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Traditional Chinese medicine

GinsengPanax ginseng

Ginseng has no gut-outcome trial on its own; it sits in rikkunshito, where a 247-person dyspepsia trial found 33.6% vs 23.8% responders, not significant.

Botanical name
Panax ginseng
Part used
root, dried (white ginseng) or steamed and dried (red ginseng)
Also called
pinyin Ren shen (white), Hong shen (red) (人参 / 红参); Asian ginseng, Korean ginseng, Panax ginseng root, Insam (Korean), Ninjin (Japanese)
Used in
Traditional Chinese medicine
Taken for
Appetite, Indigestion
Sold as
root slices, powder, extract, capsules, tea, ready-made drink

What is meant by ginseng

Ginseng, or ren shen, is the root of Panax ginseng, a perennial herb that is cultivated and sold worldwide. It is a different plant from American ginseng (Panax quinquefolius) and from Siberian ginseng (Eleutherococcus), which is unrelated. The root is prepared in two ways. White ginseng is peeled or washed and dried. Red ginseng is steamed first and then dried, a process the Korean and Chinese traditions use to change its character.

The Chinese materia medica treats ginseng as the principal qi tonic and puts it at the head of the Si Jun Zi Tang family of digestive formulas. In Japan, the Kampo formula rikkunshito, which carries ginseng, white atractylodes, poria, pinellia, tangerine peel, licorice, ginger and jujube, is the ginseng-containing digestive formula with the most trial data we found. Ginseng is sold as whole roots, slices, powder, extract, capsules and ready-made drinks, and the quality and strength of those preparations vary widely.

In the traditions

Traditional Chinese medicine (about TCM)

Ren shen is sweet, slightly bitter and slightly warm in the materia medica, entering the spleen and lung channels, and its actions are described as greatly tonifying the source qi, strengthening the spleen and lung, generating fluids and calming the spirit. For the gut the tradition uses it where the texts see a spleen and stomach that have lost strength, with poor appetite, fullness, vomiting and diarrhea, and it is the lead herb in Si Jun Zi Tang. It also appears in Liu Jun Zi Tang, Shen Ling Bai Zhu San and Ban Xia Xie Xin Tang, the last of which pairs it with coptis and pinellia for what the texts call a mixture of cold and heat in the middle, with epigastric fullness, nausea and loose stools. The texts’ pattern language is not a physiological finding.

What the plant contains

Ginseng’s best-known constituents are the ginsenosides, a family of saponins, along with polysaccharides. In rat studies, a ginsenoside extract opposed the anticoagulant effect of warfarin and raised the activity of the liver enzymes CYP3A4 and CYP2C9, which is how the interaction below is thought to arise. These are laboratory and animal findings, not trial results in people, and we could not find a human trial that tested a single ginsenoside for a gut outcome.

What has been tested in people

We could not find a placebo-controlled trial of Panax ginseng alone with a gut outcome. The US National Center for Complementary and Integrative Health notes that most ginseng trials have been small, under 200 participants, and most lasted under 3 months; the outcome where its review found a possible small benefit is general fatigue (19 studies, 2,413 people), not digestion. The gut data are all on formulas that contain ginseng.

Rikkunshito has the most trial data. In a Japanese multicenter trial of 247 people with functional dyspepsia, 2.5 g three times a day for 8 weeks gave responders of 33.6 percent against 23.8 percent on placebo, which did not reach significance (p = 0.09), though epigastric pain improved (p = 0.04). In the DREAM trial, 128 randomized people with dyspepsia and anxiety scored better on overall treatment effect at 8 weeks (p = 0.019). A Belgian crossover trial of 23 people found no change in gastric accommodation or motility, with early satiation and postprandial fullness lower than baseline, but placebo also improved most symptoms. A pooled analysis of 52 trials with 5,475 people gave RR 1.21 (1.17 to 1.25) against Western drugs; another review of 24 studies with 2,175 people found no difference on the Gastrointestinal Symptom Rating Scale (SMD -0.07) and called the evidence unclear.

Ban Xia Xie Xin Tang, which also contains ginseng, has 57 trials with 5,525 people pooled, which favored the formula over Western drugs on total efficacy, but its comparison with placebo showed no significant difference on a visual analog scale for dyspepsia.

Not tested: ginseng alone for dyspepsia, diarrhea, IBS or inflammatory bowel disease.

StudyDoseWhat it found
Multicenter placebo-controlled RCT, 247 people with functional dyspepsia (rikkunshito, a ginseng-containing formula) PMID 247662952.5 g three times a day for 8 weeksResponders 33.6% vs 23.8%, p = 0.09 (not significant); epigastric pain improved, p = 0.04
DREAM RCT, 128 randomized people with functional dyspepsia (rikkunshito vs placebo) PMID 294984578 weeks of rikkunshitoOverall treatment effect better than placebo at 8 weeks, p = 0.019; anxiety score also improved
Crossover placebo-controlled trial, 23 completers with functional dyspepsia in Belgium (rikkunshito) PMID 316085322.5 g three times a day for 4 weeksNo change in gastric accommodation; early satiation and fullness lower than baseline, but placebo improved similarly
Meta-analysis of 52 RCTs, 5,475 people with functional dyspepsia (rikkunshito vs Western drugs) PMID 32767596Formula; doses variedTotal efficacy RR 1.21 (1.17 to 1.25)
Meta-analysis of 24 studies, 2,175 people with upper gastrointestinal symptoms (rikkunshito) PMID 30670250Formula; doses variedGSRS SMD -0.07 (-0.31 to 0.17); most studies at high or unclear risk of bias
Randomized, double-blind trial, 20 healthy volunteers (American ginseng with warfarin) PMID 15238367American ginseng for 2 weeks with warfarinPeak INR lower than placebo by 0.19 (95% CI 0.07 to 0.36)

Doses used in trials and traditional preparations

The EMA monograph on Panax ginseng root gives the traditional use dose for white ginseng as 1 to 2 g of comminuted root simmered in 150 ml of water as a decoction two to three times a day, or 250 to 1,200 mg of powdered root per dose with a daily range of 600 to 2,000 mg, and states use for up to 3 months. The rikkunshito trials gave 2.5 g of the extract three times a day for 4 to 8 weeks. Red ginseng, extracts standardized to ginsenosides and ready-made drinks have different strengths, and none is tied to a trial-based dose for a gut symptom.

Treat these figures as a record of what was studied. Whether any amount of ginseng suits a particular person is a question for a clinician or pharmacist who knows their history.

Safety

The EMA monograph lists hypersensitivity reactions (itching, hives), insomnia and digestive upset (stomach discomfort, nausea, vomiting, diarrhea, constipation) as reported effects, with unknown frequency. The US National Center for Complementary and Integrative Health calls insomnia the most common side effect, notes rarer liver injury and allergic reactions, and says ginseng might worsen autoimmune disease and could affect blood clotting. The monograph says safety in pregnancy and lactation has not been established and use under 18 is not established. On product quality, a survey of 294 raw Chinese herb samples tested for 162 pesticides found 42 different ones in 108 samples (36.7 percent), and the authors put 14 samples (5 percent) at levels that could add to background exposure under a likely scenario of use. It surveyed raw herbs in general and not ginseng products.

Drug interactions

Warfarin is the main one. In a randomized, double-blind trial, 20 healthy volunteers who took American ginseng for 2 weeks had a lower peak INR than those on placebo (difference -0.19), along with lower warfarin levels; the authors noted these were young healthy volunteers, not patients on a treatment dose. Rat studies show the enzyme induction described above. The National Center for Complementary and Integrative Health also says ginseng might lower blood sugar, so diabetes medicines are another flagged class.

Products in the catalog with ginseng

These catalog entries list ginseng or one of its preparations among their active ingredients. Each page shows the amount on the label, the trials behind it and what buyers report.

Snap Dynasty Stomach Chi 4.5 out of 5 from 162 ratings from Amazon · $1.50 per day at two capsules three times a day ($29.99 for 120 on the brand site, $29.98 on Amazon, a 20-day bottle); the 60-capsule bottle is $17.99

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Related herbs

TCM Codonopsis Codonopsis pilosula TCM Astragalus Astragalus mongholicus (syn. A. membranaceus) TCM Atractylodes Atractylodes macrocephala (bai zhu); A. lancea (cang zhu) TCM Poria Wolfiporia cocos (syn. Poria cocos) TCM Pinellia Pinellia ternata

What people want to know

Is Panax ginseng the same as American ginseng?

No. Panax ginseng is Asian ginseng; American ginseng is Panax quinquefolius, which the Chinese tradition classes differently. The warfarin trial used American ginseng, while a case report involved Panax ginseng.

Does ginseng help with digestion?

The texts use it for a weak spleen and stomach with poor appetite and loose stools. We could not find a controlled trial of ginseng alone for a digestive symptom; the human data are on formulas such as rikkunshito, with mixed results.

What is rikkunshito?

It is the Kampo version of Liu Jun Zi Tang, containing ginseng, white atractylodes, poria, pinellia, tangerine peel, licorice, ginger and jujube. In a 247-person trial it showed 33.6% responders against 23.8% on placebo, not statistically significant.

What is the difference between white and red ginseng?

White ginseng is dried; red ginseng is steamed and then dried. The texts treat them as separate preparations with different uses. We could not find a trial that compared the two for a gut outcome.

Does ginseng interact with blood thinners?

A randomized trial in 20 healthy volunteers found American ginseng lowered warfarin’s effect on INR. The NCCIH says ginseng might interfere with blood clotting and advises talking with a provider before combining it with any medicine.

Sources