Stress: Ginseng

Ginseng (Panax ginseng; Panax quinquefolius)

Ginseng species include Panax ginseng and Panax quinquefolius, Asian and American ginseng, respectively. Panax notoginseng and Panax pseudoginseng are also ginsengs but are not discussed here. Eleutherococcus sentico-sus, formerly referred to as Siberian ginseng, is not, in fact, a ginseng. White and red ginsengs are both forms of Panax ginseng, white being unprocessed, and the red having been steam prepared. In TCM, white and red ginseng are considered to have different actions, the former being much less stimulating, and the latter being used for deep deficiencies and to move the qi. Western herbalists consider American ginseng to be less heating and gentler than either Asian ginseng, especially compared with red ginseng. The word Panax is derived from the word panacea in deference to wide-ranging uses from immune support to energy enhancement to promotion of longevity. Ginsenosides are considered to be the pharmacologically active components of ginseng; however, as stated in Wichtl, “the theory for its use in traditional medicine cannot be explained based on the criteria of western rational medicine.”

Chinese medicine has included ginseng in its pharmacopoeias for as much has 5000 years. It is not considered a medication so much for specific conditions; rather, it is a tonic for improving overall energy and sense of well-being. It is, however, included in formulae for specific conditions, especially those associated with debility, fatigue, immunodeficiency, irritability and insomnia, decreased cognitive and memory functions, impotence or loss of libido, calming the nerves, and promoting the production of moisture in the body, and other conditions. The German Commission E approved its use as a tonic to combat feelings of lassitude and debility, lack of energy and ability to concentrate, and during convalescence. Ginseng is one of the most extensively researched botanical medicines in the world. This review of ginseng is by no means comprehensive, and primarily is intended to convey its overall effects in the context of this section. The actions most ascribed to ginseng are tonic and adaptogenic, demonstrating the ability to enhance nonspecific immunity, inhibit fatigue, and have antiaging effects (Summary of Ginseng’s Beneficial Effects). Randomized, double-blind, controlled trials have shown that (Korean) ginseng significantly improves quality of life and well-being measures while under stress, including alertness, relaxation, appetite, fatigue levels, sleep quality, recovery from the common cold and bronchitis, and significantly decreases systolic blood pressure compared with controls.

Ginseng’s adaptogenic effects are notable in the hypothalamic-pituitary-adrenal axis. Ginseng improves recovery from chronic stress by improving corticoid response from the adrenal gland, and the corticotropin feedback loops with the HPA. Animal studies have noted ginseng administration to enhance energy metabolism during exercise. Panax ginseng has been noted to elevate testosterone when low, but not elevate it excessively when within the normal range. Panax ginseng has been investigated for immune modulating and anticancer activities. Animal and human investigations have shown ginseng to possibly reduce the occurrence of cancer. Mice exposed to carcinogens have fared better when treated with ginseng than untreated controls. In one human trial, Panax was shown to be an effective therapy in the treatment of acute infectious bronchitis. Ginseng may improve immune function, as evidenced by increased blood levels of basic immune cells including natural killer cells, lymphocytes, and macrophages, seen after the administration of ginseng preparations.

Summary of Ginseng’s Beneficial Effects

  • Improvement in physical stamina, exercise performance and well-being
  • Improvement in mental performance, learning, memory
  • Reduction in fatigue
  • Improved stress response and functioning under stress
  • Glucose regulation / blood sugar reduction in NIDDM
  • Improve cardiac function in congestive heart failure
  • Improved HDL levels
  • Improvement for diminished libido, male fertility problems, erectile dysfunction
  • Antioxidant activity
  • Cancer prevention
  • Improved recovery in infection, especially chronic bronchitis, and for the treatment of asthma, COPD, and dyspnea
  • Psychological and physical complaints associated with menopause
  • Improvement in metabolism; anabolic effects
  • A tonic for older adults and during convalescence
  • Reduction in preeclampsia in pregnant women compared to matched controls
  • Neuralgia, convulsions, neurosis, anxiety, insomnia
  • Improvement of bifida strains and inhibition of clostridia strains in human intestinal flora

Enhancing gonadotropin activity may be added to the list of the many uses for Panax. Gonadotropin levels have been shown to increase in men with low sperm counts taking ginseng extracts but not in men with normal sperm counts. After 3 months of daily ginseng consumption, testosterone, dihydrotestosterone, and related sperm counts and sperm motility were noted to improve in the infertile men, whereas normal controls displayed only slight increases, with none of the controls developing abnormally high or excessive levels of hormones. Human clinical studies also observed an increase in libido and erectile function. The Chinese species, Panax ginseng, is also reported to be a sexual tonic and aphrodisiac useful in maintaining the reproductive organs and sexual desire into old age. Low sperm counts are a symptom of hypogonadism and / or hormonal imbalance. There are case reports of acute life-threatening hypopitu-itarism (postpartum Sheehan’s syndrome) being successfully treated with Panax and Glycyrrhiza.

Ginseng may improve the stress response by reducing the excessive sympathetic response that promotes a fight or flight cascade. Adrenal cortisol production and activity may be improved, along with corticotropin feedback loops with the use of adrenal tonic herbs such as Panax ginseng. Blood sugar reductions have been demonstrated, with potential benefit for patients with type 2 diabetes mellitus. Several human trials have shown clinically useful antianxiety effects with the use of ginseng preparations, without any adverse side effects reported. Side effects, and drug interactions are not expected with proper use. However, reported side effects in noncontrolled studies in which subjects have been using high doses of caffeine and taking products with additional ingredients, have included sleeplessness, anxiety, diarrhea, and skin problems.

Concerns about ginseng abuse syndrome (GAS) occurring with regular use have been entirely debunked, the progenitor of the concept himself retracting his conclusions. Pregnancy use is contraindicated in the British Herbal Compendium to the British Herbal Pharmacopeia; however, ginseng is traditionally used during pregnancy in China, and studies have shown no teratogenicity, mutagenicity, or other adverse effects, and in fact one study demonstrated a reduction in pre-eclampsia compared with a control group. Neither the American Herbal Products Association nor the German Commission E suggest restricted use during pregnancy; however, given that long-term safety studies are lacking, it is best to avoid except in traditional Chinese medicine formulae specifically for pregnancy-related problems and under the supervision of a qualified traditional Chinese medicine provider or herbalist skilled in obstetric herbal medicine. Diabetic patients may need to adjust insulin doses; patients taking anticoagulant drugs are recommended to speak with their health care providers before taking ginseng. Herbalists generally discourage the use of stimulants with ginseng, and also may contraindicate ginseng use in patients with hypertension, hyperthyroidism, or other “excess” states.