Ginseng
Definition
Ginseng is an herbal preparation derived from the aromatic root of a plant of the genus Panax , which is native to East Asia. Ginseng belongs to the Araliaceae family of plants. Siberian ginseng belongs to a different genus, Eleutherococcus senticosus. The English name of the plant is a modification of its Chinese name, ren shen, which means "man" and "herb." The Chinese name comes from the ginseng root's resemblance to the shape of the human body, whence the plant's traditional use as a tonic for male sexual vigor and potency. The Latin name for the species, Panax , is derived from the Greek word panacea , which means "cure-all," or, "all-healer."
There are three species of ginseng in common use in the United States: American ginseng, Korean ginseng, and Siberian ginseng. All are regarded as adaptogens that normalize immune functions and are preparations that help the body adapt to change, thus lowering the risk of stress-related illness. American ginseng, whose botanical name is Panax quinquefolius , has recently been evaluated as a treatment for high blood sugar in patients with type 2 (adult-onset) diabetes. It is considered to be less stimulating than the Korean or Siberian varieties. Korean ginseng, or Panax ginseng , is the species most often studied in Western as well as Asian trials of botanical preparations. Siberian ginseng, or Eleutherococcus senticosus , has been used in Russian sports medicine to boost athletic performance and strengthen the immune system.
As of 2002, ginseng is one of the most expensive herbs in the world, costing as much as $20 per ounce, or more for red ginseng with the root, which is over 10,000 years old. It is one of the top three herbal products sold in the United States.
Purpose
In traditional Chinese medicine (TCM), ginseng is regarded as having a "sweet" and "neutral" nature. It is thought to have a particular affinity for the spleen and lungs. It is used as an aphrodisiac, a tonic for the spleen, kidney and adrenal functions, and lungs, and a general restorative for the qi or vital energy in the body. TCM also recommends ginseng for asthma, weak pulse, indigestion, lack of appetite, rectal prolapse, hypertension, diabetes, insomnia , angina, congestive heart failure, and heart palpitations. It is important to note that ginseng is an exception to the rule that Chinese herbal medicine rarely uses a single herb in the manner of Western herbalism. Ginseng is often listed as one ingredient among several in Chinese medicines; it is, however, one of the few herbs in TCM that is sometimes prescribed by itself.
In the West, ginseng is frequently advertised as an energy booster, a memory aid, a sexual stimulant, a treatment for impotence and gastrointestinal disorders, and a promoter of longevity. Many Western researchers consider these claims inflated; some studies have found no difference between ginseng and a placebo in terms of the energy levels or general well-being reported by test subjects. Most studies nevertheless have shown improved energy, memory function and performance especially when fatigued, though most of the studies have been short-term. Ginseng's association with the male reproductive system is sufficiently strong that Western feminist herbalists frequently advise women against taking ginseng for any reason.
Description
The part of the ginseng plant that is used medicinally is the root. Ginseng roots are not harvested until the plant is four to six years old. The active ingredients in ginseng root are saponin triterpenoid glycosides, or chemicals commonly called ginsenosides. Other compounds found in Asian ginseng include glycans (panaxans); polysaccharide fraction DPG-3-2; peptides; maltol; and volatile oil. The active compounds in Siberian ginseng are called eleutherosides. Eleutherosides are somewhat different from the ginsenosides found in the Panax varieties of ginseng. There has been some debate among herbalists whether Siberian ginseng should be considered a true ginseng at all, due to this difference in active ingredients. Ginseng root from any of the three varieties is dried and can then be made into powder, capsules, or a liquid tincture. American ginseng is also available in the United States as whole roots.
Recommended dosages
Dosages of Korean ginseng used in traditional Chinese medicine are given as 2–8 g as a tonic and 15–20 g for acute conditions.
Researchers who studied the potenial effectiveness of ginseng as a treatment for diabetes found that 1–3 g of American ginseng taken 40 minutes before a meal was effective in reducing blood sugar levels. Because dried ginseng root is hard and brittle, it must be simmered for about 45 minutes to extract the ginsenosides. Two to three teaspoonsful of dried root are used per cup. Powder made from American ginseng can be made into tea or taken with water or juice. One-half to one teaspoon is recommended per serving. American ginseng is usually taken two to three times per day between meals.
For Siberian ginseng, the recommended dosage for the powdered form is 1–2 g daily, taken in capsules or mixed with water or juice. The dose should be divided and taken two or three times per day between meals. The recommended dosage for liquid extract of Siberian ginseng is 1–2 mL twice daily.
Precautions
Because ginseng is considered a dietary supplement rather than a drug, it is not regulated by the Food and Drug Administration (FDA). Studies done between 1999 and 2001 found that many ginseng products for sale in the United States contain little or no ginseng. There have been no recent reports of contaminated products.
It is important for patients with Type 2 diabetes who are taking oral prescription medications to lower blood sugar levels to tell their physician if they are using any products containing ginseng. One Chinese-American physician reported several incidents of patients developing hypoglycemia (low blood sugar) from taking ginseng preparations alongside their regular prescription drugs.
People who use ginseng should discontinue it prior to abdominal or dermatologic surgery, or dental extraction. It has been associated with bleeding problems following surgery.
The American Herbal Products Association (AHPA) states that ginseng should not be taken by people with hypertension (high blood pressure). Data suggests variable effects on blood pressure. Some patients experience hypertension and some experience hypotension.
Ginseng should not be given to children. In addition, pregnant or lactating women should not use ginseng, as it may lower estrogen production.
Ginseng should not be used uninterruptedly for long periods of time. In Asian medicine, it is customary to take ginseng for two months and then stop for a full month before taking it again, but the basis for this is uncertain.
Side effects
Ginseng can have serious side effects. The American Herbal Products Association, or AHPA, classifies ginseng as a Class 2d herb, which means that its use is subject to restrictions.
Contemporary Chinese practitioners recognize a condition known as ginseng abuse syndrome, caused by taking ginseng incorrectly or excessively. In China, ginseng is almost always used for longevity by people over the age of 60; it is not given to younger people unless they are severely debilitated. Chinese medicine also recommends ginseng for use in winter only; it is not taken year round. The symptoms of ginseng abuse syndrome include include heart palpitations, heaviness in the chest, high blood pressure, dizziness, insomnia, agitation, restlessness, nausea, vomiting, abdominal pain and/or bloating, diarrhea, possible upper digestive tract bleeding, edema, and a red skin rash that is most noticeable on the face. Western herbalists recommend that anyone taking ginseng who develops these symptoms should stop taking the herb at once and contact a licensed practitioner of TCM to determine whether ginseng abuse is the cause of the problem.
A number of case studies involving severe side effects from habitual use of ginseng have been reported in American medical journals. These studies include a case of Stevens-Johnson syndrome (a disorder of the skin and mucosa usually caused by reactions to corticosteroids and a few other systemic drugs) in a Chinese student; a case of cerebral arthritis in a 28-year-old woman following a large dose of ginseng extract; a case of metrorrhagia (uterine hemorrhage) following two months of steady use of ginseng; and a case of hemorrhagic bleeding from the vagina following habitual use of ginseng douches.
Interactions
Ginseng has been reported to interact with caffeine to cause overstimulation and insomnia in some people. It has also been reported to increase the effects of digoxin, a medication used to treat congestive heart failure; and to interact with phenelzine , an antidepressant. Its interactions with phenelzine cause symptoms ranging from manic episodes to headaches. It also may alter the effects of the drug coumadin, and any anticoagulant therapies.
Resources
BOOKS
Medical Economics staff. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Company, 1998.
Pelletier, Kenneth R., MD. "Western Herbal Medicine: Nature's Green Pharmacy." Chapter 6 in The Best Alternative Medicine. New York: Simon & Schuster, 2002.
Reid, Daniel P. Chinese Herbal Medicine. Boston, MA: Shambhala, 1993.
Sander, Pela. "Natural Healing Therapies." In Women of the 14th Moon: Writings on Menopause, edited by Dena Taylor and Amber Coverdale Sumrall. Freedom, CA: The Crossing Press, 1991.
PERIODICALS
Ang-Lee, Michael K., Jonathan Moss, and Chun-Su Yuan. "Herbal Medicines and Perioperative Care." Journal of the American Medical Association 286 (July 11, 2001): 208.
Bone, Kerry. "Safety Issues in Herbal Medicine: Adulteration, Adverse Reactions and Organ Toxicities." Townsend Letter for Doctors and Patients (October 2001): 142.
Cardinal, Bradley J., and Hermann-Johann Engels. "Ginseng Does Not Enhance Psychological Well-Being in Healthy, Young Adults: Results of a Double-Blind, Placebo-Controlled, Randomized Clinical Trial." Journal of the American Dietetic Association 101 (June 2001): 655–660.
Cheng, Tsung O. "Panax (Ginseng) is Not a Panacea." Archives of Internal Medicine 160 (November 27, 2000): 3329.
Flaws, Bob. "Using Ginseng Wisely." Townsend Letter for Doctors and Patients (October 2001): 28.
Harkey, Martha R., Gary L. Henderson, M. Eric Gershwin, and others. "Variability in Commercial Ginseng Products: An Analysis of 25 Preparations." American Journal of Clinical Nutrition 73 (June 2001): 1101.
Hoffman, R. J., and others. "Life-Threatening Vaginal Hemorrhage Caused by Therapeutic Chinese Ginseng Douche." Journal of Toxicology: Clinical Toxicology 39 (April 2001): 313.
Miller, Lucinda G., PharmD. "Herbal Medicinals." Archives of Internal Medicine 158 (1998): 2200–2211.
Tyler, Varro E. "Drug-Free Hope for Type 2 Diabetes." Prevention 53 (October 2001): 107.
Vuksan, Vladimir, John L. Sievenpiper, Julia Wong, and others. "American Ginseng ( Panax quinquefolius L.) Attenuates Postprandial Glycemia in a Time-Dependent But Not Dose-Dependent Manner in Healthy Individuals." American Journal of Clinical Nutrition 73 (April 2001): 753.
"Watch for Use of Three Herbal Gs in Surgical Patients." Skin & Allergy News 32 (October 2001): 9.
OTHER
American Association of Oriental Medicine. 433 Front Street, Catasaqua, PA 18032. (610) 266-1433. Fax: (610) 264-2768. <www.aaom.org> .
American Botanical Council. PO Box 144345. Austin, TX 78714-4345. <www.herbalgram.org> .
Herb Research Foundation. 1007 Pearl Street. Suite 200. Boulder, CO 80302. <www.herbs.org> .
National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse. P.O. Box 7923, Gaithersburg, MD 20898. (888) 644-6226. TTY: (866) 464-3615. Fax: (866) 464-3616. <www.nccam.nih.gov> .
Rebecca J. Frey, Ph.D