American Ginseng

Many eastern and Great Lakes peoples used the root, and their uses are compiled in the Native American Ethnobotany database ^{45Reference 45Moerman · 1998Moerman, D. E. Native American Ethnobotany Database (NAEB): Panax quinquefolius L. — ethnobotanical database (compiled from Moerman, Native American Ethnobotany, Timber Press, 1998). http://naeb.brit.org/uses/species/2793/View study →}. The Cherokee are among the peoples whose medicinal plants, American ginseng included, are still in use as herbal medicines today ^{46Reference 46Setzer WN · 2018ReviewThe Phytochemistry of Cherokee Aromatic Medicinal Plants — reviewView study →}.

The Delaware, Mohegan, Meskwaki, Iroquois and Seminole used the root as a general tonic, and the Delaware, Mohegan, Meskwaki and Iroquois also treated it as a panacea. The Delaware gave it in severe illness when other cures had failed. The Iroquois used it as a stimulant and a blood medicine, and the Meskwaki and Potawatomi added it to other medicines to make them stronger ^{45Reference 45Moerman · 1998Moerman, D. E. Native American Ethnobotany Database (NAEB): Panax quinquefolius L. — ethnobotanical database (compiled from Moerman, Native American Ethnobotany, Timber Press, 1998). http://naeb.brit.org/uses/species/2793/View study →}.

The Cherokee gave the root as a tonic and for headache, convulsions and palsy, coughs, colic, thrush and “weakness of the womb” ^{45Reference 45Moerman · 1998Moerman, D. E. Native American Ethnobotany Database (NAEB): Panax quinquefolius L. — ethnobotanical database (compiled from Moerman, Native American Ethnobotany, Timber Press, 1998). http://naeb.brit.org/uses/species/2793/View study →}. The Iroquois gave it for night fevers, vomiting and upset stomach, sore eyes and earache, asthma and poor appetite. The Creek took a decoction to bring on a sweat in fevers and for shortness of breath, and the Houma took it for vomiting and, with whiskey, for rheumatism ^{45Reference 45Moerman · 1998Moerman, D. E. Native American Ethnobotany Database (NAEB): Panax quinquefolius L. — ethnobotanical database (compiled from Moerman, Native American Ethnobotany, Timber Press, 1998). http://naeb.brit.org/uses/species/2793/View study →}.

The root also had uses beyond medicine. Menominee hunters chewed it to attract deer, the Meskwaki, Pawnee and Seminole used it in love medicines, and the Chippewa carried it as a good-luck charm ^{45Reference 45Moerman · 1998Moerman, D. E. Native American Ethnobotany Database (NAEB): Panax quinquefolius L. — ethnobotanical database (compiled from Moerman, Native American Ethnobotany, Timber Press, 1998). http://naeb.brit.org/uses/species/2793/View study →}. The Cherokee and Chippewa also sold the root to traders as a cash crop ^{45Reference 45Moerman · 1998Moerman, D. E. Native American Ethnobotany Database (NAEB): Panax quinquefolius L. — ethnobotanical database (compiled from Moerman, Native American Ethnobotany, Timber Press, 1998). http://naeb.brit.org/uses/species/2793/View study →}.

It was chewed, taken as an infusion or decoction, smoked, or pounded into a poultice ^{45Reference 45Moerman · 1998Moerman, D. E. Native American Ethnobotany Database (NAEB): Panax quinquefolius L. — ethnobotanical database (compiled from Moerman, Native American Ethnobotany, Timber Press, 1998). http://naeb.brit.org/uses/species/2793/View study →}.

Chinese medicine received Panax quinquefolius as xi yang shen, “western ocean ginseng”, through the trade with North America that followed its identification in the 1700s ^{44Reference 44Bahaji Azami NL et al. · 2021A Survey of the History and Applications of American Ginseng (西洋参)View study →}. It is classed as cool, where Asian ginseng is warm ^{36Reference 36Huang et al. · 2023AnimalInvestigation on property differences of ginseng and American ginseng by spatial metabolomics of neurochemicals with desorption electrospray ionization mass spectrometry imaging — animal model (rat)View study →}.

It is classed as sweet and slightly bitter, entering the Heart, Lung and Kidney channels ^{44Reference 44Bahaji Azami NL et al. · 2021A Survey of the History and Applications of American Ginseng (西洋参)View study →}. It is used to tonify qi while nourishing yin, generating fluids and clearing deficiency heat ^{44Reference 44Bahaji Azami NL et al. · 2021A Survey of the History and Applications of American Ginseng (西洋参)View study →}.

That suits it to patterns of qi-and-yin depletion with heat signs, such as thirst, a dry mouth and throat, irritability, a dry chronic cough and fatigue in someone who runs hot, and to convalescence where the warming Asian ginseng would add to the heat ^{44Reference 44Bahaji Azami NL et al. · 2021A Survey of the History and Applications of American Ginseng (西洋参)View study →}.

The dried root is decocted at 3–9 g a day ^{44Reference 44Bahaji Azami NL et al. · 2021A Survey of the History and Applications of American Ginseng (西洋参)View study →}.

In Western practice American ginseng is the ginseng used when a tonic is wanted without stimulation. It is given for depleted, dry, irritable or convalescent states, for fatigue after illness or medical treatment, and to people who find Asian ginseng overstimulating or disturbing to sleep.

It is typically given as a 1–3 g daily decoction of the dried root, or as a 1:5 tincture at 5–10 mL a day.

A multisite, double-blind phase III trial (N07C2) randomised 364 fatigued cancer survivors to 2,000 mg/day of pure Wisconsin ginseng root or placebo for 8 weeks ^{1Reference 1Barton et al. · 2013RCTWisconsin Ginseng (Panax quinquefolius) to improve cancer-related fatigue: a randomized, double-blind trial, N07C2 — randomised controlled trial, phase IIIView study →}. The primary endpoint, at 4 weeks, narrowly missed significance (P=.07). By 8 weeks the ginseng arm had improved significantly more on the general fatigue subscale (change 20 vs 10.3, P=.003). The benefit was greater in patients still receiving active cancer treatment, and side effects did not differ from placebo ^{1Reference 1Barton et al. · 2013RCTWisconsin Ginseng (Panax quinquefolius) to improve cancer-related fatigue: a randomized, double-blind trial, N07C2 — randomised controlled trial, phase IIIView study →}.

An earlier dose-finding pilot (N03CA, n=290) found non-significant trends favouring the 1,000–2,000 mg/day doses ^{2Reference 2Barton et al. · 2010RCTPilot study of Panax quinquefolius to improve cancer-related fatigue: a randomized, dose-finding evaluation, N03CA — randomised controlled trialView study →}.

Two systematic reviews conclude that the evidence, while limited, supports 2,000 mg/day of American ginseng for cancer-related fatigue with minimal side effects ^{3,4Reference 3Arring et al. · 2018Systematic reviewGinseng as a Treatment for Fatigue: A Systematic Review — systematic reviewView study →Reference 4Lemke · 2021ReviewGinseng for the Management of Cancer-Related Fatigue: An Integrative Review — reviewView study →}.

Gap: Effects are modest and slow to appear, the pivotal data come from one preparation (pure ground root), and no trial has established the optimal duration or generalized beyond cancer populations.

Several acute, double-blind, placebo-controlled crossover trials report that a single dose of the standardised extract Cereboost (root standardised to 10.65% ginsenosides) improves working memory.

The first human trial, in 32 healthy young adults, found working-memory gains across 100–400 mg doses with no change in blood glucose ^{5Reference 5Scholey et al. · 2010RCTEffects of American ginseng (Panax quinquefolius) on neurocognitive function: an acute, randomised, double-blind, placebo-controlled, crossover study — randomised controlled trialView study →}.

A partial replication in 52 healthy middle-aged adults (200 mg) confirmed improved working memory at 3 hours ^{6Reference 6Ossoukhova et al. · 2015RCTImproved working memory performance following administration of a single dose of American ginseng to healthy middle-age adults — randomised controlled trialView study →}, and an EEG study linked the same 200 mg dose to reduced prefrontal steady-state visually evoked potential latency during memory retrieval ^{7Reference 7White et al. · 2020RCTEffects of Panax quinquefolius on the steady state visually evoked potential during cognitive performance — randomised controlled trialView study →}.

A combination product containing American ginseng also improved working memory and prefrontal hemodynamics ^{8Reference 8Best et al. · 2021RCTAcute effects of combined Bacopa, American ginseng and whole coffee fruit on working memory and cerebral haemodynamic response — randomised controlled trialView study →}.

Animal and cell work attributes the effect to the extract’s high ginsenoside Rb1 content, acting through increased choline acetyltransferase and cholinergic neuroprotection ^{9Reference 9Shin et al. · 2016In vitroCereboost, an American ginseng extract, improves cognitive function via up-regulation of choline acetyltransferase expression and neuroprotection — animal model / in vitroView study →}.

Gap: All positive trials are acute single-dose studies of one proprietary extract, largely from a single research group. There is no evidence for sustained daily dosing, whole-root preparations or clinical cognitive outcomes.

American ginseng reproducibly blunts the rise in blood sugar after a glucose drink.

In an early crossover trial, 3 g of root reduced the rise in 10 people without diabetes when taken 40 minutes before a glucose challenge, but not when taken with it. In 9 people with type 2 diabetes it worked either way ^{10Reference 10Vuksan et al. · 2000RCTAmerican ginseng (Panax quinquefolius L) reduces postprandial glycemia in nondiabetic subjects and subjects with type 2 diabetes mellitus — randomised controlled trialView study →}. A follow-up in people without diabetes found the effect depended on timing but not on dose across 1–3 g ^{11Reference 11Vuksan et al. · 2001RCTAmerican ginseng attenuates postprandial glycemia in a time-dependent but not dose-dependent manner in healthy individuals — randomised controlled trialView study →}.

In a double-blind crossover trial, 24 people with type 2 diabetes took 1 g of extract with each meal (3 g/day) for 8 weeks on top of their usual treatment. HbA1c fell by 0.29% and fasting glucose by 0.71 mmol/L, with lower systolic blood pressure and LDL-cholesterol and no change in safety measures ^{12Reference 12Vuksan et al. · 2019RCTEfficacy and safety of American ginseng extract on glycemic control and cardiovascular risk factors in type 2 diabetes: a double-blind, randomized, cross-over clinical trial — randomised controlled trialView study →}.

In healthy volunteers taking the HIV drug indinavir, 1 g of American ginseng three times a day for 14 days did not reverse the fall in insulin sensitivity the drug caused ^{43Reference 43Andrade AS et al. · 2008Clinical trialPharmacokinetic and metabolic effects of American ginseng (Panax quinquefolius) in healthy volunteers receiving the HIV protease inhibitor indinavir — clinical trialView study →}.

Gap: The sample sizes are small and much of the work comes from one research group.

A systematic review and meta-analysis of ginseng for seasonal acute upper-respiratory infections found a significant reduction in infection incidence (RR 0.69, 95% CI 0.52–0.90). In healthy adults, infections were also shorter. The authors flagged high-to-unclear risk of bias and possible publication bias ^{13Reference 13Antonelli et al. · 2020Meta-analysisGinseng integrative supplementation for seasonal acute upper respiratory infections: a systematic review and meta-analysis — meta-analysis, systematic reviewView study →}.

An earlier systematic review found five trials, all of North American ginseng. One trial showed 25% fewer colds, and two together showed colds or respiratory infections lasting about 6.2 days less. The authors judged the evidence insufficient to show that ginseng reduces how often colds occur ^{14Reference 14Seida et al. · 2011Systematic reviewNorth American (Panax quinquefolius) and Asian Ginseng preparations for prevention of the common cold in healthy adults: a systematic review — systematic reviewView study →}.

Individual RCTs of the proprietary poly-furanosyl-pyranosyl-saccharide extract CVT-E002 (COLD-fX) showed fewer and shorter acute respiratory illnesses in community-dwelling seniors ^{15Reference 15McElhaney et al. · 2006RCTEfficacy of COLD-fX (CVT-E002) in the prevention of respiratory symptoms in community-dwelling adults: a randomized, double-blinded, placebo-controlled trial — randomised controlled trialView study →} and reduced severity in influenza-vaccinated adults ^{16Reference 16McElhaney et al. · 2011RCTEfficacy and Safety of CVT-E002 in the Prevention of Respiratory Infections in Influenza-Vaccinated Community-Dwelling Adults: a multicenter, randomized, double-blind, placebo-controlled trial — randomised controlled trialView study →}.

A trial in patients with chronic lymphocytic leukaemia missed its primary endpoints, with no reduction in infection days and benefit only on secondary measures ^{17Reference 17High et al. · 2012RCTA randomized, controlled trial of Panax quinquefolius extract (CVT-E002) to reduce respiratory infection in patients with chronic lymphocytic leukemia — randomised controlled trialView study →}. A paediatric trial was a safety and dose-finding study rather than an efficacy trial ^{18Reference 18Vohra et al. · 2008RCTSafety and tolerability of North American ginseng extract in the treatment of pediatric upper respiratory tract infection: a phase II randomized, controlled trial — randomised controlled trialView study →}.

Gap: The active preparation is a specific polysaccharide-rich extract (CVT-E002), not whole root or ginsenosides. Trial quality is uneven, and the largest rigorous trial was negative on its primary endpoints.

In a 12-week double-blind trial, 3 g/day of a selected American ginseng extract added to usual therapy lowered radial augmentation index (arterial stiffness) by 5.3% and systolic blood pressure by 11.7% in 64 people with type 2 diabetes and high blood pressure, without affecting diastolic pressure ^{19Reference 19Mucalo et al. · 2013RCTEffect of American ginseng (Panax quinquefolius L.) on arterial stiffness in subjects with type-2 diabetes and concomitant hypertension — randomised controlled trialView study →}.

A separate multicenter RCT combining ginsenoside-Rg3-enriched Korean Red ginseng with American ginseng found a modest reduction in central systolic blood pressure but no change in pulse-wave velocity or endothelial function ^{20Reference 20Jovanovski et al. · 2020RCTVascular effects of combined enriched Korean Red ginseng and American ginseng in individuals with hypertension and type 2 diabetes: a randomized controlled trial — randomised controlled trialView study →}.

Gap: The human data are confined to people with diabetes and high blood pressure, one key study used a ginseng combination, and there are no cardiovascular-outcome trials.

In a small clinical pharmacology study, 10 healthy volunteers took a ginsenoside-enriched extract (8.5% ginsenosides, 200 mg twice daily) for two weeks. Their oxidative-stress markers fell (F2-isoprostane and 8-hydroxy-deoxyguanosine), and the clearance of zidovudine did not change. The same extract induced the phase 2 enzyme quinone reductase in laboratory tests ^{21Reference 21Lee et al. · 2008Clinical trialPossible differential induction of phase 2 enzyme and antioxidant pathways by American ginseng — clinical trialView study →}.

Most antioxidant evidence is preclinical: American ginseng berry extract attenuated oxidative stress (lower malondialdehyde and TNF-α) in post-infarction rat hearts, although it did not improve cardiac function ^{22Reference 22Parikh et al. · 2019AnimalGinseng Berry Extract Rich in Phenolic Compounds Attenuates Oxidative Stress but not Cardiac Remodeling post Myocardial Infarction — animal model (rat)View study →}, and root extract reduced oxidative markers in diabetic mouse retina and heart ^{23Reference 23Sen et al. · 2013AnimalPreventive effects of North American ginseng on diabetic retinopathy and cardiomyopathy — animal model (mouse)View study →}.

Gap: The human signal rests on one small study, and several animal studies used berry rather than root.

A novel neutral polysaccharide (PPQN, ~3.1 kDa) isolated from the root suppressed nitric oxide, TNF-α, IL-6 and IL-1β secretion in LPS-stimulated macrophages ^{24Reference 24Wang et al. · 2015In vitroStructural and anti-inflammatory characterization of a novel neutral polysaccharide from North American ginseng — in vitroView study →}.

Gut bacteria convert American ginseng mainly into compound K and ginsenoside Rg3. These metabolites attenuated DSS-induced colitis and abdominal pain in mice while lowering pro-inflammatory cytokines, and compound K was active at lower concentrations than its parent, ginsenoside Rb1 ^{25Reference 25Wang et al. · 2018AnimalAmerican ginseng microbial metabolites attenuate DSS-induced colitis and abdominal pain — animal model (mouse)View study →}.

Reviews attribute much of this to Rg3’s suppression of NF-κB signaling ^{26Reference 26Wang et al. · 2022ReviewPharmacological properties, molecular mechanisms and therapeutic potential of ginsenoside Rg3 as an antioxidant and anti-inflammatory agent — reviewView study →}.

Gap: No human anti-inflammatory trials exist, and the conversion to compound K depends on gut bacteria that vary between people.

Rodent studies consistently show liver protection, but from parts other than the root. Ginsenosides from P. quinquefolius leaves, given for 7 days before an acetaminophen overdose, lowered serum ALT, AST, TNF-α and IL-1β dose-dependently in mice ^{27Reference 27Xu et al. · 2017AnimalSaponins (Ginsenosides) from the Leaves of Panax quinquefolius Ameliorated Acetaminophen-Induced Hepatotoxicity — animal model (mouse)View study →}.

American ginseng berry extract likewise protected against acetaminophen hepatotoxicity ^{28Reference 28Xu et al. · 2018AnimalImproved protective effects of American ginseng berry against acetaminophen-induced liver injury — animal model (mouse)View study →}, and a ginseng-containing herbal formulation reduced carbon-tetrachloride-induced liver injury in rats ^{29Reference 29Lu et al. · 2017AnimalGinseng essence ameliorates carbon tetrachloride-induced liver injury — animal model (rat)View study →}.

Gap: Every hepatoprotective study is preclinical and most use leaf or berry preparations rather than the root; there is no human liver-outcome evidence.

Steamed American ginseng enhanced learning and memory and protected neurons in animal models ^{30Reference 30Yang et al. · 2025AnimalNeuroprotection and Enhanced Learning and Memory Abilities of Steamed American Ginseng — animal modelView study →}, and P. quinquefolius saponins protected neuronal activity by promoting mitophagy in D-galactose cell and SAMP8 mouse models of Alzheimer’s disease ^{31Reference 31Zhao et al. · 2025In vitroPanax quinquefolium saponins protect neuronal activity by promoting mitophagy in in-vitro and in-vivo Alzheimer’s models — animal model / in vitroView study →}.

The Cereboost mechanistic work (increased choline acetyltransferase, protection against amyloid-β toxicity) belongs here too ^{9Reference 9Shin et al. · 2016In vitroCereboost, an American ginseng extract, improves cognitive function via up-regulation of choline acetyltransferase expression and neuroprotection — animal model / in vitroView study →}.

Gap: These are animal and cell studies. No human neurodegeneration trial has tested American ginseng, and steaming changes the ginsenoside profile of the raw root.

Oral American ginseng markedly reduced tumor initiation and progression in high-fat-diet Apc^Min/+ mice while suppressing inflammatory cytokines ^{32Reference 32Yu et al. · 2015AnimalAmerican ginseng significantly reduced the progression of high-fat-diet-enhanced colon carcinogenesis in Apc(Min/+) mice — animal model (mouse)View study →}.

Ginsenoside Rg3 inhibited colorectal tumor growth in xenografts by down-regulating Wnt/β-catenin signaling ^{33Reference 33He et al. · 2011In vitroGinsenoside Rg3 inhibits colorectal tumor growth through the down-regulation of Wnt/β-catenin signaling — animal model / in vitroView study →}, and protopanaxadiol inhibited colon-cancer cells via the TRAIL apoptosis pathway ^{34Reference 34Zhang et al. · 2015In vitroTRAIL pathway is associated with inhibition of colon cancer by protopanaxadiol — animal model / in vitroView study →}.

Gap: All anticancer evidence is animal or cell-line; there are no human efficacy trials, and one registered trial combining ginseng with regorafenib was terminated.

Tolerability. In the phase III fatigue trial, 2,000 mg/day of pure ground root for 8 weeks (364 people) caused no more side effects than placebo ^{1Reference 1Barton et al. · 2013RCTWisconsin Ginseng (Panax quinquefolius) to improve cancer-related fatigue: a randomized, double-blind trial, N07C2 — randomised controlled trial, phase IIIView study →}. Trials in type 2 diabetes, in chronic lymphocytic leukaemia and in children with colds found no change in safety measures ^{12,17,18Reference 12Vuksan et al. · 2019RCTEfficacy and safety of American ginseng extract on glycemic control and cardiovascular risk factors in type 2 diabetes: a double-blind, randomized, cross-over clinical trial — randomised controlled trialView study →Reference 17High et al. · 2012RCTA randomized, controlled trial of Panax quinquefolius extract (CVT-E002) to reduce respiratory infection in patients with chronic lymphocytic leukemia — randomised controlled trialView study →Reference 18Vohra et al. · 2008RCTSafety and tolerability of North American ginseng extract in the treatment of pediatric upper respiratory tract infection: a phase II randomized, controlled trial — randomised controlled trialView study →}. The trials ran 8–12 weeks, and long-term safety has not been studied.

Diabetes medicines. American ginseng lowers both after-meal and fasting blood sugar ^{10,12Reference 10Vuksan et al. · 2000RCTAmerican ginseng (Panax quinquefolius L) reduces postprandial glycemia in nondiabetic subjects and subjects with type 2 diabetes mellitus — randomised controlled trialView study →Reference 12Vuksan et al. · 2019RCTEfficacy and safety of American ginseng extract on glycemic control and cardiovascular risk factors in type 2 diabetes: a double-blind, randomized, cross-over clinical trial — randomised controlled trialView study →}, so it can add to the effect of insulin and oral diabetes drugs. Monitor blood sugar closely when starting it or changing the dose.

Blood-pressure medicines. It lowered systolic blood pressure in people with type 2 diabetes and high blood pressure ^{12,19Reference 12Vuksan et al. · 2019RCTEfficacy and safety of American ginseng extract on glycemic control and cardiovascular risk factors in type 2 diabetes: a double-blind, randomized, cross-over clinical trial — randomised controlled trialView study →Reference 19Mucalo et al. · 2013RCTEffect of American ginseng (Panax quinquefolius L.) on arterial stiffness in subjects with type-2 diabetes and concomitant hypertension — randomised controlled trialView study →}, so an additive effect with blood-pressure drugs is possible. This has not been tested as an interaction.

Warfarin. In a randomised controlled trial in 20 healthy volunteers, two weeks of American ginseng lowered the INR, the peak blood level of warfarin and total warfarin exposure compared with placebo ^{37Reference 37Yuan et al. · 2004RCTAmerican ginseng reduces warfarin’s effect in healthy patients — randomised controlled trialView study →}. It reduces rather than increases warfarin’s effect. Use it with warfarin only under supervision, with INR monitoring.

Drug metabolism. In healthy volunteers, 1 g three times a day for 14 days did not change blood levels of the HIV drug indinavir, which is cleared by CYP3A4 ^{43Reference 43Andrade AS et al. · 2008Clinical trialPharmacokinetic and metabolic effects of American ginseng (Panax quinquefolius) in healthy volunteers receiving the HIV protease inhibitor indinavir — clinical trialView study →}. A ginsenoside-enriched extract did not change the glucuronidation or clearance of zidovudine ^{21Reference 21Lee et al. · 2008Clinical trialPossible differential induction of phase 2 enzyme and antioxidant pathways by American ginseng — clinical trialView study →}. Neither study found a sign of a major effect on drug metabolism.

Species. American and Asian ginseng have different ginsenoside profiles and different traditional uses, and one should not be substituted for the other. Ginsenoside Rb1, pseudoginsenoside F11 and the near-absence of ginsenoside Rf are used to tell them apart and to detect substitution ^{35Reference 35Wang et al. · 2015ReviewChemical analysis of Panax quinquefolius (North American ginseng): a review — reviewView study →}.