Ginseng (Korean ginseng) is a well-known Chinese and foreign medicinal herb, from ancient times to the present, famous for health and disease prevention and anti-aging, in addition to being used in dietary therapy stew, but also made into a variety of health products, the variety is amazing.
There are many legends about the origin of the name ginseng, one is that hunters climbed mountains and encountered heavy snow, and survived by eating ginseng, and because of its human-like appearance, they took the name of life and changed the ginseng known today.
What are the benefits of using ginseng in empirical medicine? Are there any side effects or contraindications? See the article for details.
What is Ginseng (Korean Ginseng)?
Ginseng is a perennial herb that has been used by humans to heal diseases and strengthen the body for a long time, known as the king of medicinal herbs, generally divided into Asian ginseng (Panax ginseng) and American ginseng (Panax uinquefolium), and the following will discuss the Asian ginseng that grew in East Asia.
According to the origin, cultivation method and processing method, ginseng can be classified up to more than ten kinds, each with different taste, attribution and efficacy, but the main activity is polysaccharides, saponins, peptides, fatty acids, etc., which are considered to have potential effects such as immune regulation, anti-fatigue, anti-aging, anti-diabetes, anti-cancer, etc
According to the place of origin: Changbai ginseng, Korean ginseng
According to the planting method: wild ginseng (natural growth), garden ginseng (artificial cultivation)
According to the preparation method: fresh ginseng, white ginseng, red ginseng, raw ginseng
What are the proven benefits of ginseng?
To some extent, the effect of ginseng (Korean ginseng) is difficult to evaluate, and the most important factor is different types/origin/preparation methods of ginseng, which have different medicinal properties.
In addition, most of the studies related to ginseng are small, short-term studies, poorly designed, and use different dosage forms and doses, so it is difficult to compare (and the research results currently available are listed below)
1. Ginseng is beneficial for erectile dysfunction
Erectile dysfunction is a common male sexual dysfunction. Defined as a prolonged inability to obtain or maintain enough erections for satisfactory sex (prevalence approximately 19.2%), which seriously affects the quality of life of men.
Erections are primarily vascular events, a process that is attributed to the release of neurotransmitters and nitric oxide (NO) from the cavernous bodies, allowing blood to flow into the dilation and then maintain an erection. Therefore, any condition that may cause endothelial dysfunction can interfere with vasodilation and prevent erections.
A Cochrane Database of Systematic Reviews (9 randomized controlled trials of 587 men with mild to moderate erectile dysfunction) noted that ginseng (studies mainly using Korean red ginseng) had a slightly positive effect on erectile function or sexual satisfaction compared with placebo (assessed using IIEF-5 or IIEF-15 tools). Note 1
In addition, ginseng also improves men’s self-reported ability to have sexual intercourse.
*Conclusion: Ginseng may provide positive help for mild to moderate erectile dysfunction, but due to the low quality of the available evidence, more research is needed
2. Ginseng is beneficial to liver function
Chronic liver disease is one of the most common diseases in China and is rapidly becoming an increasing burden on the health care system.
Because the liver has a large functional reserve, most people with chronic liver disease are not diagnosed until late in the course of the disease.
When the liver can no longer maintain homeostasis and begins to lose compensation, patients may present with ascites, variceal bleeding, spontaneous bacterial peritonitis, encephalopathy, or jaundice.
A systematic literature review and meta-analysis (14 randomized controlled trials, 992 participants) showed that ginseng administration was not significantly helpful for alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyltransferase (GGT), alkaline phosphatase (ALP), and albumin (ALB) levels. Note 1
In addition, subgroup analysis showed that bilirubin increased significantly in unhealthy individuals when the daily supplement dose of ginseng was ≥ 3 g.
*Conclusion: Up to now, the evidence shows that ginseng supplementation has not brought significant benefits for people with relatively normal liver function, and due to the heterogeneity between studies, more studies are needed to confirm the effect on patients with liver disease
3. Ginseng is beneficial for male infertility
Over the past few decades, the quality of semen in humans is declining, which may lead to an increase in male infertility, with an estimated 4850 million couples worldwide suffering from infertility
In addition to intrinsic factors (genetic or congenital disorders), semen quality can also be influenced by extrinsic lifestyle, including diet, physical activity, environmental pollutants, endocrine disruptors, exposure to electrical magnetic fields, and occupational characteristics.
A systematic review (5 studies) noted that one randomized controlled study reported that the use of Korean red ginseng improved sperm quality in infertile men, but other studies found no effect (either in healthy or infertile people). Note 1
*Conclusion: So far, there is no clear evidence that ginseng can improve semen quality, and due to the small sample size and risk of error, more high-quality studies are needed to further validate
4. Ginseng has cognitive enhancement (for mild cognitive impairment)
Mild cognitive impairment is considered to be an intermediate state between normal cognitive aging and early dementia.
Individuals diagnosed with mild cognitive impairment may remain stable and return to normal (about 14.4% to 55.6% of patients), but may also progress to dementia.
It is estimated that 58% to 40% of patients aged 60 years and older with mild cognitive impairment have underlying pathological features of Alzheimer’s disease.
A randomized, double-blind, placebo-controlled clinical trial (6-month trial of 90 volunteers with mild cognitive impairment) showed that oral ginseng powder capsules (daily dose of 3 g) helped improve immediate recall and 20-minute delayed recall test scores. Note 2
*Conclusion: For mild cognitive impairment, the use of ginseng has a positive effect on cognitive improvement, but limited by the small sample size, more large studies are still needed for further verification
5. Ginseng reduces inflammation indicators (C-type reactive protein)
C-reactive protein, a homogeneous acute-phase inflammatory protein, is a highly sensitive plasma protein first discovered in 1930 by Tillet and Francis while studying serum from patients with acute pneumococcal infection.
In inflammatory situations such as rheumatoid arthritis, cancer, certain cardiovascular diseases, and infections, C-reactive protein is significantly elevated, even up to 1000 times more at the site of infection or inflammation.
In addition to this, there are many factors that can alter baseline levels of type C-reactive protein, including age, sex, smoking status, weight, lipid levels, and blood pressure.
A systematic literature review and meta-analysis (7 randomized placebo-controlled trials with 420 participants) noted that, overall, ginseng supplementation was not significantly helpful in reducing C-reactive protein. Note 1
However, subgroup analysis showed that ginseng significantly reduced serum CRP levels when baseline CRP levels were greater than 3 mg/dl.
*Conclusion: For patients with elevated serum C-reactive protein levels, ginseng supplementation may have a positive effect on reducing values
6. Ginseng lowers blood lipids
Cholesterol, triglycerides, and high-density lipoprotein are important components of human blood lipids.
Cholesterol is an unsaturated alcohol in the steroid family of compounds, which is necessary for the proper functioning of all animal cells and a precursor to various important substances such as adrenal and gonadal steroid hormones and bile acids.
Triglycerides are a glycerol fatty acid ester that is the main lipid component of animal dietary fats and fat banks.
A systematic literature review and meta-analysis (10 randomized controlled trials associated with metabolic syndrome) found that oral ginseng extract reduced total cholesterol and LDL-cholesterol compared with placebo. There is no significant effect on HDL-cholesterol and triacylglycerides. Note 1
*Conclusion: For patients with metabolic syndrome, oral ginseng extract may have a positive effect on the improvement of some blood lipid indexes, but due to the heterogeneity of the studies included, more high-quality studies are still needed to support it
7. Ginseng is good for diabetes
Diabetes has affected the population exponentially in the last 30 years, and the main factors are related to obesity, stress, overeating, and lack of exercise.
Symptoms of hyperglycemia include polyuria, polydipsia, weight loss, and sometimes polyphagia and blurred vision.
A systematic literature review and meta-analysis (8 studies) pointed out that ginseng intake helped improve the effect of blood glucose control (related indicators include: fasting blood glucose, postprandial insulin, insulin resistance) in patients with type 2 diabetes or glucose intolerance, and was most significant in those who did not receive drugs or insulin therapy. Note 1
The mechanism behind it may be related to the regulation of insulin secretion, glucose metabolism and absorption, inflammatory pathway, and initiation of AMPK pathway.
*Conclusion: Ginseng intake is beneficial to blood glucose regulation, but due to possible bias and heterogeneity, more clinical studies are still needed to further confirm
8. Ginseng is beneficial for ischemic heart disease – angina
Angina pectoris is caused by plaque rupture, coronary artery spasm, thrombosis, and oxygen supply and demand imbalance, and is characterized by pressure in the sternum, dullness, inability to breathe, and most often occurs during physical activity or mood swings.
A meta-analysis (18 randomized controlled trials with 1549 angina patients) showed that the use of person-based prescriptions produced better symptoms and ECG improvement than nitrates. Note 1
*Conclusion: For the treatment of angina, ginseng-based therapy can produce a more significant symptom improvement effect than nitrates
9. Ginseng prevents acute respiratory diseases
Acute respiratory illness is a self-limiting viral infection with symptoms including fever, tremors, chills, malaise, dry cough, etc., with rhinovirus and coronavirus (50%-70%) infection being the most common, followed by influenza virus (20%-35%) and adenovirus (5%-10%).
According to the Burden of Disease Survey, acute respiratory diseases are the diseases with the highest morbidity and mortality among children under 5 years of age in developing countries, due to age, sex, nutritional status, breastfeeding (type and duration), socioeconomic level, overcrowding, indoor pollution, passive smoking.
A randomized, double-blind, placebo-controlled trial (12 weeks, 100 healthy adults) found that oral Korean red ginseng/Korean red ginseng extract significantly reduced the frequency of acute respiratory infections and helped reduce symptom duration and severity scores (although the latter two were not statistically significant). Note 1
*Conclusion: Korean red ginseng extract may have the efficacy of preventing acute respiratory disease, but due to the size of the study, more large studies are still needed to confirm it
10. Ginseng reduces cancer incidence
Cancer usually occurs not as a single factor, but is caused by an interaction between internal factors (genetic mutations, hormonal and immune conditions) and environmental/acquired factors (tobacco, diet, radiation, and infectious diseases).
According to U.S. statistics, local men and women have a 43% and 38% chance of being diagnosed with cancer in their lifetime, respectively, which is indeed staggeringly high.
A meta-analysis (9 studies, 7,436 cancer cases, 334,544 participants) found that, overall, ginseng intake reduced cancer risk by 16% compared to non-users. Note 2
The subgroup analysis also found that for individual types of cancer, such as colorectal cancer, lung cancer, gastric cancer and liver cancer, the risk reduction was as follows: 23%, 19%, 17% and 23%, respectively.
The mechanism behind it is related to the regulation of the cell cycle, induce apoptosis, and inhibit angiogenesis and invasion through a variety of cell signaling pathways.
*Conclusion: Ginseng intake has the effect of reducing cancer incidence, but due to the heterogeneity of the included studies, more large-scale clinical trials are still needed to verify
11. Ginseng fights fatigue and improves physical fitness
Fatigue refers to a physiological condition that lacks physical strength and motivation, usually caused by physical activity, emotional stress, boredom, lack of sleep, or related medical conditions.
A meta-analysis (12 randomized controlled trials, 630 participants) showed that ginseng-related supplements had statistically significant improvements in reducing fatigue, but not in improving physical performance. Note 3
*Conclusion: Due to the insufficient number of studies and sample sizes, there is insufficient evidence to confirm the anti-fatigue and physical performance effects of ginseng, and more large-scale studies are needed to further confirm
12. Ginseng is good for women with menopausal disorders
Female menopause, or menopausal transition, usually refers to the period between irregular menstrual cycles and the cessation of menstrual cycles, which is between the ages of 40 and 50.
During menopause, due to the sharp fluctuations of estrogen, it is often accompanied by physical and mental symptoms such as mood changes, hot flashes, insomnia, vaginal dryness, loss of libido, and impaired cognitive function.
A systematic review (10 randomised controlled trials) found that ginseng use improved sexual function, arousal, and hot flashes in menopausal women (but did not improve hot flashes frequency, hormonal levels, or endometrial thickness). Note 4
*Conclusion: Due to the unknown risk of error and small sample size of the included experiments, the use of ginseng has limited improvement effect on female menopausal disorders, and more rigorous experiments are needed to support it
13. Ginseng is good for Alzheimer’s disease
Alzheimer’s disease was developed a century ago by the German psychiatrist Alois. A progressive neurodegenerative disease identified in Alzheimer’s accounts for 75% of all dementia cases, with a prevalence of 60.3% over 9 years of age, equivalent to 5 million new cases worldwide each year.
As the disease progresses, Alzheimer’s disease often causes a variety of functional disabilities and requires specialized care, and is the highest among all diseases (11.2%) in the period of coexistence with disability, better than stroke, musculoskeletal diseases, and cardiovascular diseases.
A literature review and meta-analysis (4 randomized controlled trials with 259 participants) pointed out that due to inconsistent results, the use of ginseng is effective in Alzheimer’s patients is inconclusive. Note 5
*Conclusion: Due to small sample sizes, poor methodological quality, and the absence of placebo controls, the effect of using ginseng in improving Alzheimer’s disease is questionable and needs to be confirmed
Are there any side effects of ginseng?
Ginseng has been used for thousands of years in China, Japan, South Korea and other countries, and it is considered safe to use natural supplements in the short term, but the possible side effects or adverse reactions that have been reported include: insomnia, hypoglycemia, loss of appetite, diarrhea, itching, rapid heartbeat, increased or decreased blood pressure, headache, dizziness, rash, breast pain, mood changes, vaginal bleeding, allergies, etc., especially after excessive doses or long-term use.
1. Do not use if you are pregnant, lactating, infant, liver and kidney function (due to unknown safety)
2. Do not use in autoimmune patients (such as multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis), as ginseng may stimulate the immune system and cause the condition to worsen
3. It may have anticoagulant effect, so do not use it if you have coagulation disorders or take related anticoagulants, which will increase the risk of bruising and bleeding
4. May produce weak estrogen effect, if you have hormonal sensitive symptoms, such as uterine cancer, breast cancer, endometriosis, uterine fibroids and other diseases, do not take it, it may cause symptoms to worsen
5. There may be hypoglycemic effect, diabetic patients or patients taking hypoglycemic drugs please be careful, it may cause hypoglycemia
6. Do not use if you have received organ transplantation and take related anti-rejection drugs, which may affect the efficacy of the drug
7. Do not use with coffee, it may accelerate the occurrence of side effects such as palpitations, sweating, arrhythmia, nervousness, etc
8. Do not use when taking blood pressure lowering drugs, coronary heart disease, acute stage of stroke, and unstable hypertension (systolic blood pressure higher than 140mmHg).
9. Patients with bipolar disorder or taking monoamine oxidase inhibitors (MAOIs) should not use, headache or manic symptoms may occur