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General information
“Ginseng” is an ambiguous vernacular term, which can refer to Panax species such as Panax ginseng (Asian ginseng) and Panax quinquefolius (American ginseng), Eleutherococcus senticosus (Siberian ginseng), Pfaffia paniculata (Brazilian ginseng), or unidentified material (for example Rumanian ginseng). The genera in the family of Araliaceae (qv) include aralia, ginseng, and ivy.
Asian ginseng ( Panax ginseng ) contains a wide variety of flavonoids, saponins, steroids, sesquiterpenoids, and triterpenoids. These include ginsenolides and ginsenosides, protopanaxadiol, panaxadiol, panaxatriol, and panasinsene.
The botanical quality of ginseng preparations is problematic [ ]. For instance, when a case of neonatal androgenization was associated with maternal use of Siberian ginseng tablets during pregnancy, botanical analysis showed that the incriminated material almost certainly came from Periploca sepium (Chinese silk vine) [ ].
Brazilian ginseng ( Panax glomerata ) has been found to be contaminated with cadmium and mercury [ ].
There is no good evidence that ginseng confers benefit for any indication [ ].
General adverse effects and adverse reactions
The various adverse effects that have been attributed to ginseng formulations include hypertension, pressure headaches, dizziness, estrogen-like effects, vaginal bleeding, and mastalgia. Prolonged use has been associated with a “ginseng abuse syndrome” including symptoms like hypertension, edema, morning diarrhea, skin eruptions, insomnia, depression, and amenorrhea. However, most reports are difficult to interpret, because of the absence of a control group, the simultaneous use of other agents, insufficient information about dosage, and lack of botanical authentication [ ].
The authors of a review of the adverse reactions associated with P. ginseng concluded that it is generally safe but at high doses can cause insomnia, headache, diarrhea, and cardiovascular and endocrine disorders [ ]. Inappropriate use and suboptimal formulations were deemed to be the most likely reason for adverse effects of ginseng. The authors of a systematic review reached similar conclusions and showed that serious adverse reactions to ginseng seem to be true rarities [ ].
Organs and systems
Cardiovascular
The WHO database contains seven cases from five countries of ginseng intake followed by arterial hypertension [ ]. In five of them no other medication was noted. In four cases the outcome was mentioned, which was invariably full recovery without sequelae after withdrawal of ginseng.
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A 64-year-old previously normotensive man presented with amaurosis fugax and hypertension (blood pressure 220/130 mmHg) after taking Ginseng Forte-Dietisa 500 mg/day for 13 days [ ]. All other tests were normal. He was advised to stop taking ginseng, and 1 week later his blood pressure was normal (140/90 mmHg).
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