Ginseng (Panax)

• Fatigue and quality of life: Research suggests standardized Panax ginseng extracts may modestly reduce fatigue and improve well‑being in chronic illness and cancer‑related fatigue (meta‑analyses and RCTs; evidence = moderate; effects are generally small to moderate).
• Cognitive function: Some studies show small, short‑term improvements in working memory, attention, and subjective calmness with standardized extracts (systematic reviews/RCTs; evidence = moderate for acute effects, mixed for long‑term).
• Erectile dysfunction: Red/Panax ginseng may modestly improve erectile function and sexual satisfaction versus placebo (systematic reviews/meta‑analyses; evidence = moderate).
• Glycemic control: Panax species (especially American ginseng, P. quinquefolius) can modestly lower fasting and post‑prandial glucose; Panax ginseng shows mixed but generally favorable effects (meta‑analyses/RCTs; evidence = moderate; clinical significance varies). Monitor for hypoglycemia if on glucose‑lowering drugs.
• Immune modulation and respiratory infections: Limited evidence indicates ginseng preparations can enhance certain immune markers and may reduce incidence or duration of common colds (more consistent with American ginseng extracts; evidence = emerging for Panax ginseng specifically).
• Menopausal and mood symptoms: Some trials report improvements in mood, sleep, and sexual function, but effects on vasomotor symptoms are inconsistent (evidence = emerging).
• Exercise performance and cardiometabolic markers: Findings are inconsistent; small trials show minimal to modest benefits on endurance, blood pressure, and lipids (evidence = emerging).

Common: insomnia, restlessness, nervousness, headache, gastrointestinal upset (nausea, diarrhea), changes in appetite. These are often dose‑dependent and more likely with stimulant co‑use (e.g., caffeine). Less common: dizziness, rash/pruritus, dry mouth, palpitations, mild blood pressure fluctuations (up or down), sleep disturbances. Rare but reported: hypoglycemia (especially with antidiabetic medications or fasting), allergic reactions (including anaphylaxis), vaginal bleeding or mastalgia (likely due to weak estrogenic activity), manic or hypomanic symptoms (particularly with antidepressants/MAOIs or in bipolar disorder), hepatotoxicity case reports (causality uncertain), abnormal INR changes in warfarin users. Tolerability: Generally well tolerated short‑term (up to 12 weeks) in studies; long‑term safety data are more limited.

These are commonly used ranges in studies; optimal dosing varies by individual, product, and indication.

• Standardized Panax ginseng extract (Asian/Korean ginseng, typically 4–7% ginsenosides): 200–400 mg per day in divided doses for 4–12 weeks for cognition and fatigue in RCTs.
• Red ginseng for erectile dysfunction: 900–1,000 mg, three times daily (total 2.7–3 g/day) for 8–12 weeks in several trials.
• Glycemic control: Both Panax ginseng extracts (200–400 mg/day) and American ginseng (P. quinquefolius) 1–3 g before meals have been studied; effects and species differ.
• Traditional use (whole root/decoction): Typically 0.5–2 g/day of dried root, with higher doses used short‑term under practitioner guidance in TCM. Product standardization and ginsenoside content vary widely among brands; consult product‑specific labeling and a clinician, especially if you take medications or have chronic conditions.

• Pregnancy and breastfeeding: Insufficient reliable safety data; avoid.
• Bleeding risk: Bleeding disorders, peri‑operative period, or concurrent anticoagulant/antiplatelet therapy—effects on coagulation and platelet function are unpredictable. Discontinue at least 1–2 weeks before elective surgery.
• Diabetes or hypoglycemia: Can lower blood glucose; use caution with insulin or oral hypoglycemics; monitor closely.
• Cardiovascular conditions: Uncontrolled hypertension, significant arrhythmias, or unstable cardiovascular disease—stimulatory effects may exacerbate symptoms.
• Hormone‑sensitive conditions: History of breast, uterine, or ovarian cancer, endometriosis, or uterine fibroids—due to weak estrogenic activity; consult an oncologist.
• Psychiatric disorders: History of mania/hypomania or schizophrenia—stimulant‑like and mood‑elevating effects may worsen symptoms.
• Autoimmune disease or transplant recipients: Potential immunostimulatory effects; avoid with immunosuppressive therapy unless supervised by a specialist.
• Known allergy to Panax species or Araliaceae family.