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Tradition

WARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
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Dosing

Adults (18 years and older)

Capsules containing 100-200 milligrams of a standardized ginseng extract (4% ginsenosides) taken by mouth once or twice daily has been used in studies for up to 12 weeks. 0.5 to 2 grams of dry ginseng root, taken daily by mouth in divided doses, has also been used. E. senticosus dry extract at a dose of 300 milligrams per day was used in a small study for eight weeks to improve quality of life in elderly patients. A proprietary ginseng root extract (Cold-FX, CV Technologies Inc., Edmonton, AB) has been studied in athletes for 28 days at a dose of 400 milligrams per day. Higher doses are sometimes given in studies or under the supervision of a qualified healthcare provider. Many different doses are used traditionally. Practitioners sometimes recommended that after using ginseng continuously for two to three weeks, people should take a break for one or two weeks, and that long-term dosing should not exceed 1 gram of dry root daily.

A decoction of 1 to 2 grams added to 150 milliliters of water, taken by mouth daily has been used; a 1:1 (grams per milliliter) fluid extract taken as 1 to 2 milliliters by mouth daily has been used; 5 to 10 milliliters (approximately 1 to 2 teaspoons) of a 1:5 (grams per milliliter) tincture taken by mouth daily has been used. Practitioners sometimes recommended that after using ginseng continuously for two to three weeks, people should take a break for one or two weeks.

Children (younger than 18 years)

There is not enough scientific information available to recommend the safe use of ginseng in children.

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

People with known allergy to plants in the Araliaceae family should avoid ginseng.

Side Effects and Warnings

Ginseng has been well tolerated by most people in scientific studies when used at recommended doses, and serious side effects appear to be rare.

Based on limited evidence, long-term use may be associated with skin rash or spots, itching, diarrhea, sore throat, loss of appetite, excitability, anxiety, depression, or insomnia. Less common reported side effects include headache, fever, dizziness/vertigo, blood pressure abnormalities (increases or decreases), chest pain, difficult menstruation, heart palpitations, rapid heart rate, leg swelling, nausea/vomiting, or manic episodes in people with bipolar disorder.

Based on human research, ginseng may lower blood sugar levels. This effect may be greater in patients with diabetes than in non-diabetic individuals. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary.

There are anecdotal reports of nosebleeds and vaginal bleeding with ginseng use, although scientific study is limited in this area. There is also evidence in humans of ginseng reducing the effectiveness of the "blood thinning" medication warfarin (Coumadin®). Caution is advised in patients with bleeding disorders or taking drugs that may affect the risk of bleeding or blood clotting. Dosing adjustments may be necessary. Several cases of severe drops in white blood cell counts were reported in people using a combination product containing ginseng in the 1970s, and may have been due to contamination.

Ginseng may have estrogen-like effects, and has been associated with reports of breast tenderness, loss of menstrual periods, vaginal bleeding after menopause, breast enlargement (reported in men), difficulty developing or maintaining an erection, or increased "sexual responsiveness." Avoid use of ginseng in patients with hormone sensitive conditions, such as breast cancer, uterine cancer, or endometriosis.

Ginseng may produce manic symptoms, based on a case report.

A severe life-threatening rash known as Stevens-Johnson syndrome occurred in one patient and may have been due to contaminants in a ginseng product. A case report describes liver damage (cholestatic hepatitis) after taking a combination product containing ginseng. High doses of ginseng have been associated with rare cases of temporary inflammation of blood vessels in the brain (cerebral arteritis), abnormal dilation of the pupils of the eye, confusion, or depression.

There is preliminary evidence that ginseng may increase the QTc interval (thus increasing the risk of abnormal heart rhythms) and decrease diastolic blood pressure two hours after ingestion in healthy adults.

Pregnancy and Breastfeeding

Ginseng has been used traditionally in pregnant and breastfeeding women. Animal studies and preliminary human research suggest possible safety, although safety has not been clearly established in humans. Therefore, ginseng use cannot be recommended during pregnancy or breastfeeding. There is a report of neonatal death and the development of male characteristics in a developing baby girl after exposure of a pregnant mother to ginseng.

Many tinctures contain high levels of alcohol and should be avoided during pregnancy.