Ginger: Practice Points – Patient Counselling. FAQ

Pregnancy Use Although Commission E suggests that ginger is contraindicated in pregnancy, more recent research suggests that ginger is not contraindicated in pregnancy — doses up to 2 g/day of dried ginger root have been used safely. No adverse effects on pregnancy were observed in multiple studies of ginger or nausea and vomiting. Practice Points / Patient Counselling • Ginger is most often used for its anti-emetic, anti-inflammatory and gastrointestinal effects. • There is clinical support for the use of ginger in the treatment of nausea and vomiting associated with motion sickness, the postoperative period, pregnancy and chemotherapy. • Ginger is traditionally used for gastrointestinal disorders including dyspepsia, poor appetite, flatulence, colic, vomiting, diarrhea and spasms, as well as a diaphoretic in the treatment of the common cold and influenza. • Ginger is also used as an anti-inflammatory agent for arthritis, although large controlled studies have yet to produce strong support for this use. • Although antiplatelet effects have been reported, this requires very large doses and is not likely to be significant in normal therapeutic doses or dietary intake levels. Answers to Read more […]

Ginger: Dosage. Interactions. Contraindications.

Dosage Range The recommended dose ranges widely from 500 mg to 9 g/day dried root or equivalent; however, as there are wide variations in the gingerol concentrations in commercial ginger supplements the effective dosage will depend on the preparation and the indication for use. • Liquid extract (1:2): 0.7-2.0 mL/day. • Dried root: 1-3 g daily in divided doses or 1-2 g taken as a single dose for nausea and vomiting. • Infusion: 4-6 slices of fresh ginger steeped in boiling water for 30 minutes. Adverse Reactions Gastric irritation, heartburn and bloating have been reported in clinical trials. Contact dermatitis of the fingertips has also been reported with topical use. Significant Interactions Controlled studies are not available for many interactions; therefore they are based on evidence of activity and are largely theoretical and speculative. WARFARIN Due to the herb’s antiplatelet effects there is a theoretical risk of increased bleeding at high doses (> 10 g) although this is not evident clinically. There is no evidence of an interaction with warfarin at the usual dietary and therapeutic intakes, and ginger has been shown not to alter prothrombin times in pooled human plasma collected from Read more […]

Ginger: Uses

Clinical Use Although ginger is used in many forms, including fresh ginger used in cooking or chai (Indian spicy tea), pickled or glazed ginger, ethanol extracts and concentrated powdered extracts, preparations made with the root are used medicinally. Depending on the specific solvent used, the resultant preparation will contain different concentrations of the active constituents and may differ markedly from crude ginger. Although the great majority of research refers specifically to the species Zingiber officinale, there is the potential for confusion with other species or even with other genera. Furthermore, there are reported to be wide variations in the quality of commercial ginger supplements with concentrations of gingerols ranging from 0.0 to 9.43 mg/g. As such, the results of specific research can not necessarily be extrapolated to different preparations. PREVENTION OF NAUSEA AND VOMITING Many clinical studies have investigated the effects of ginger in the prevention and treatment of nausea and vomiting associated with different circumstances, including pregnancy, the postoperative period, motion sickness and chemotherapy. A recent systematic review of 24 RCTs covering 1073 patients suggest that results Read more […]

Ginger: Background. Actions

Historical Note Ginger has been used as both a food and a medicine since ancient times. Confucius wrote about it in his Analects, the Greek physician, Dioscorides, listed ginger as an antidote to poisoning, as a digestive, and as being warming to the stomach in De Materia Medica, and the Koran, the Talmud and the Bible all mention ginger. Records suggest that ginger was highly valued as an article of trade and in 13th and 14th century England, one pound of ginger was worth the same as a sheep. Ginger is still extremely popular in the practice of phytotherapy, particularly in TCM, which distinguishes between the dried and fresh root. It is widely used to stimulate circulation, treat various gastrointestinal disorders and as a stimulant heating agent. Other Names African ginger, Indian ginger, Jamaica ginger, common ginger, rhizoma zingiberis, shokyo (Japanese) Botanical Name / Family Zingiber officinale Roscoe (family Zingiberaceae) Plant Part Used Rhizome Chemical Components The ginger rhizome contains an essential oil and resin known collectively as oleoresin. The composition of the essential oil varies according to the geographical origin, but the chief constituents, sesquiterpene hydrocarbons, which are Read more […]

Korean ginseng: Practice Points – Patient Counselling. FAQ

Contraindications and Precautions Korean ginseng is generally contraindicated in acute infections with fever, and in persons who are very hot, tense and overly stimulated. Overuse may result in headache, insomnia and palpitation. Ginseng should not be taken concurrently with other stimulants including caffeine and should be discontinued 1 week before major surgery. Use in hypertension should be supervised however it may prove beneficial for this indication. Pregnancy Use Ginseng is traditionally used in Korea as a tonic during pregnancy. The Commission E does not list any restrictions. However, due to the potential teratogenicity of some compounds (ginsenoside Rb1) observed under experimental conditions, ginseng should be used cautiously during the first trimester of pregnancy. In a two-generation rat study, a ginseng extract fed at doses as high as 1 5 mg/kg/day did not produce adverse effects on reproductive performance, including embryo development and lactation. Practice Points / Patient Counselling TRADITIONAL USE Ginseng is traditionally used for deficiency of Qi (energy/life force) manifested by shallow respiration, shortness of breath, cold limbs, profuse sweating and a weak pulse (such as may occur Read more […]

Korean ginseng: Adverse Reactions. Significant Interactions

Adverse Reactions Ginseng abuse syndrome (hypertension, nervousness, insomnia, morning diarrhea, inability to concentrate and skin reactions) has been reported and there has been a report of a 28-year-old woman who had a severe headache after ingesting a large quantity of ethanol-extracted ginseng. Cerebral angiograms showed ‘beading’ appearance in the anterior and posterior cerebral and superior cerebellar arteries, consistent with cerebral arteritis. High doses (1 5 g/day) have been associated with confusion, depression and depersonalisation in four patients. However, the majority of the scientific data suggest that ginseng is rarely associated with adverse events or drug interactions. A systematic review found that the most commonly experienced adverse events are headache, sleep and gastrointestinal disorders. Data from clinical trials suggest that the incidence of adverse events with ginseng mono-preparations is similar to that of placebo. Any documented effects are usually mild and transient. Combined preparations are more often associated with adverse events, but causal attribution is usually not possible. A case of suspected ginseng allergy has recently been reported in the scientific literature. The case Read more […]

Korean ginseng: Other Uses. Dosage

Other Uses GASTROPROTECTION DURING HEART SURGERY In a trial of 24 children undergoing heart surgery for congenital heart defects, 12 children received 1.35 mg/kg ginsenoside compound or placebo intravenously before and throughout the course of cardiopulmonary bypass surgery. Ginseng administration resulted in attenuation of gastrointestinal injury and inflammation. RESPIRA TORY DISEASE Ginseng extract (G115) has been shown significantly (P < 0.05) to improve pulmonary function test, maximum voluntary ventilation, maximum inspiratory pressure and maximal oxygen consumption (VO2max) in a study of 92 patients suffering moderately severe chronic obstructive pulmonary disease (n = 49, G115 100 mg twice daily for 3 months). HEUCOBACTER PYLORI Helicobacter pylori can provoke gastric inflammation, ulceration and DNA damage, resulting in an increased risk of carcinogenesis. As preliminary evidence suggests that Panax ginseng inhibits the growth of Helicobacter pylori and can inhibit adhesion it may be useful as a gastroprotective agent against Helicobacter pylori-associated gastric mucosal cell damage. HIV INFECTION Long-term intake of Korean ginseng slows the depletion of CD4+ T cells and may delay disease progression Read more […]

Korean ginseng: Clinical Use

In the scientific arena, ginseng and the various ginsenosides are used in many forms and administered via various routes. This review will focus primarily on those methods commonly used in clinical practice. CANCER PREVENTION The various anticancer actions of Panax ginseng, as demonstrated in animal and in vitro trials, support its use as an agent to prevent the development and progression of cancer. A 5-year prospective study of 4634 patients over 40 years of age found that ginseng reduced the relative risk of cancer by nearly 50%. A retrospective study of 905 case-controlled pairs taking ginseng showed that ginseng intake reduced the risk of cancer by 44% (odds ratio equal to 0.56). The powdered and extract forms of ginseng were more effective than fresh sliced ginseng, juice or tea. The preventative effect was highly significant (P < 0.001). There was a significant decline in cancer occurrence with increasing ginseng intake (P < 0.05). Epidemiological studies in Korea strongly suggest that cultivated Korean ginseng is a non-organ-specific human cancer preventative agent. In case-control studies, odds ratios of cancer of lip, oral cavity and pharynx, larynx, lung, oesophagus, stomach, liver, pancreas, Read more […]

Korean ginseng: Other Actions

PREVENTION OF DAMAGE FROM TOXINS Ginseng extract has been shown to be beneficial in the prevention and treatment of testicular damage induced by environmental pollutants. Dioxin is one of the most potent toxic environmental pollutants. Exposure to dioxin either in adulthood or during late fetal and early postnatal development causes a variety of adverse effects on the male reproductive system. The chemical decreases spermatogenesis and the ability to conceive and carry a pregnancy to full term. Pretreatment with 100 or 200 mg/kg ginseng aqueous extract intraperitoneally for 28 days prevented toxic effects of dioxin in guinea pigs. There was no loss in body weight, testicular weight or damage to spermatogenesis. In guinea pigs Panax ginseng also improves the survival and quality of sperm exposed dioxin. PROMOTING HAEMOPOIESIS Ginseng is traditionally used to treat anaemia. The total saponin fraction, and specifically Rg1 and Rb1, have been shown to promote haemopoiesis by stimulating proliferation of human granulocyte-macrophage progenitors. ANTIOXIDANT In vitro studies did not find various extracts of ginseng to be particularly potent antioxidants against several different free radicals. However, animal models Read more […]

Korean ginseng: Main Actions

Clinical note — Adaptogens Adaptogens are innocuous agents, non-specifically increasing resistance against physical, chemical or biological factors (stressors), having a normalising effect independent of the nature of the pathological state (original definition of adaptogen by Brekhman & Dardymov 1969). Adaptogens are natural bioregulators, which increase the ability of the organism to adapt to environmental factors and to avoid damage from such factor (revised definition by Panossian et al 1999). (Refer to the Siberian ginseng post for more information about adaptogens and allostasis.) ADAPTOGEN The pharmacological effects of ginseng are many and varied, contributing to its reputation as a potent adaptogen. The adrenal gland and the pituitary gland are both known to have an effect on the body’s ability to respond to stress and alter work capacity, and ginseng is thought to profoundly influence the hypothalamic-pituitary-adrenal axis. The active metabolites of protopanaxadiol and protopanaxatriol saponins reduce acetylcholine-induced catecholamine secretion in animal models and this may help to explain the purported antistress effects of ginseng. Ginseng has been shown in numerous animal experiments Read more […]