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Panax: The ginseng abuse syndrome

by Paul Bergner

Medical Herbalism 2(3):1,4-5

Ginseng has been the subject of several articles identifying a “ginseng abuse syndrome” in people who take it for long periods of time. (Siegel; 1979, 1980a, 1980b). Although the scientific basis of the articles is poor, Chinese practitioners also note detrimental side effects to inappropriate ginseng use. Herbalists will serve their patients better by learning the appropriate use of and contraindications for ginseng, and learning to identify signs of its abuse.

The “syndrome” as reported in the Western studies includes elevated blood pressure, nervousness, insomnia, skin eruptions, and diarrhea. Several studies have also identified a side effect of breast tenderness. (Koreich; Palmer et al.) The studies have been criticized widely in both scientific literature and by herbalists. A recent German review article of the worldwide scientific literature concludes that no report of side effects for ginseng offered complete or controllable data. (Sonnenborn; 1990). The article concludes that the symptoms only seem to appear in countries where herbs are not controlled as to content and dosage, and that with appropriate informed use, ginseng is a safe medicine.

Siegel (1979) studied 133 ginseng users, and monitored them at intervals for two years. Ten percent experienced the syndrome, and 16% experienced elevated blood pressure. The study was subject to major scientific errors. Among them:

Siegel did not actually find what substance the subjects were using. (They used a wide variety of commercial products.) At least four different plant species are called “ginseng,” and adulterants are common in the U.S. marketplace. Siegel (1977) had earlier identified ginseng adulterants which cause some of the symptoms of the syndrome, but failed to mention this in the article.

All subjects who had the syndrome, and all who had elevated blood pressure, also consumed caffeine beverages. Although long term use of caffeine does not elevate the blood pressure (Smits et al; Robertson et al) it could be entirely responsible for the “nervousness” and “insomnia” portions of the syndrome. The syndrome might be more properly named the “ginseng-caffeine-abuse” syndrome, and ginseng users might be warned about interactions. Caffeine is contraindicated for the kind of deficiency states most appropriate for ginseng use. Siegel also did not define the extent of hypertension in the subjects. Did their blood pressure rise by a few points, or did it rise to a level which presented a risk to the health?

The scientific weakness in the basis of Siegel’s “ginseng abuse syndrome” does not mean that ginseng is appropriate for general public use, however, or that it will never have side effects.

Professor Yan Zheng-Hua, of the Department of Pharmacology at the Beijing College of Traditional Chinese Medicine says of the chi tonics of which ginseng is a member: “Incorrect use . . . is frequently harmful, and indiscriminate use of them is strictly prohibited.” (Zheng-Hua)

Overuse or inappropriate use can lead to headache, insomnia, heart palpitations and a rise in blood pressure, according to Chinese texts. It may affect the potency of insulin or cardiac glycosides, such as digitalis. (Bensky) Patients taking these medicines wishing to take ginseng should have a physician monitor and adjust their drug dosages. Russian researchers suggest that ginseng is not appropriate for healthy people under the age of 40. (Baranov) Ginseng should also be used with caution by those with asthma or emphysema. (Duke).

References

Baranov, AI: “Medicinal uses of ginseng and related plants in the Soviet Union: recent trends in the Soviet literature. J Ethnopharmacol 6:339, 1982.

Bensky,D; Gamble, A.:Chinese Herbal Medicine: Materia Medica. Eastland Press,1986

Duke, J Handbook of medicinal plants.

Koreich, OM. “Ginseng and mastalgia.” Brit med j. 1556 (1978)

Siegel, RK: “Kola, ginseng, and mislabeled drugs,” JAMA 237:24-25. (1977)

—————-. “Ginseng abuse syndrome—problems with the panacea.” JAMA 241:15, 1614-1615 (1979).

Palmer, BV; Montgomery, ACV;Montiero, JCMP. “Ginseng and mastalgia.” Brit med j 1284 (1978).

Robertson D, Holliste r A, Kincaid D, et al. “Caffeine and hypertension.” Am J Med 77(1):54-60, 1984.

Smits P et al Circulatory effects of coffee in relation to the pharmacodynamics of caffeine. Am J Cardiol. 56(15): 958-963, 1985

Sonnenborn, U; Proppert, Y. “Ginseng (Panax ginseng C.A. Meyer). Zeitschrift fur phytotherapy 11:35-49 (1990)