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Ginseng

Ginseng

Definition

Ginseng is an herbal preparation derived from the aromatic root of a plant of the genus Panax, which is native to East Asia. Ginseng belongs to the Araliaceae family of plants. Siberian ginseng belongs to a different genus, Eleutherococcus senticosus. The English name of the plant is a modification of its Chinese name, ren shen, which means "man" and "herb." The Chinese name comes from the ginseng root's resemblance to the shape of the human body, whence the plant's traditional use as a tonic for male sexual vigor and potency. The Latin name for the species, Panax, is derived from the Greek word panacea, which means "cure-all," or, "all-healer."

There are three species of ginseng in common use in the United States: American ginseng, Korean ginseng, and Siberian ginseng. All are regarded as adaptogens that normalize immune functions and are preparations that help the body adapt to change, thus lowering the risk of stress-related illness. American ginseng, whose botanical name is Panax quinquefolius, has recently been evaluated as a treatment for high blood sugar in patients with type 2 (adult-onset) diabetes. It is considered to be less stimulating than the Korean or Siberian varieties. Korean ginseng, or Panax ginseng, is the species most often studied in Western as well as Asian trials of botanical preparations. Siberian ginseng, or Eleutherococcus senticosus, has been used in Russian sports medicine to boost athletic performance and strengthen the immune system.

As of 2002, ginseng is one of the most expensive herbs in the world, costing as much as $20 per ounce, or more for red ginseng with the root, which is over 10,000 years old. It is one of the top three herbal products sold in the United States.

Purpose

In traditional Chinese medicine (TCM), ginseng is regarded as having a "sweet" and "neutral" nature. It is thought to have a particular affinity for the spleen and lungs. It is used as an aphrodisiac, a tonic for the spleen, kidney and adrenal functions, and lungs, and a general restorative for the qi or vital energy in the body. TCM also recommends ginseng for asthma, weak pulse, indigestion, lack of appetite, rectal prolapse, hypertension, diabetes, insomnia , angina, congestive heart failure, and heart palpitations. It is important to note that ginseng is an exception to the rule that Chinese herbal medicine rarely uses a single herb in the manner of Western herbalism. Ginseng is often listed as one ingredient among several in Chinese medicines; it is, however, one of the few herbs in TCM that is sometimes prescribed by itself.

In the West, ginseng is frequently advertised as an energy booster, a memory aid, a sexual stimulant, a treatment for impotence and gastrointestinal disorders, and a promoter of longevity. Many Western researchers consider these claims inflated; some studies have found no difference between ginseng and a placebo in terms of the energy levels or general well-being reported by test subjects. Most studies nevertheless have shown improved energy, memory function and performance especially when fatigued, though most of the studies have been short-term. Ginseng's association with the male reproductive system is sufficiently strong that Western feminist herbalists frequently advise women against taking ginseng for any reason.

Description

The part of the ginseng plant that is used medicinally is the root. Ginseng roots are not harvested until the plant is four to six years old. The active ingredients in ginseng root are saponin triterpenoid glycosides, or chemicals commonly called ginsenosides. Other compounds found in Asian ginseng include glycans (panaxans); polysaccharide fraction DPG-3-2; peptides; maltol; and volatile oil. The active compounds in Siberian ginseng are called eleutherosides. Eleutherosides are somewhat different from the ginsenosides found in the Panax varieties of ginseng. There has been some debate among herbalists whether Siberian ginseng should be considered a true ginseng at all, due to this difference in active ingredients. Ginseng root from any of the three varieties is dried and can then be made into powder, capsules, or a liquid tincture. American ginseng is also available in the United States as whole roots.

Recommended dosages

Dosages of Korean ginseng used in traditional Chinese medicine are given as 28 g as a tonic and 1520 g for acute conditions.

Researchers who studied the potenial effectiveness of ginseng as a treatment for diabetes found that 13 g of American ginseng taken 40 minutes before a meal was effective in reducing blood sugar levels. Because dried ginseng root is hard and brittle, it must be simmered for about 45 minutes to extract the ginsenosides. Two to three teaspoonsful of dried root are used per cup. Powder made from American ginseng can be made into tea or taken with water or juice. One-half to one teaspoon is recommended per serving. American ginseng is usually taken two to three times per day between meals.

For Siberian ginseng, the recommended dosage for the powdered form is 12 g daily, taken in capsules or mixed with water or juice. The dose should be divided and taken two or three times per day between meals. The recommended dosage for liquid extract of Siberian ginseng is 12 mL twice daily.

Precautions

Because ginseng is considered a dietary supplement rather than a drug, it is not regulated by the Food and Drug Administration (FDA). Studies done between 1999 and 2001 found that many ginseng products for sale in the United States contain little or no ginseng. There have been no recent reports of contaminated products.

It is important for patients with Type 2 diabetes who are taking oral prescription medications to lower blood sugar levels to tell their physician if they are using any products containing ginseng. One Chinese-American physician reported several incidents of patients developing hypoglycemia (low blood sugar) from taking ginseng preparations alongside their regular prescription drugs.

People who use ginseng should discontinue it prior to abdominal or dermatologic surgery, or dental extraction. It has been associated with bleeding problems following surgery.

The American Herbal Products Association (AHPA) states that ginseng should not be taken by people with hypertension (high blood pressure). Data suggests variable effects on blood pressure. Some patients experience hypertension and some experience hypotension.

Ginseng should not be given to children. In addition, pregnant or lactating women should not use ginseng, as it may lower estrogen production.

Ginseng should not be used uninterruptedly for long periods of time. In Asian medicine, it is customary to take ginseng for two months and then stop for a full month before taking it again, but the basis for this is uncertain.

Side effects

Ginseng can have serious side effects. The American Herbal Products Association, or AHPA, classifies ginseng as a Class 2d herb, which means that its use is subject to restrictions.

Contemporary Chinese practitioners recognize a condition known as ginseng abuse syndrome, caused by taking ginseng incorrectly or excessively. In China, ginseng is almost always used for longevity by people over the age of 60; it is not given to younger people unless they are severely debilitated. Chinese medicine also recommends ginseng for use in winter only; it is not taken year round. The symptoms of ginseng abuse syndrome include include heart palpitations, heaviness in the chest, high blood pressure, dizziness, insomnia, agitation, restlessness, nausea, vomiting, abdominal pain and/or bloating, diarrhea, possible upper digestive tract bleeding, edema, and a red skin rash that is most noticeable on the face. Western herbalists recommend that anyone taking ginseng who develops these symptoms should stop taking the herb at once and contact a licensed practitioner of TCM to determine whether ginseng abuse is the cause of the problem.

A number of case studies involving severe side effects from habitual use of ginseng have been reported in American medical journals. These studies include a case of Stevens-Johnson syndrome (a disorder of the skin and mucosa usually caused by reactions to corticosteroids and a few other systemic drugs) in a Chinese student; a case of cerebral arthritis in a 28-year-old woman following a large dose of ginseng extract; a case of metrorrhagia (uterine hemorrhage) following two months of steady use of ginseng; and a case of hemorrhagic bleeding from the vagina following habitual use of ginseng douches.

Interactions

Ginseng has been reported to interact with caffeine to cause overstimulation and insomnia in some people. It has also been reported to increase the effects of digoxin, a medication used to treat congestive heart failure; and to interact with phenelzine , an antidepressant. Its interactions with phenelzine cause symptoms ranging from manic episodes to headaches. It also may alter the effects of the drug coumadin, and any anticoagulant therapies.

Resources

BOOKS

Medical Economics staff. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Company, 1998.

Pelletier, Kenneth R., MD. "Western Herbal Medicine: Nature's Green Pharmacy." Chapter 6 in The Best Alternative Medicine. New York: Simon & Schuster, 2002.

Reid, Daniel P. Chinese Herbal Medicine. Boston, MA: Shambhala, 1993.

Sander, Pela. "Natural Healing Therapies." In Women of the 14th Moon: Writings on Menopause, edited by Dena Taylor and Amber Coverdale Sumrall. Freedom, CA: The Crossing Press, 1991.

PERIODICALS

Ang-Lee, Michael K., Jonathan Moss, and Chun-Su Yuan. "Herbal Medicines and Perioperative Care." Journal of the American Medical Association 286 (July 11, 2001): 208.

Bone, Kerry. "Safety Issues in Herbal Medicine: Adulteration, Adverse Reactions and Organ Toxicities." Townsend Letter for Doctors and Patients (October 2001): 142.

Cardinal, Bradley J., and Hermann-Johann Engels. "Ginseng Does Not Enhance Psychological Well-Being in Healthy, Young Adults: Results of a Double-Blind, Placebo-Controlled, Randomized Clinical Trial." Journal of the American Dietetic Association 101 (June 2001): 655660.

Cheng, Tsung O. "Panax (Ginseng) is Not a Panacea." Archives of Internal Medicine 160 (November 27, 2000): 3329.

Flaws, Bob. "Using Ginseng Wisely." Townsend Letter for Doctors and Patients (October 2001): 28.

Harkey, Martha R., Gary L. Henderson, M. Eric Gershwin, and others. "Variability in Commercial Ginseng Products: An Analysis of 25 Preparations." American Journal of Clinical Nutrition 73 (June 2001): 1101.

Hoffman, R. J., and others. "Life-Threatening Vaginal Hemorrhage Caused by Therapeutic Chinese Ginseng Douche." Journal of Toxicology: Clinical Toxicology 39 (April 2001): 313.

Miller, Lucinda G., PharmD. "Herbal Medicinals." Archives of Internal Medicine 158 (1998): 22002211.

Tyler, Varro E. "Drug-Free Hope for Type 2 Diabetes." Prevention 53 (October 2001): 107.

Vuksan, Vladimir, John L. Sievenpiper, Julia Wong, and others. "American Ginseng (Panax quinquefolius L.) Attenuates Postprandial Glycemia in a Time-Dependent But Not Dose-Dependent Manner in Healthy Individuals." American Journal of Clinical Nutrition 73 (April 2001): 753.

"Watch for Use of Three Herbal Gs in Surgical Patients." Skin & Allergy News 32 (October 2001): 9.

OTHER

American Association of Oriental Medicine. 433 Front Street, Catasaqua, PA 18032. (610) 266-1433. Fax: (610) 264-2768. <www.aaom.org>.

American Botanical Council. PO Box 144345. Austin, TX 78714-4345.<www.herbalgram.org>.

Herb Research Foundation. 1007 Pearl Street. Suite 200. Boulder, CO 80302. <www.herbs.org>.

National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse. P.O. Box 7923, Gaithersburg, MD 20898. (888) 644-6226. TTY: (866) 464-3615. Fax: (866) 464-3616. <www.nccam.nih.gov>.

Rebecca J. Frey, Ph.D

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ginseng

ginseng (jĬn´sĕng), common name for the Araliaceae, a family of tropical herbs, shrubs, and trees that are often prickly and sometimes grow as climbing forms. The true ginseng (Panax ginseng), long prized by the Chinese for its medicinal qualities, was in such demand that a North American ginseng, P. quinquefolius, was imported in large quantities as a substitute. Both species have been all but exterminated in the wild by commercial exploitation. The herbal medicine ginseng is prepared from the plants' dried roots; it is used as a mild sedative and to increase stamina.

The widely varied family includes also the dwarf ginseng (P. trifolium) of North America; the English ivy (Hedera helix), a popular ornamental evergreen vine; the Hercules'-club, devil's-club, or devil's-walking-stick (names applied to several related species) of North America and E Asia, used locally for medicinal purposes; and the rice-paper plant (Tetrapanax papyriferus) of China, the pith of which is used to make Chinese rice paper. Native American species of this family include the wild sarsaparilla (Aralia nudicaulis) and the American, or wild, spikenard (A. racemosa). The names sarsaparilla and spikenard are applied also to plants of other families.

Ginseng is classified in the division Magnoliophyta, class Magnoliopsida, order Apiales, family Araliaceae.

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Ginseng

Ginseng

Pronounced "jin-seng," a plant of the genus Panax, family Aralia, indigenous to China, Korea, and North America. The Chinese and Korean species, Panax ginseng, is said to have curative properties, including the ability to prolong life.

The roots sometimes resemble the human form, rather like the mandragoras or mandrake, and a legend similar to that of the mandrake says that ginseng also screams when uprooted. Chinese tradition claims that ginseng absorbs a special earth vitality that is communicated to those who consume the plant (usually in the form of an infusion); hence in former times its use was restricted to emperors.

Although the plant's medicinal value is still disputed in Europe and the United States, it is now cultivated widely for sale in health food stores.

The American general William Westmoreland reportedly took ginseng tea at breakfast during the Vietnam War, and Russians gave it to cosmonauts to combat infectious disease.

Sources:

Harriman, Sarah. The Book of Ginseng. New York: Pyramid Books, 1975.

Melton, J. Gordon, Jerome Clark, and Aidan Kelly. New Age Encyclopedia. Detroit: Gale Research, 1990.

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ginseng

ginseng Herbal products from the roots of three species; Korean or Chinese ginseng is Panax ginseng, Siberian is Eleutherococcus senticosus, American is P. quinquefolius. Reported to have an immunostimulant action, to increase work capacity, and act as an adaptogen, with limited evidence of efficacy.

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ginseng

gin·seng / ˈjinseng/ • n. 1. a plant tuber credited with various tonic and medicinal properties. 2. the plant (genus Panax, family Araliaceae) from which this tuber is obtained, native to eastern Asia and North America.

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ginseng

ginseng Either of two perennial plants found in the USA (Panax quinquefolius) and e Asia (P. ginseng). It has yellow-green flowers and compound leaves. The dried tuberous roots are used in Chinese traditional medicine. Height: to 51cm (20in). Family Araliaceae.

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ginseng

ginseng See PANAX.

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ginseng

ginsengKaifeng, Yancheng •ginseng

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Ginseng

Ginseng

Resources

Ginseng refers to several species of plants in the genus Panax, family Araliaceae. Ginseng is a perennial, herbaceous plant with compound leaves that grow from a starchy root. The natural habitat of ginseng is the understory of mature angiosperm forest in the temperate zones of east Asia and eastern North America.

Ginseng root is highly valued for its many therapeutic properties by practitioners of traditional Chinese medicine, who regard it as a tonic, stimulant, aphrodisiac, and even a cure for some diseases. Oriental ginseng (Panax ginseng ) is the original ginseng upon which this medicinal usage was based. Because of the insatiable demand for its roots, this Asian species has been overharvested from its natural habitat of hardwood forest in eastern Asia, and is now endangered in the wild. Although Oriental ginseng is now cultivated as a medicinal crop, it is widely believed that wild plants are of much better medicinal quality than cultivated ginseng. Consequently, virtually any wild ginseng plants that are found are harvested, because they are so valuable.

Soon after the colonization by the French of parts of eastern North America in the sixteenth century, it was realized that there was a large and profitable market in China for the roots of American ginseng (Panax quinquifolium ), which grew abundantly in the temperate angiosperm forests of that region. These wild plants were initially collected in southern Quebec, and then anywhere else that ginseng could be found. For a while, ginseng root was one of the most important commodities exported from North America.

Inevitably, however, the once-abundant natural resource of wild ginseng was quickly exhausted, and today these plants are extremely rare in the wild in North America. American ginseng is now considered an endangered species in the wild. Another, much smaller species known as dwarf ginseng (P. trifolium ) was not over-collected, and is more common.

An agricultural system has been developed for the cultivation of ginseng, and it is now grown as a valuable cash crop in various places in North America. The plants are started from seed, which are collected from mature plants and stored in moist sand for one year, so that they will scarify and be capable of germinating. It can take as long as five to seven years for cultivated ginseng plants to reach their prime maturity for harvesting. However, the plants are sometimes harvested when smaller, and less valuable, because of the risk that a longer period of growth might allow a fungal infection to develop. Such an infection can ruin an entire crop, and devastate the result of years of patient work and investment. Agricultural ginseng is grown under a shading, plastic or wood-lattice canopy, because this species is a plant of the forest understory and does not tolerate full sunlight.

Once harvested, the largest, best-quality ginseng roots are dried, and are mostly exported to China, Korea, and Japan to be sold in traditional-medicine stores. Customers purchase their carefully selected roots, and then watch as the ginseng is prepared. Poorer-quality, thinner, cracked roots may b processed into ginseng tea and other bulk preparations.

Resources

BOOKS

Moramarco, J. The Complete Ginseng Handbook: A Practical Guide for Energy, Health, and Longevity. NTC/Contemporary Publishing, 1998.

OTHER

Botanical.com: A Modern Herbal. Ginseng <http://www.botanical.com/botanical/mgmh/g/ginsen15.html> (accessed November 25, 2006).

Purdue University: Horticulture and Landscape Architecture. Alternative Field Crops Manual: Ginseng <http://www.hort.purdue.edu/newcrop/afcm/ginseng.html> (accessed November 25, 2006).

Bill Freedman

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Ginseng

Ginseng

Definition

Purpose

Description

Recommended dosages

Precautions

Side effects

Interactions

Resources

Definition

Ginseng is an herbal preparation derived from the aromatic root of a plant of the genus Panax, which is native to East Asia. Ginseng belongs to the Araliaceae family of plants. Siberian ginseng belongs to a different genus, Eleutherococcus senticosus. The English name of the plant is a modification of its Chinese name, ren shen, which means “man” and “herb.” The Chinese name comes from the ginseng root’s resemblance to the shape of the human body, hence the plant’s traditional use as a tonic for male sexual vigor and potency. The Latin name for the species, Panax, is derived from the Greek word panacea, which means “cure-all,”or, “all-healer.”

There are three species of ginseng in common use in the United States: American ginseng, Korean ginseng, and Siberian ginseng. All are regarded as adaptogens, that normalize immune functions, and are preparations that help the body adapt to change, thus lowering the risk of stress-related illness. American ginseng, whose botanical name is Panax quinquefolius, has recently been evaluated as a treatment for high blood sugar in patients with type 2 (adult-onset) diabetes. It is considered to be less stimulating than the Korean or Siberian varieties. Korean ginseng, or Panax ginseng, is the species most often studied in Western as well as Asian trials of botanical preparations. Siberian ginseng, or Eleutherococcus senticosus, has been used in Russian sports medicine to boost athletic performance and strengthen the immune system.

Ginseng is one of the most expensive herbs in the world, costing as much as $20 per ounce, or more for red ginseng with the root, which is over 10,000 years old. It is one of the top three herbal products sold in the United States.

Purpose

In traditional Chinese medicine (TCM), ginseng is regarded as having a “sweet” and “neutral” nature. It is thought to have a particular affinity for the spleen and lungs. It is used as an aphrodisiac; a tonic for the spleen, kidney and adrenal functions, and lungs; and a

general restorative for the qi or vital energy in the body. TCM also recommends ginseng for asthma, weak pulse, indigestion, lack of appetite, rectal prolapse, hypertension, diabetes, insomnia , angina, congestive heart failure, and heart palpitations. It is important to note that ginseng is an exception to the rule that Chinese herbal medicine rarely uses a single herb in the manner of Western herbalism. Ginseng is often listed as one ingredient among several in Chinese medicines; it is, however, one of the few herbs in TCM that is sometimes prescribed by itself.

In the West, ginseng is frequently advertised as an energy booster, a memory aid, a sexual stimulant, a treatment for impotence and gastrointestinal disorders, and a promoter of longevity. Many Western researchers consider these claims inflated; some studies have found no difference between ginseng and a placebo in terms of the energy levels or general well-being reported by test subjects. Most studies nevertheless have shown improved energy, memory function and performance especially when fatigued, though most of the studies have been short-term. Ginseng’s association with the male reproductive system is sufficiently strong that Western feminist herbalists frequently advise women against taking ginseng for any reason.

Description

The part of the ginseng plant that is used medicinally is the root. Ginseng roots are not harvested until the plant is four to six years old. The active ingredients in ginseng root are saponin triterpenoid glycosides, or chemicals commonly called ginsenosides. Other compounds found in Asian ginseng include glycans (panaxans); polysaccharide fraction DPG-3-2; peptides; maltol; and volatile oil. The active compounds in Siberian ginseng are called eleutherosides. Eleutherosides are somewhat different from the ginsenosides found in the Panax varieties of ginseng. There has been some debate among herbalists whether Siberian ginseng should be considered a true ginseng at all, due to this difference in active ingredients. Ginseng root from any of the three varieties is dried and can then be made into powder, capsules, or a liquid tincture. American ginseng is also available in the United States as whole roots.

Recommended dosages

Dosages of Korean ginseng used in traditional Chinese medicine are given as 2-8 g as a tonic and 15-20 g for acute conditions.

Researchers who studied the potenial effectiveness of ginseng as a treatment for diabetes found that 1-3 g of American ginseng taken 40 minutes before a meal was effective in reducing blood sugar levels. Because dried ginseng root is hard and brittle, it must be simmered for about 45 minutes to extract the ginsenosides. Two to three teaspoonsful of dried root are used per cup. Powder made from American ginseng can be made into tea or taken with water or juice. One-half to one teaspoon is recommended per serving. American ginseng is usually taken two to three times per day between meals.

For Siberian ginseng, the recommended dosage for the powdered form is 1-2 g daily, taken in capsules or mixed with water or juice. The dose should be divided and taken two or three times per day between meals. The recommended dosage for liquid extract of Siberian ginseng is 1-2 mL twice daily.

Precautions

Because ginseng is considered a dietary supplement rather than a drug, it is not regulated by the Food and Drug Administration (FDA). Studies done between 1999 and 2001 found that many ginseng products for sale in the United States contain little or no ginseng. There have been no recent reports of contaminated products.

It is important for patients with Type 2 diabetes who are taking oral prescription medications to lower blood sugar levels to tell their physician if they are using any products containing ginseng. One Chinese-American physician reported several incidents of patients developing hypoglycemia (low blood sugar) from taking ginseng preparations alongside their regular prescription drugs.

People who use ginseng should discontinue it prior to abdominal or dermatologic surgery, or dental extraction. It has been associated with bleeding problems following surgery.

The American Herbal Products Association (AHPA) states that ginseng should not be taken by people with hypertension (high blood pressure). Data suggests variable effects on blood pressure. Some patients experience hypertension and some experience hypotension.

Ginseng should not be given to children. In addition, pregnant or lactating women should not use ginseng, as it may lower estrogen production.

Ginseng should not be used uninterruptedly for long periods of time. In Asian medicine, it is customary to take ginseng for two months and then stop for a full month before taking it again, but the basis for this is uncertain.

Side effects

Ginseng can have serious side effects. The AHPA classifies ginseng as a Class 2d herb, which means that its use is subject to restrictions.

Contemporary Chinese practitioners recognize a condition known as ginseng abuse syndrome, caused by taking ginseng incorrectly or excessively. In China, ginseng is almost always used for longevity by people over the age of 60; it is not given to younger people unless they are severely debilitated. Chinese medicine also recommends ginseng for use in winter only; it is not taken year round. The symptoms of ginseng abuse syndrome include include heart palpitations, heaviness in the chest, high blood pressure, dizziness, insomnia, agitation, restlessness, nausea, vomiting, abdominal pain and/or bloating, diarrhea, possible upper digestive tract bleeding, edema, and a red skin rash that is most noticeable on the face. Western herbalists recommend that anyone taking ginseng who develops these symptoms should stop taking the herb at once and contact a licensed practitioner of TCM to determine whether ginseng abuse is the cause of the problem.

A number of case studies involving severe side effects from habitual use of ginseng have been reported in American medical journals. These studies include a case of Stevens-Johnson syndrome (a disorder of the skin and mucosa usually caused by reactions to corticosteroids and a few other systemic drugs) in a Chinese student; a case of cerebral arthritis in a 28-year-old woman following a large dose of ginseng extract; a case of metrorrhagia (uterine hemorrhage) following two months of steady use of ginseng; and a case of hemorrhagic bleeding from the vagina following habitual use of ginseng douches.

KEY TERMS

Adaptogen —A remedy that helps the body adapt to change, and thus lowers the risk of stress-related illnesses.

Aphrodisiac —A medication or preparation given to stimulate sexual desire.

Douche —A jet or current of water, often with a medication or cleansing agent dissolved in it, applied to a body cavity for medicinal or hygienic purposes.

Ginseng abuse syndrome —A group of symptoms recognized by Chinese physicians as the result of excessive use of ginseng. The symptoms include dizziness, high blood pressure, restlessness, nausea, possible bleeding from the digestive tract, and skin rashes.

Panacea —A medicine or other substance regarded as a cure for all ills. Ginseng should not be considered a panacea.

Qi —The Chinese term for energy, life force, or vital force.

Interactions

Ginseng has been reported to interact with caffeine to cause overstimulation and insomnia in some people. It has also been reported to increase the effects of digoxin, a medication used to treat congestive heart failure; and to interact with phenelzine , an antidepressant. Its interactions with phenelzine cause symptoms ranging from manic episodes to headaches. It also may alter the effects of the drug Coumadin, and any anticoagulant therapies.

Resources

BOOKS

Medical Economics staff. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Company, 1998.

Pelletier, Kenneth R., MD. “Western Herbal Medicine: Nature’s Green Pharmacy.” Chapter 6 in The Best Alternative Medicine. New York: Simon & Schuster, 2002.

Reid, Daniel P. Chinese Herbal Medicine. Boston, MA: Shambhala, 1993.

Sander, Pela. “Natural Healing Therapies.” In Women of the 14th Moon: Writings on Menopause, edited by Dena Taylor and Amber Coverdale Sumrall. Freedom, CA: The Crossing Press, 1991.

PERIODICALS

Ang-Lee, Michael K., Jonathan Moss, and Chun-Su Yuan. “Herbal Medicines and Perioperative Care.” Journal of the American Medical Association 286 (July 11, 2001): 208.

Bone, Kerry. “Safety Issues in Herbal Medicine: Adulteration, Adverse Reactions and Organ Toxicities.” Townsend Letter for Doctors and Patients (October 2001): 142.

Cardinal, Bradley J., and Hermann-Johann Engels. “Ginseng Does Not Enhance Psychological Well-Being in Healthy, Young Adults: Results of a Double-Blind, Placebo-Controlled, Randomized Clinical Trial.” Journal of the American Dietetic Association 101 (June 2001): 655–660.

Cheng, Tsung O. “Panax (Ginseng) is Not a Panacea.” Archives of Internal Medicine 160 (November 27, 2000): 3329.

Flaws, Bob. “Using Ginseng Wisely.” Townsend Letter for Doctors and Patients (October 2001): 28.

Harkey, Martha R., Gary L. Henderson, M. Eric Gershwin, and others. “Variability in Commercial Ginseng Products: An Analysis of 25 Preparations.” American Journal of Clinical Nutrition 73 (June 2001): 1101.

Hoffman, R. J., and others. “Life-Threatening Vaginal Hemorrhage Caused by Therapeutic Chinese Ginseng Douche.” Journal of Toxicology: Clinical Toxicology 39 (April 2001): 313.

Miller, Lucinda G., PharmD. “Herbal Medicinals.” Archives of Internal Medicine 158 (1998): 2200–2211.

Tyler, Varro E. “Drug-Free Hope for Type 2 Diabetes.” Prevention 53 (October 2001): 107.

Vuksan, Vladimir, John L. Sievenpiper, Julia Wong, and others. “American Ginseng (Panax quinquefolius L.) Attenuates Postprandial Glycemia in a Time-Dependent But Not Dose-Dependent Manner in Healthy Individuals.” American Journal of Clinical Nutrition 73 (April 2001): 753.

“Watch for Use of Three Herbal Gs in Surgical Patients.” Skin & Allergy News 32 (October 2001): 9.

OTHER

American Association of Oriental Medicine. 433 Front Street, Catasaqua, PA 18032. Telephone: (610) 266-1433. Fax: (610) 264-2768. <http://www.aaom.org>.

American Botanical Council. PO Box 144345. Austin, TX 78714-4345. <http://www.herbalgram.org>.

Herb Research Foundation. 1007 Pearl Street. Suite 200. Boulder, CO 80302. <http://www.herbs.org>.

National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse. P.O. Box 7923, Gaithersburg, MD 20898. Telephone: (888) 644-6226. TTY: (866) 464-3615. Fax: (866) 464-3616. <http://www.nccam.nih.gov>.

Rebecca J. Frey, Ph.D

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Ginseng

Ginseng

Definition

Purpose

Description

Precautions

Interactions

Complications

Parental concerns

Resources

Definition

Ginseng refers to two closely related herbs of the genus Panax. Asian ginseng (P. ginseng) and American ginseng (P. quinquefolius) have traditionally been used for healing. Asian ginseng is also known as Korean red ginseng, Chinese ginseng, Japanese ginseng, ginseng radix, ninjin, sang, and ren shen. American ginseng is also known as Canadian ginseng, North American ginseng, Ontario ginseng, Wisconsin ginseng, red berry, sang, and ren shen. Siberian ginseng (Eleutherococcus senticosus) is a plant with different properties that belongs to a completely different genus. Ginseng in this entry refers only to Asian and American ginseng of the genus Panax.

Purpose

Ginseng has been used for about 2,000 years in Traditional Chinese Medicine (TCM) to boost energy, hasten recovery from illness or injury, reduce stress, improve mental and physical performance (including sexual performance) and to treat a several dozen different infections, gastrointestinal disorders, circulatory problems, and conditions as diverse as burns, cancers, diabetes, migraine headaches, and weight loss. The genus name Panax means “heal all,” and ginseng is considered by herbalists to be an almost universal remedy. Most of these traditional uses of ginseng have not yet been substantiated by conventional medicine, however encouraging results from some well-designed, controlled human studies strongly suggest that ginseng may improve mental performance and have other health benefits.

Description

Ginseng is a perennial herb that grows in cool, damp, shady forests. Asian ginseng is native to

Northern China and today is grown as a cash crop in China, Korea, Japan, and Russia. American ginseng once grew wild from the Appalachian Mountains to Minnesota. Today it is cultivated mainly in Wisconsin and in the Canadian provinces of Ontario and British Columbia. Most cultivated ginseng from North America is exported to Asia. In both Asia and North America, wild ginseng is threatened with extinction from over harvesting. In the United States, a government permit is usually required to export wild ginseng. High-quality wild ginseng is very expensive. Illegal harvesting of wild ginseng from public lands is an ongoing law enforcement problem for the United States Fish and Wildlife Service.

Ginseng is a slow-growing plant that reaches a height of 12–30 inches and produces red berries. Only the root used for medicinal purposes. Ginseng is difficult to cultivate. Plants must grow 4–6 years before the roots can be harvested. Ginseng roots are forked and twisted, looking somewhat like a miniature human body. They are occasionally used fresh but more often are dried and ground or powdered. The root can be soaked to make an extract or tincture. Ground ginseng can be added to tea and powered ginseng put into capsules. Ginseng extract can be added to products as diverse as chewing gum and soft drinks. Ginseng is sold under dozens of different brand names. It is often found in multi-herb remedies sold under a huge variety of names. The active ingredients of ginseng are thought to be more than twenty compounds called ginsenosides. Some manufacturers standardize the amount of ginsengosides in their product while others do not. Standardized products usually contain 4-% ginsenosides.

Regulation of ginseng sales

In the United States, ginseng is regulated by the Food and Drug Administration (FDA) as a dietary supplement under the 1994 Dietary Supplement Health and Education Act (DSHEA). At the time the act was passed, legislators felt because many dietary supplements such as ginseng come from natural sources and have been used for hundreds of years by practitioners of complementary and alternative medicine (CAM), these supplements did not need to be regulated as rigorously as prescription and over-the-counter drugs used in conventional medicine.

The DSHEA regulates ginseng in the same way that food is regulated. Like food manufacturers, manufacturers of herbal products containing ginseng do not have to prove that they are either safe or effective before they can be sold to the public. This differs from conventional pharmaceutical drugs, which must undergo extensive human testing to prove their safety and effectiveness before they can be marketed. Also unlike conventional drugs, the label for a dietary supplement such as ginseng does not have to contain any statements about possible side effects. All herbal supplements sold in the United States must show the scientific name of the herb on the label. Consumers should look for ginseng of the Panaxvariety. Sometimes less expensive herbs such as Siberian “ginseng” are substituted for true ginseng.

Health claims

Dozens of health claims are made for ginseng, many based on traditional or folk use of the herb. These claims are difficult to substantiate in ways that satisfy conventional medicine for several reasons including:

  • The amount and strength of ginseng in dietary supplements is not standardized and a wide range of doses are used in different studies
  • Ginseng is often one of several herbs contained in herbal remedies, making it difficult to tell if the effects are due to ginseng or another herb
  • Many studies done on ginseng are poorly designed so that it is impossible to show a direct link between cause and effect, or they poorly reported, making analysis of the results difficult
  • Many rigorous and well-designed human studies have a small sample size

KEY TERMS

Alternative medicine— A system of healing that rejects conventional, pharmaceutical-based medicine and replaces it with the use of dietary supplements and therapies such as herbs, vitamins, minerals, massage, and cleansing diets. Alternative medicine includes well-established treatment systems such as homeopathy, Traditional Chinese Medicine, and Ayurvedic medicine, as well as more-recent, fad-driven treatments.

Alzheimer’s disease— An incurable disease of older individuals that results in the destruction of nerve cells in the brain and causes gradual loss of mental and physical functions.

Conventional medicine— Mainstream or Western pharmaceutical-based medicine practiced by medical doctors, doctors of osteopathy, and other licensed health care professionals.

Dietary supplement— A product, such as a vitamin, mineral, herb, amino acid, or enzyme, that is intended to be consumed in addition to an individual’s diet with the expectation that it will improve health.

Traditional Chinese Medicine (TCM)— An ancient system of medicine based on maintaining a balance in vital energy or qi that controls emotions, spiritual, and physical well being. Diseases and disorders result from imbalances in qi, and treatments such as massage, exercise, acupuncture, nutritional and herbal therapy is designed to restore balance and harmony to the body.

  • Many studies are sponsored by ginseng growers, manufacturers, or importers who have a financial interest in obtaining positive results.

Despite these drawbacks, there is enough evidence that ginseng provides health benefits that the National Center for Complementary and Alternative Medicine (NCCAM), a government organization within the National Institutes of Health, is sponsoring clinical trials to determine safety and effectiveness ginseng as a treatment for several diseases and disorders. Individuals interested in participating in a clinical trial at no charge can find a list of open trials at <http://www.clinicaltrials.gov>.

Some health claims for ginseng appear more promising than others. There is good evidence that ginseng can cause short-term improvement in mental performance in both healthy young adults and elderly ill adults. Not enough information is available to determine if long-term gains also occur, but the results have been promising enough that ginseng is being studied in patients with Alzheimer’s disease and other dementias. Along with improved mental performance, some studies have shown that ginseng improves the sense of well being and quality of life. Results of these studies are mixed, with some finding improvements and others finding no change. The situation is complicated by the fact that different studies define and measure “well being” and “quality of life” in different ways. In general, people with the worst quality of life report the most improvement.

Many claims are made that ginseng boosts the immune system, thus helping to prevent disease and promote a more rapid recovery from illness and injury. Some studies also claim that ginseng boosts the effect of antibiotics and improves the body’s response to influenza vaccines. Some studies of patients with diseases that cause a low white cell count (white cells are a part of the immune system) show that white cell count increases with high doses of ginsenosides. Better studies are needed before the effect of ginseng on the immune system can be determined.

There is good evidence that ginseng lowers blood sugar in people with type 2 (non-insulin dependent) diabetes. The effect of ginseng on blood sugar in people with type 1 (insulin dependent) diabetes has not been studied enough to produce any definite findings.

Ginseng has been promoted as a preventative and/ or cure for cancer. According the American Cancer Society in 2007, “There is no reliable scientific evidence that ginseng is effective in preventing or treating cancer in humans.” However, controversial evidence from some studies done in Asia suggests the possibility that ginseng powder or extract may prevent some cancers. More and better studies are needed to clarify these results.

Some studies have reported that ginseng improves stamina and athletic performance and decreases fatigue, while other studies find no effect. There are so many other lifestyle variables in most of these studies that it is difficult to separate the effect of ginseng from other factors.

Studies of the effect of ginseng on the circulatory system are mixed. Some studies find that ginseng lowers blood pressure and in combination with other herbs prevents coronary artery disease and possibly congestive heart failure. Other studies find no effect, or that the effect is apparent only at very high, and possibly unsafe, doses. The effect of ginseng on the circulatory system continues to be investigated.

Many other health claims are made for herbal mixtures that contain ginseng. These claims are extremely difficult to evaluate because of the number of variables, including the strength of the mixture, the effects of the different herbs, and potential interactions among other herbs. Until much more is known about the chemical properties and active ingredients of common medicinal herbs, it is almost impossible to evaluate these mixtures in a way that satisfies the demands of conventional medicine.

Precautions

Ginseng is generally safe and causes few side effects when taken at recommended doses. The generally recommended dose is 100–200 mg of standardized ginseng extract containing 4% ginsenosides once or twice daily. The safety of ginseng in children and pregnant and breastfeeding women has not been studied. Pregnant and breastfeeding women should be aware that some tinctures of ginseng contain high levels of alcohol. Some herbalists recommend that individuals take ginseng for 2–3 weeks and then take a break of 1–2 weeks before beginning the herb again.

Independent laboratory analyses have repeatedly found that many products labeled as ginseng contain little or none of the herb. True ginseng is expensive, and unscrupulous manufacturers often substitute low-cost herbs for ginseng. Another problem is that some ginseng products have been found to be contaminated with pesticides and other chemicals that can cause serious side effects.

Interactions

Ginseng appears to interact with blood-thinning and anti-coagulant medicines such as warfarin (Cou-madin), clopidogrel (Plavix), aspirin, and nonsteroidal anti-inflammatory drugs (e.g. Advil, Motrin). Individuals taking these drugs should not begin taking ginseng without consulting their health care provider.

Because ginseng lowers blood sugar levels, individuals who are taking insulin or other medications that also lower blood sugar, and those with type 2 diabetes, should be monitored for low blood sugar if they begin taking ginseng. Adjustments are needed in their other medications.

Ginseng may also interact with monoamine-oxi-dase (MAO) inhibitors used to treat certain kinds of depression and mental illness. Examples of MAOs include isocarboxazid (Marplan), phenelzine (Nardil) and tranylcypromine (Parnate). Individuals taking MAOs with ginseng may develop headache, tremors, increased anxiety, restlessness, sleeplessness, and mania.

Preliminary evidence suggests that ginseng may interact with certain blood pressure and heart medications. The herb may also interfere with the way the liver processes other drugs and herbs. Before beginning to take a supplement containing ginseng, individuals should review their current medications with their health care provider to determine any possible interactions.

Complications

Serious side effects of ginseng are rare. The most common side effects are increased restlessness, insomnia, nausea, diarrhea, and rash. Allergic reactions are possible, but uncommon. Some of the more serious side effects reported are thought to be the result of contamiNation with pesticides, heavy metals, or other chemicals rather than a side effect caused by ginseng.

Parental concerns

Parents should be aware that the safe dose of many herbal supplements has not been establsihed for children. Accidental overdose may occur if children are give adult herbal supplements.

Resources

BOOKS

Court, William E. Ginseng: The Genus Panax. Australia: Harwood Academic, 2000.

Johanssen, Kristin. Ginseng Dreams: The Secret World of America’s Most Valuable Plant. Lexington, KY: University Press of Kentucky, 2006.

PDR for Herbal Medicines, 3rd ed. Montvale, NJ: Thompson Healthcare, 2004.

Pierce, Andrea. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York: William Morrow, 1999.

Taylor, David. Ginseng, the Divine Root: The Curious History of the Plant That Captivated the World. Chapel Hill, NC: Algonquin Books of Chapel Hill, 2006.

Wildman, Robert E. C., ed. Handbook of Nutraceuticals and Functional Foods, 2nd ed. Boca Raton, FL: CRC/Taylor &Francis, 2007.

PERIODICALS

Kaneko, Hitoshi and Kozo Nakanish. “Proof of the Mysterious Efficacy of Ginseng: Basic and Clinical Trials: Clinical Effects of Medical Ginseng, Korean Red Ginseng: Specifically, Its Anti-stress Action for Prevention of Disease.” Journal of Pharmacological Sciences 95 (2004):158–62.

Kiefer, David and Traci Pantuso. “Panax Ginseng.” American Family Physician 68 (October 15, 2003):1539–42. Also available at <http://www.aafp.org/afp/20031015/1539.html>

.

ORGANIZATIONS

Alternative Medicine Foundation. P.O. Box 60016, Potomac, MD 20859. Telephone: (301) 340-1960. Fax: (301) 340-1936. Website: <http://www.amfoundation.org>

National Center for Complementary and Alternative Medicine Clearinghouse. P.O. Box 7923, Gathersburg, MD 20898. Telephone: (888) 644-6226. TTY: (866) 464-3615. Fax: (866) 464-3616. Website: <http://nccam.nih.gov>

Ginseng Board of Wisconsin. 555 N. 72nd Avenue, Suite 2, Wausau, WI 54401. Telephone: (714) 845-7300. Fax: (715) 845-7300. Website: <http://www.ginsengboard.com>

National Center for Complementary and Alternative Medicine Clearinghouse. P.O. Box 7923, Gathersburg, MD 20898. Telephone: (888) 644-6226. TTY: (866) 464-3615. Fax: (866) 464-3616. Website: <http://nccam.nih.gov>

Natural Standard. 245 First Street, 18th Floor, Cambridge, MA 02142. Telephone: (617) 444-8629. Fax: (617) 444-8642. Website: <http://www.naturalstandards.com>

Office of Dietary Supplements, National Institutes of Health. 6100 Executive Blvd., Room 3B01, MSC 7517, Bethesda, MD 20892-7517 Telephone: (301) 435-2920. Fax: (301)480-1845. Website: <http://dietary-supplements.info.nih.gov>.

OTHER

American Cancer Society. “Ginseng.” American Cancer Society, October 3, 2005. <http://www.cancer.org/docroot/eto/content/eto_5_3x_ginseng.asp?sitearea=eto>

Harrison, H. C. et al. “Ginseng.” Alternative Field Crops Manual, University of Wisconsin-Extension, undated; accessed February 7, 2007. <http://www.purdue.edu/newcrop/afcm/ginseng.html/Coo>

Mayo Clinic Staff. “Ginseng (American Ginseng, Asian Ginseng, Chinese Ginseng, Korean Red Ginseng, Panax Ginseng: Panax ssp. Including P. Ginseng C.C. Meyer and P. quincefolium L., excluding Eleutherococcus senticosus.” MayoClinic.com, May 1, 2006. <http://www.mayoclinic.com/health/ginseng/NS_patient-ginseng>

Medline Plus. “Ginseng.” U. S. National Library of Medicine, November 1, 2006. <http://www.nlm.nih/gov/medlineplus/druginfo/natural/patient-ginseng.html>

National Center for Complementary and Alternative Medicine. “Asian Ginseng.” National Center for Comple mentary and Alternative Medicine, December 2006. <http://nccam.nih.gov/health/asianginseng>

Personal Health Zone. “Ginseng Side Effects, Interactions and Warnings.” Personal Health Zone October 2006. <http://www.personalhealthzone,com/ginseng.html>

Tish Davidson, A.M.

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Ginseng

Ginseng

Ginseng refers to several species of plants in the genus Panax, family Araliaceae. Ginseng is a perennial, herbaceous plant , with compound leaves that grow from a starchy root. The natural habitat of ginseng is the understory of mature angiosperm forest in the temperate zones of east Asia and eastern North America .

The root of ginseng is highly valued as having many therapeutic properties by practitioners of traditional Chinese medicine, who regard it as a tonic, stimulant, aphrodisiac, and cure for some diseases. Oriental ginseng (Panax ginseng) is the original ginseng upon which this medicinal usage was based. Because of the insatiable demand for its roots, this Asian species has been overharvested from its natural habitat of hardwood forest in eastern Asia, and is now endangered in the wild. Although Oriental ginseng is now cultivated as a medicinal crop, it is widely believed that wild plants are of much better medicinal quality than cultivated ginseng. Consequently, virtually any wild ginseng plants that are found are harvested, because they are so valuable.

Soon after the colonization by the French of parts of eastern North America in the sixteenth century, it was realized that there was a large and profitable market in China for the roots of American ginseng (Panax quinquifolium), which grew abundantly in the temperate angiosperm forests of that region. These wild plants were initially collected in southern Quebec, and then anywhere else that ginseng could be found. For a while, ginseng root was one of the most important commodities being exported from North America. Inevitably, however, the once abundant natural resource of wild ginseng was quickly exhausted, and today these plants are extremely rare in the wild in North America. American ginseng is now considered an endangered species in the wild. Another, much smaller species known as dwarf ginseng (P. trifolium) was not over-collected, and is more common.

An agricultural system has been developed for the cultivation of ginseng, and it is now grown as a valuable cash crop in various places in North America. The plants are started from seed, which are collected from mature plants and stored in moist sand for one year, so that they will scarify and be capable of germinating. It can take as long as five to seven years for cultivated ginseng plants to reach their prime maturity for harvesting. However, the plants are sometimes harvested when smaller, and less valuable, because of the risk that a longer period of growth might allow a fungal infection to develop. Such an infection can ruin an entire crop, and devastate the result of years of patient work and investment. Agricultural ginseng is grown under a shading, plastic or wood-lattice canopy, because this species is a plant of the forest understory and does not tolerate full sunlight.

Once harvested, the largest, best-quality ginseng roots are dried, and are mostly exported to China, Korea, and Japan to be sold in traditional-medicine stores. Customers purchase their carefully selected roots, and then watch as the ginseng is prepared. Poorer-quality, thinner, cracked roots may b processed into ginseng tea and other bulk preparations.

Resources

books

Moramarco, J. The Complete Ginseng Handbook: A Practical Guide for Energy, Health, and Longevity. NTC/Contemporary Publishing, 1998.


Bill Freedman

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