Ginseng

Ginseng usually refers to ginseng radix (panax ginseng) is the root of the plants in the genus "Panax", subspecies coming from Appalachia, South China, and Korea and has been used in traditional medicine for centuries. It is commonly used for general fatigue and weakness. Traditional Chinese medicine uses it as a muscle relaxant and a tonic for patients with chronic illnesses.

There are many different types of ginseng, with several types of ginseng coming from a number of different plants. Siberian ginseng has the most evidence to help improve fatigue and weakness in the short term.

American
Panax quincefolius is commonly known as American ginseng, and is found in Canada and the US. Typical doses uses in trials for cancer-related fatigue and fatigue from multiple sclerosis were 750 - 2000mg, for up to six months. Most studies found American ginseng moderately effective for fatigue, particularly when used at higher doses or for six months.

Panax radix
Asian, Chinese and Korean ginseng terms all refer to panax radix, which is also found in Russia. Panax radix is adaptogenic, and was found to be moderately effective in most trials for cancer-related fatigue or fatigue caused by multiple sclerosis, particularly when used for around six months or in doses of course to 2000mg. Doses used in the trials are typically between 800 - 2000mg.

Siberian
Siberian ginseng refers to a different but related plant, known as eleutherococcus, which has different properties.

White and Red
Ginseng may be described as white or red depending on the method used to prepare or process it, typically these are a form of ginseng radix (Chinese ginseng).

Ginsenosides
Ginsenosides is a name that refers to the bioactive components of ginseng.

The three types of ginsenosides are:
 * Oleanolic acid type, also known as oleanic acid, caryophyllin, astrantiagenin C or giganteumgenin C
 * Protopanaxadiol (PPD) type, also known as protopanaxdiol, (20R)-Protopanaxdiol, (20R)-Protopanaxadiol or 24-Dammarene-3beta,12beta-20S-triol and
 * Protopanaxatriol (PPT) type

ME/CFS
There is a lack of evidence about the benefits or risks of ginseng in patients with ME/CFS; a recent systematic review found that clinical trials have assessed only the effects of ginseng on fatigue caused by other illnesses, including fibromyalgia, multiple sclerosis, and cancer-related fatigue, or have assessed only the symptom of fatigue in people with idiopathic chronic fatigue, some of whom may have also had ME/CFS. The effect of ginseng on symptoms of ME/CFS other than fatigue are not known due to the absence of clinical trials as a treatment for ME/CFS.

Risks and side effects
There is a lack of information from clinical trials, but it is generally regarded as safe for adult use by the European Medicines Agency, which describes possible risks and side effects.

Ginseng can also cause a hypersensitivity reaction or anaphylaxis in some people. Interactions with other drugs are likely unknown.

Ginseng abuse syndrome causes hypertension, diarrhea, insomnia, mastalgia, skin rashes, confusion, and depression. A very small number of cases of new onset acute manic episodes subsequent have been reported after usage of high doses.

Costs and availability
Asian and American ginseng supplements are readily available over the counter, with American ginseng being significantly cheaper.

Notable studies

 * 2003, Antifatigue Effects of Panax ginseng C.A. Meyer: A Randomised, Double-Blind, Placebo-Controlled Trial - (Full text)
 * 2004, Randomized controlled trial of Siberian ginseng for chronic fatigue (Full text)
 * 2018, Ginseng as a Treatment for Fatigue: A Systematic Review - (Full text)

Learn more

 * Ginseng - European Medicines Agency
 * Ginseng - Meyer's Side Effects of Drugs
 * Ginseng - drugs.com