Asian Ginseng

Western herbal practice used Asian ginseng as a mild stomachic, tonic and stimulant for loss of appetite, digestive complaints and mental exhaustion ^{39Reference 39Bone K · 2013Principles and Practice of Phytotherapy}.

The British Herbal Pharmacopoeia lists it as a thymoleptic, sedative, demulcent, stomachic and aphrodisiac, indicated for neurasthenia, neuralgia, insomnia and hypotonia ^{42Reference 42British Herbal Medicine Association · 1983British Herbal Pharmacopoeia}. The Eclectics used it for cerebral anaemia, asthma, convulsions, paralysis and urinary gravel ^{39Reference 39Bone K · 2013Principles and Practice of Phytotherapy}.

Across these sources the recurring uses are prostration and fatigue, heart complaints, asthma, cold limbs and poor circulation, digestive weakness, anxiety and neuralgia, low libido and infertility, and liver disease ^{39,42,43Reference 39Bone K · 2013Principles and Practice of PhytotherapyReference 42British Herbal Medicine Association · 1983British Herbal PharmacopoeiaReference 43Panax ginseng · 2009ReviewAlternative Medicine Review : A Journal Of Clinical Therapeutic, 14(2), 172-6}.

In Chinese medicine ginseng is ren shen, one of the oldest and most valued qi tonics, used to tonify qi, promote longevity and generate fluids ^{39Reference 39Bone K · 2013Principles and Practice of Phytotherapy}.

It is classed as sweet and slightly bitter in taste and warm in nature, entering the Spleen, Lung and Heart channels ^{41Reference 41Hempen et al. · 2009A Materia Medica for Chinese Medicine: Plants, Minerals, and Animal Products. (Pg}.

Its classical actions are to tonify qi, generate fluids, tonify the lungs and stomach, strengthen the spleen and calm the spirit (shen). Its most dramatic use is in qi collapse, the sudden exhaustion of vital energy ^{39,41Reference 39Bone K · 2013Principles and Practice of PhytotherapyReference 41Hempen et al. · 2009A Materia Medica for Chinese Medicine: Plants, Minerals, and Animal Products. (Pg}.

The dried root is decocted at 1–10 g for three hours or more ^{41Reference 41Hempen et al. · 2009A Materia Medica for Chinese Medicine: Plants, Minerals, and Animal Products. (Pg}.

Because it is warm, classical practice avoids it in hot presentations: yin deficiency with heat, damp-heat, and ascendant liver yang with high blood pressure. The cooling American ginseng (xi yang shen) is used instead ^{40,41Reference 40Hoffmann · 2003Medical herbalism: The science and practice of herbal medicineReference 41Hempen et al. · 2009A Materia Medica for Chinese Medicine: Plants, Minerals, and Animal Products. (Pg}.

A systematic review and meta-analysis of 16 randomised trials of ginseng (genus Panax) found a significant fall in fasting blood glucose versus control (mean difference −0.31 mmol/L, 770 participants). It found no significant overall change in fasting insulin, HbA1c or insulin resistance (HOMA-IR). Two-thirds of the trials lasted under 12 weeks, and most enrolled people with fairly good baseline blood-sugar control ^{1Reference 1Shishtar et al. · 2014Meta-analysisThe effect of ginseng (the genus Panax) on glycemic control — systematic review and meta-analysis of randomised controlled trialsView study →}.

A later meta-analysis of 20 RCTs in prediabetes and type 2 diabetes reported significant reductions in fasting glucose, total cholesterol, IL-6 and HOMA-IR, and a rise in heart rate. Cholesterol changes were seen at doses of 2 g/day or more ^{2Reference 2Naseri et al. · 2022Meta-analysisThe efficacy of ginseng (Panax) on human prediabetes and type 2 diabetes mellitus — systematic review and meta-analysisView study →}.

A single 200–400 mg dose of the G115 extract lowered blood glucose during a sustained mental-effort task ^{3Reference 3Reay et al. · 2005RCTSingle doses of Panax ginseng (G115) reduce blood glucose levels and improve cognitive performance during sustained mental activity — RCTView study →}.

Gap: effects are small, mostly on fasting glucose rather than HbA1c, and trials are short with heterogeneous extracts — no long-term outcome data on diabetic complications.

A 2016 meta-analysis of ginseng trials found a significant effect on fatigue in four RCTs (standardised mean difference 0.34), and no effect on physical performance in eight. Its authors judged the evidence insufficient, because the trials were few and small ^{5Reference 5Bach et al. · 2016Meta-analysisEfficacy of ginseng supplements on fatigue and physical performance — meta-analysis of RCTsView study →}.

A broader systematic review concluded that both Asian and American ginseng may reduce fatigue, particularly in people with chronic illness ^{4Reference 4Arring et al. · 2018Systematic reviewGinseng as a treatment for fatigue — systematic reviewView study →}. A 2023 systematic review and meta-analysis of ginseng and ginseng formulas reached a similar conclusion ^{6Reference 6Li et al. · 2023Meta-analysisGinseng and ginseng herbal formulas for symptomatic management of fatigue — systematic review and meta-analysisView study →}.

In cancer-related fatigue, a review of trials found suggestive but limited evidence, with American ginseng carrying much of the positive result ^{7Reference 7Sadeghian et al. · 2021Systematic reviewGinseng and cancer-related fatigue — systematic review of clinical trialsView study →}.

The effect sizes are small-to-moderate, outcome scales vary, and part of the positive evidence comes from American rather than Asian ginseng.

A 2022 Cochrane systematic review of nine placebo-controlled trials rated ginseng’s effect on erectile function trivial by the IIEF-15 instrument (mean difference 3.52), with low certainty of evidence ^{8Reference 8Lee et al. · 2022Systematic reviewGinseng for erectile dysfunction — a Cochrane systematic reviewView study →}.

An earlier meta-analysis of seven RCTs of Korean Red Ginseng was more favourable, reporting a significant benefit (risk ratio 2.40), though the trials were of low methodological quality on average ^{9Reference 9Jang et al. · 2008Systematic reviewRed ginseng for treating erectile dysfunction — systematic reviewView study →}.

An early trial in 90 men found overall efficacy of 60% with Korean Red Ginseng, against 30% with placebo or trazodone, with improvements in rigidity, girth and libido ^{10Reference 10Choi et al. · 1995RCTClinical efficacy of Korean red ginseng for erectile dysfunction — randomised controlled trialView study →}.

The trials agree on the direction of the effect but are small, short and mostly from one region, so the size of the benefit is uncertain.

A 2024 meta-analysis of 15 RCTs (671 participants) found ginseng significantly improved memory (standardised mean difference 0.19, larger at high doses) but had no significant effect on global cognition, attention or executive function ^{11Reference 11Zeng et al. · 2024Meta-analysisEffects of ginseng on cognitive function — systematic review and meta-analysis of RCTsView study →}.

The 2010 Cochrane review found no convincing evidence of benefit in healthy adults or people with impairment, citing poor study quality ^{12Reference 12Geng et al. · 2010Systematic reviewGinseng for cognition — Cochrane systematic reviewView study →}. A 2025 meta-analysis restricted to MMSE and ADAS-cog outcomes in memory-impaired populations reported limited effects ^{13Reference 13Kim et al. · 2025Meta-analysisCognitive benefits of ginseng — systematic review and meta-analysis of MMSE and ADAS-cog changesView study →}.

In Alzheimer’s disease, meta-analysis found inconsistent results ^{14Reference 14Wang et al. · 2016Meta-analysisGinseng for Alzheimer’s disease — systematic review and meta-analysis of RCTsView study →}. One 12-week open-label RCT of 4.5 g/day Panax ginseng powder improved ADAS-cog and MMSE scores, and the gains faded after stopping ^{15Reference 15Lee et al. · 2008RCTPanax ginseng enhances cognitive performance in Alzheimer disease — randomised open-label trialView study →}.

Some of the clearest acute cognitive data come from an American ginseng extract (Cereboost) in healthy young adults ^{16Reference 16Bell et al. · 2022RCTAcute and chronic effects of American ginseng (Cereboost) on mood and cognition in healthy young adults — randomised placebo-controlled trialView study →}.

Gap: benefit appears confined to memory rather than overall cognition, trials are short and heterogeneous, and several positive acute studies used American ginseng.

In a randomised, placebo-controlled trial, the standardised extract G115 (100 mg for 12 weeks) was given alongside influenza vaccination. Cases of influenza and the common cold fell to 15 in the ginseng group against 42 on placebo, and antibody titres were higher ^{17Reference 17Scaglione et al. · 1996RCTEfficacy and safety of the standardised ginseng extract G115 for potentiating influenza vaccination — randomised placebo-controlled trialView study →}.

Much of the wider cold-prevention literature is on North American ginseng (Panax quinquefolius). A 4-month RCT of a poly-furanosyl-pyranosyl-saccharide-rich extract reduced the number of confirmed colds ^{18Reference 18Predy et al. · 2005RCTEfficacy of a North American ginseng extract for preventing upper respiratory tract infections — randomised controlled trialView study →}.

Earlier work described effects of Panax ginseng extracts on immune-cell activity ^{19Reference 19Scaglione et al. · 1990Immunomodulatory effects of two extracts of Panax ginseng C.AView study →}.

Gap: the strongest cold-prevention evidence is for American, not Asian, ginseng; the Asian-ginseng data center on a single vaccination-adjuvant trial.

Ginseng’s cancer-prevention signal comes almost entirely from Korean observational studies. A prospective cohort in a ginseng-growing area found lower cancer risk among regular users ^{20Reference 20Yun et al. · 1998ObservationalNon-organ-specific cancer prevention of ginseng — prospective cohort study in KoreaView study →}, supported by nested case-control analyses reporting odds ratios around 0.5 ^{21Reference 21Yun · 2001ObservationalEpidemiological study on cancer prevention by ginsengView study →}.

The Kangwha cohort found lower all-cause mortality among male ginseng users (hazard ratio 0.90) but not among women ^{22Reference 22Yi et al. · 2009ObservationalAssociation between ginseng intake and mortality — Kangwha cohort studyView study →}, and a recent Korean multi-centre cohort examined ginseng tea and liver-cancer risk ^{23Reference 23Moon et al. · 2026ObservationalGinseng tea consumption and liver cancer risk — prospective Korean multi-centre cancer cohort studyView study →}.

Residual confounding by diet, income and health habits cannot be excluded, and there are no chemoprevention RCTs.

Gap: entirely observational and geographically concentrated; no randomized evidence and plausible confounding.

A meta-analysis of 17 RCTs (1,381 participants) found no significant effect of ginseng on systolic, diastolic or mean arterial pressure, with a non-significant trend toward lower systolic pressure in people with diabetes, metabolic syndrome or obesity ^{24Reference 24Komishon et al. · 2016Meta-analysisThe effect of ginseng (genus Panax) on blood pressure — systematic review and meta-analysis of RCTsView study →}. This counters the older concern that ginseng raises blood pressure.

A 2025 dose-response meta-analysis of 70 studies reported reduced high-sensitivity CRP ^{25Reference 25Jafari A et al. · 2025Meta-analysisThe effect of ginseng supplementation on CVD risk factors — systematic review and dose-response meta-analysisView study →}, a 2024 meta-analysis found favourable shifts in several cardiovascular biomarkers ^{26Reference 26Zhang XF et al. · 2024Meta-analysisEffects of ginseng consumption on cardiovascular health biomarkers in adults — systematic review and meta-analysis of RCTsView study →}, and a Korean Red Ginseng RCT improved arterial stiffness in people with high blood pressure ^{27Reference 27Rhee et al. · 2011RCTEffect of Korean red ginseng on arterial stiffness in subjects with hypertension — randomised controlled trialView study →}.

Lipid effects are inconsistent: one meta-analysis found modest improvement ^{28Reference 28Hernández-García et al. · 2019Meta-analysisEfficacy of Panax ginseng supplementation on blood lipid profile — meta-analysis and systematic review of RCTsView study →} and another found no significant change ^{29Reference 29Ziaei et al. · 2020Meta-analysisThe efficacy of ginseng supplementation on plasma lipid concentration in adults — systematic review and meta-analysisView study →}.

The positive findings are on inflammatory and vascular markers, not on heart attacks, strokes or other hard outcomes.

The adaptogen idea holds that ginseng improves general resistance to stress through the hypothalamic-pituitary-adrenal (HPA) axis. The direct experimental evidence is largely preclinical, including a comparative animal study of anti-stress effects ^{30Reference 30Rai et al. · 2003AnimalAnti-stress effects of Ginkgo biloba and Panax ginseng — a comparative study (animal model)View study →}.

Human data rely on quality-of-life and well-being endpoints that overlap with the fatigue and cognition trials, rather than on dedicated stress-response trials.

Gap: the HPA-axis mechanism is demonstrated mainly in animals; robust human trials with physiological stress endpoints are lacking.

A systematic review of double-blind RCTs found no consistent effect of Korean Red Ginseng on hot-flush frequency, with only isolated positive findings ^{31Reference 31Lee et al. · 2016Systematic reviewGinseng for managing menopausal woman’s health — systematic review of double-blind, randomised, placebo-controlled trialsView study →}.

A small RCT (500 mg twice daily, 4 weeks) reported improved Female Sexual Function Index scores in postmenopausal women with sexual dysfunction ^{32Reference 32Ghorbani et al. · 2019RCTThe effect of ginseng on sexual dysfunction in menopausal women — double-blind randomised controlled trialView study →}. Another RCT in genitourinary syndrome of menopause found no difference from placebo on objective measures such as vaginal maturation index and pH ^{33Reference 33Ghorbani et al. · 2021RCTThe effect of Panax ginseng on genitourinary syndrome in postmenopausal women — randomised, double-blind, placebo-controlled trialView study →}.

The trials are few, small and short. Self-reported sexual function improved, while objective urogenital measures did not.

Tolerability. Systematic reviews find that reactions to ginseng are usually mild and short-lived: headache, poor sleep and stomach upset. Serious events are rare ^{34,35Reference 34Coon et al. · 2002Systematic reviewPanax ginseng — systematic review of adverse effects and drug interactionsView study →Reference 35Lee et al. · 2011Systematic reviewSystematic review of randomised controlled trials evaluating the efficacy and safety of ginsengView study →}.

Stimulation. Ginseng is mildly stimulating and can cause sleeplessness or nervousness, especially at high doses or with caffeine and other stimulants ^{34Reference 34Coon et al. · 2002Systematic reviewPanax ginseng — systematic review of adverse effects and drug interactionsView study →}.

Warfarin. In 12 healthy men, Asian ginseng did not change warfarin levels, its effect on clotting (INR) or platelet aggregation ^{51Reference 51Jiang et al. · 2004RCTEffect of St John’s wort and ginseng on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects — randomised crossover trialView study →}. The weaker warfarin effect seen in a randomised trial came from American ginseng, a different species ^{36Reference 36Yuan et al. · 2004RCTAmerican ginseng reduces warfarin’s effect in healthy patients — randomised controlled trialView study →}.

Phenelzine. A case report describes headache, tremor and mania when ginseng was taken with the MAO inhibitor phenelzine ^{37Reference 37Jones et al. · 1987Interaction of ginseng with phenelzineView study →}.

Diabetes medicines. Ginseng lowers fasting blood sugar, so it can add to the effect of diabetes drugs. Monitor blood sugar when combining them ^{1,2Reference 1Shishtar et al. · 2014Meta-analysisThe effect of ginseng (the genus Panax) on glycemic control — systematic review and meta-analysis of randomised controlled trialsView study →Reference 2Naseri et al. · 2022Meta-analysisThe efficacy of ginseng (Panax) on human prediabetes and type 2 diabetes mellitus — systematic review and meta-analysisView study →}.

Drug metabolism. In healthy volunteers, 28 days of ginseng lowered blood levels of the CYP3A4 probe midazolam by about a third and left the P-glycoprotein probe fexofenadine unchanged ^{50Reference 50Malati et al. · 2012Influence of Panax ginseng on cytochrome P450 (CYP)3A and P-glycoprotein (P-gp) activity in healthy participants — open-label pharmacokinetic studyView study →}. The authors advised monitoring people who take it with narrow-margin drugs cleared by CYP3A ^{50Reference 50Malati et al. · 2012Influence of Panax ginseng on cytochrome P450 (CYP)3A and P-glycoprotein (P-gp) activity in healthy participants — open-label pharmacokinetic studyView study →}.

In 14 healthy men, two weeks of red ginseng caused only weak shifts in CYP1A2, CYP2C9, CYP2C19, CYP2D6 and CYP3A4 activity, none of them clinically significant, and did not change P-glycoprotein activity ^{52Reference 52Kim et al. · 2016Effect of Red Ginseng on cytochrome P450 and P-glycoprotein activities in healthy volunteers — open-label crossover studyView study →}.

Blood pressure. A meta-analysis found no effect of ginseng on blood pressure ^{24Reference 24Komishon et al. · 2016Meta-analysisThe effect of ginseng (genus Panax) on blood pressure — systematic review and meta-analysis of RCTsView study →}. Classical Chinese practice still avoids it in high blood pressure of the ascendant-liver-yang type ^{41Reference 41Hempen et al. · 2009A Materia Medica for Chinese Medicine: Plants, Minerals, and Animal Products. (Pg}, and people with high blood pressure or a tendency to overstimulation should monitor their response.