Ginseng

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Contents 1 More Specific Terms 2 Introduction 3 Uses 4 Contraindications 5 Dosage 6 Adverse-effects 7 Drug-interactions 8 Preparation 9 Mechanism-of-action 10 More General Terms 11 References

More Specific Terms

• Eleutherococcus senticosus (Siberian ginseng)
• Panax ginseng (Asian or Korean ginseng)
• Panax quinquefolius (American ginseng)

Introduction

• Ginseng has been used in Chinese medicine for >5000 years. Marco Polo introduced the root to Europe in 1274 AD, but it did not gain popularity until the early 1700s, when a French Jesuit missionary working in China wrote about the popular Chinese root to his colleagues in Canada. When Ginseng was found growing wild in regions of North America, the root was exported to China & sold at a high price. Allegedly, Daniel Bone made his living by collecting & selling ginseng. Ginseng is the top selling herbal medicine in the US today.

• Ginseng is a perennial plant which takes 5-7 years to mature. Older roots are considered of higher quality because they contain a higher concentration of ginsenosides. Over-harvesting has made wild ginseng rare. Most Asian ginseng sold today is cultivated in NE China & most American ginseng is grown in farms in Wisconsin & Canada.

Uses

• Traditional use:
• maintain general state of well being
• improve sexual function
• invigorate the body
• cure for problems of multiple organ systems

• digestive
• nervous
• cardiovascular
• pulmonary

• Current uses:

• maintain general health
• prevent illness
• invigorate the body
• protect against stress
• increase energy level
• enhance physical & mental performance
• stimulate the immune system
• prevent cancer

Contraindications

• ginseng should not be used during pregnancy, by children or by patients with uncontrolled hypertension because of stimulatory effects
• renal failure [2]

Dosage

• 0.5-2.0 mg QD (dried ginseng root)
• 200-600 mg QD of extract
• duration of therapy 3 months
• discontiune 7 days before surgery [2]

Adverse-effects

• most reports of toxicity have been traced to mislabeled or aldulterated products
• high doses, i.e. 3 grams/day for > 1-3 weeks

• hypertension
• nervousness
• sleeplessness
• skin eruptions
• morning diarrhea
• tachycardia [2]

• case report of cerebral arteritis
• case report of Stevens-Johnson syndrome associated with Panax ginseng
• case report of neonatal androgenization following mother's use of Siberian ginseng discredited after analysis revealed the product contained a contaminant, Periplca sepium (silk vine)
  
• drug adverse effects of ginsengs

Drug-interactions

• antigoagulants: possible interaction with warfarin
• antiplatelet agents including NSAIDs [2]
• case report of ginseng increasing serum digoxin level
  
• drug interaction(s) of warfarin with ginseng

Preparation

• The root is dried prior to preparation. If it is air dried, it retains a slight yellowish color & is called white ginseng. If it is steamed before it is dried, it turns red & is called red ginseng. Ginseng can be prepared as teas, tinctures, wines, powders, capsules, tablets & salves. It is added to toothpaste, candies, & make-up. Some ginseng preparations may contain up to 34% alcohol.

• Active ingredients:

• a group of 28 saponins, called ginsenosides

Mechanism-of-action

• unclear
• enhanced nitric oxide synthesis in endothelium of lung, heart, kidney & corpus cavernosum
• increase in plasma ACTH & corticosterone in mice
• anti- complement activity
• antagonism of platelet activating factor ( PAF)
• one of the ginsenosides is a glucocorticoid receptor ligand
• ginseng has effects on the central nervous system

• increase in dopamine & norepinephrine in the brainstem
• increased serotonin in the cerebral cortex

More General Terms

• pharmaceutical herb (medicinal herb)

References

1. Victoria Rand, UCSF Fresno Lecture
2. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society

Ginseng (Elixir of life)