may also be taken as a tea or
extract. A 3-month maximum treatment
course followed by a 2-week break between courses has been recommended. A major
concern is that many commercial preparations do not contain the quantity of
herb stated on the label. In one assessment of 54 tested ginseng products, 60%
showed subtherapeutic amounts of active ingredients, and 25% showed no evidence
of any ginseng at all.
Ginseng has been popular for
more than 2000 years as a tonic for improved stamina and sense of well-being,
particularly in the elderly. Although subjective quality of life reports
substantiate this tradition, objective evi-dence of improved cognitive function
and physical stamina remains incomplete or lacking. Further studies of
standardized ginseng preparations will be necessary to clarify its use in
fatigue and diabetes.
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