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Ginseng is now found throughout the world. Panax quinquefolius is native to North America; Panax ginseng is native to the Far East.

Panax ginseng describes the root from two species of plants, Asian ginseng (Panax ginseng) and American ginseng (Panax quinquefolius), popularly used for improving 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 expensive 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.

Major components are named the ginsenosides. The chemical constituents of ginseng are called ginsenosides or panaxosides. A total of 12 of these have been isolated but are present in such small quantities that purification is difficult. Sterols, flavonoids, proteins, and vitamins (B₁, B₂, B₁₂, pantothenic acid, niacin, and biotin) are also components with pharmacological activity. The chemistry of ginseng gives a good example of how different compounds in one herb can have opposing pharmacological effects. Ginsenoside Rb-1 acts as a CNS depressant, anticonvulsant, analgesic, and antipsychotic, prevents stress ulcers, and accelerates glycolysis and nuclear RNA synthesis. Ginsenoside Rg-1 stimulates the CNS, combats fatigue, is hypertensive, and aggravates stress ulcers.
Additionally, ginsenosides Rg and Rg-1 enhance cardiac performance, whereas Rb depresses that function. Some of the other ginsenosides display antiarrhythmic activity similar to that of the calcium channel blocker verapamil and amiodarone. Ginseng is popularly believed to enhance concentration, stamina, alertness, and the ability to do work. Longer-term use in elderly patients is claimed to enhance “well-being.”.

Ginsenosides are thought to be the active principles in Panax ginseng root. The various subtypes can have opposing pharmacological actions: Rg1 stimulates the central nervous system (CNS) and elevates blood pressure, while Rb1 does just the opposite. Somehow these multiple ginsenoside constituents are thought to act in concert to provide increased stamina. In addition, these compounds have antiplatelet aggregation effects and antioxidant properties, and they may stimulate the immune system.

Ginseng can refer to either white or red ginseng, and herbal preparations varyaccording to the type. In European herbal medicine, ginseng is powdered into300 mg/capsule, with 2–3 capsule/day dosage (Lust 2014). For ginseng in dryextract, 15 ml of oral liquid is given once daily. Each 15 ml of oral liquid contains140 mg of dry extract (Kapoor 2000). American ginseng is also listed as an ingredientin some soft drinks, and its oil and extracts are used in soap and cosmetics(Gupta et al. 2004). There is a little evidence in terms of clinical research to supportginseng treating breast cancer (Shin et al. 2000). However, research conducted inChina suggests that patients treated with any form of ginseng maintained betterpsychological condition. Thus, it might be more appropriate to say it has benefits interms of supporting and minimising damage from the cancer drug tamoxifen intreatment (Cui et al. 2006).

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 discussed in this chapter. 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 reduced 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, palpitations, nervousness, and tremor in susceptible individuals. These effects are increased if caffeine or other stimulants 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 reported. A controversial ginseng abuse syndrome consisting 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 hypoglycemic 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 theoretical risk of increased bleeding. Also, coadministration of ginseng with digoxin and MAOIs should be avoided.