Written by Markus Horneber and the CAM-Cancer Consortium.
Updated October 20, 2014

Ginseng in the management of cancer

What is it?

Description and names

Herbal drugs called "Ginseng" are derived from roots of different species of the genus Panax (C. Lin­naeus) which belong to the Araliaceae plant family. Scientific names are Panax ginseng C.A. Meyer and Panax quinquefolius L.

This summary is restricted to Korean or Asian ginseng (Panax ginseng) and American ginseng (Panax quinquefolius). Other commonly used Panax species are P. japonicus, P. notoginseng and P. vietnamensis. Not every plant termed as ginseng does really belong to the genus Panax. In collo­quial terms plants of other genera such as, for instance, Eleutherococcus senticosus and Pfaffia paniculata are also labelled as “Siberian ginseng” and “Brazilian ginseng” respectively. As a result of a farm bill passed by the US Cong­ress, the FDA ruled that the term "ginseng" could only be associated with the genus Panax.


Roots from P. ginseng and P. quinquefolius (for the purpose of this summary called "gin­seng") are commercially produced mainly by cultivation and contain ginse­nosi­des, polysac­charides, fatty acids, vitamins, essential oils, trace elements and amino acids.[1]

Ginsenosides are the putative main active compounds and are nearly exclusively found in Panax spe­cies. The content of ginsenosides is seen as a measurement of the quality of a gin­seng root. Preferably, the plant is harvested once at 4-7 years old and all parts of the root (primary root, lateral roots and rootlets including their peel) are processed. Ginsenosides are bitter-tasting, surface active steroid glycosides which comprise of a sugar part and a triter­pene part the so-called aglycone. The major agly­cones are protopanaxadiol and proto­panaxatriol, both tetracyclic triterpenes from the dammarane-type. Ginsenosides are la­beled with letters and index numbers according to chromatography and there are seven major ginsenosides present inP. ginseng the protopanaxatriols (Rg1, Re, and Rf) and the protopanaxadiols (Rb1, Rc, Rb2, and Rd)P. quinquefolius contains the same ginse­nosides, with the exception of Rf.[2]

The type and content of ginsenosides are indicative of the species and, depending on the part of the root, the age of the plant and the manufacturing process (e.g. red or white gin­seng), can vary considerably.[3] The terms red or white ginseng are not taxonomic refe­rences but indicate how the ginseng roots had been treated (steamed = red; dried = white).

Ginsenosides are deglycosylated in the digestive tract and the aglycone part is me­tabolized. Resorp­tion and bioavailability of ginsenosides and their metabolites are low.[4]

Application and dosage

There are many types and grades of ginseng, depending on the origin, root maturity, parts of the root used, and methods of raw material preparation or processing. For medical pur­poses, primarily the crème-coloured roots (harvested at 4-7 years old) are used, mostly as capsules or tablets with dried powders or extracts for oral application.[5]

According to the German Commission E daily doses of 1-2 g of dried root with a mi­ni­mum content of 1.5% ginsenosides are recommended.[6]

In Asia, dosage recommendations are higher than in Europe, the Chinese pharma­co­peia for instance recommends 3-9 g root and thus a daily dosage of 45-136 mg gin­senosides. Ginseng is supposed to be consumed 1-2 times daily with plenty of liquid. It is recommended that its application is interrupted after 3 months for a certain period of time.

In two recent clinical trials with cancer patients, extracts from P. quinquefolius were orally applied with daily doses ranging from 400mg to 2000mg for periods from 8 to 12 weeks.[7;8]

History / providers

For thousands of years P. ginseng has been regarded in Asia as a panacea, promoting health and longevity.[3] At the beginning of the 18th century the Jesuit father Lafitau discov­ered P. quinquefolius just outside present day Montreal. The plant has been used for hun­dreds of years by Native Americans as a medicinal plant.[9] P. quinquefolius is mainly cultivated in some parts of Canada, in a number of states in the U.S., predominantly Wisconsin and New York, and now also in China. P. ginseng is mainly produced in South Ko­rea, with an annual production of more than 11 thousand tons.[1] Ginseng products which are advertised for healing pur­po­ses can be purchased almost anywhere, for instance, at chemists’, in health food stores, drug stores and over the Internet. Ginseng preparations differ in their composi­tion, preservative agents and binding agents.[1]

Claims of efficacy and alleged indications

Ginseng is claimed to be an adaptogen. The definition of plant adaptogens is based on em­pirical knowledge from traditional medicinal systems. In Traditional Chinese Medi­cine, gin­seng has been used for thousands of years for balancing what is referred to as the so-called “Yin-Yang” equilibrium. P. ginseng is supposed to act as a “warming” substance and thereby strengthen what is called “Yang”; whereas P. quin­que­folius is claimed to have a “cooling” effect and strengthens “Yin”.[10;11]

Today, adaptogens are defined as drugs enhancing the “state of non-specific resis­tance” in stress.[12] Medicinal uses of ginseng that are supported by clinical data include strengthening and invigoration in cases of fatigue and weakness as well as in states of re­duced performance and concentration, with some other studies researching treatment of cancer, cardiovascular disease, and diabetes.[13]

Mechanisms of action

The detailed mechanisms underlying the clinical effects of ginseng still need to be fully eluci­dated. Some of the effects possibly result from a modulation of the hypo­tha­lamus-pituitary axis or of the central monoamine neurotransmitter system.[14] Ginsenosides are known to exhibit several effects on the central nervous system in­cluding increased survival of neu­rons after different injuries.[15]

Other data suggest that the immunomodulatory activities of ginseng are responsible for its adaptogenic effects.[16]

The results of several trials with healthy subjects indicate that benefits in physical per­form­ance and exercise capacity through preparations from Panax species, namely P. ginseng, may include im­proved capacity of skeletal muscle to oxidize free fatty acids, reduced plasma IL-6, creatine phosphokinase, and cortisol levels.[17]

Findings from animal studies suggest antiangiogenic effects of ginsenoside Rg3.[18;19] Preparations from P. quinquefolius inhibited tumorigenesis in a mouse model of inflammation-associated colonic cancer. Those effects were thought to derive from ability of ginseng to downregulate EGFR and ErbB2 activation and Cox-2 expression.[20] Anti-inflammatory effects of ginsenosides seem to be mediated through the glucocor­ticoid receptor and through inhibitory effects on LPS-induced MAPK activa­tion.[21] Data from laboratory studies suggest that the ginsenoside Rg3 also has proliferation inhibit­ing effects on a human colon cancer cell line (HCT 116). The inhibition of ß-catenin, a protein which is overexpressed and mutated in many cancer cells, were dis­cussed as the putative underlying mechanism.[22] Current results suggest that protopanaxadiol, the aglycone part of Rg3 effectively suppresses signaling pathways which are known to be involved in several steps of the development and progression of cancer: the NF-κB, JNK and MAPK/ERK pathways.[23;24]

The hypoglycaemic effects of ginseng are thought to be caused by polypeptides and glycans via sti­mulation of hepatic glucose utilization, stimulation of insulin secretion and enhanced insulin receptor sensitivity.[25]

Prevalence of use

Ginseng is one of the most consumed plant products worldwide and in the United States, ginseng has been ranked as the fourth top-selling herbal remedy.[1,48] In a population-based cohort study with breast cancer patients shortly after diagnosis in Shanghai, 14% of women reported use of extracts from P. ginseng or P. quinquefolius at 6 months follow-up.[49]

Legal issues

The content of ginsenosides for the root according to the European Pharmaco­poeia has to be a mi­nimum of 0.40 per cent for the sum of ginsenosides Rg1 (C42H72O14,2H2O; Mr 837) and Rb1 (C54H92O23,3H2O; Mr 1163) (dried drug) and for the dry extract a minimum of 4.0 per cent of the sum of ginsenosides Rb1, Rb2, Rc, Rd, Re, Rf, Rg1 and Rg2, expressed as ginsenoside Rb1 (C54H92O23; Mr 1109).[26]

In Germany for in­stance, P. ginseng has been licensed as an over-the-counter (OTC) drug by the Fe­deral Institute for Pharma­ceuticals (Bundesinstitut für Arzneimittel, BfArm). For those OTC drugs licensed in Germany a minimum content of 1.5% ginsenosides is required.

Costs and expenditures

Costs vary depending on the quality of the ginseng. Daily costs for drugs licensed in Germany amount to approximately 1-3 Euros.

Citation Markus Horneber, CAM-Cancer Consortium. Ginseng (Panax ginseng, P. quinquefolium) [online document]. http://ws.cam-cancer.org/The-Summaries/Herbal-products/Ginseng-Panax-ginseng-P.-quinquefolium. October 20, 2014.


  1. Jia L, Zhao Y: Current evaluation of the millennium phytomedicine--ginseng (I): etymology, pharmacognosy, phytochemistry, market and regulations. Curr Med Chem 2009; 16(19):2475-2484.
  2. Christensen LP: Chapter 1 ginsenosides chemistry, biosynthesis, analysis, and potential health effects. Adv Food Nutr Res 2008; 55:1-99.
  3. Court WE: Ginseng - The genus panax. Amsterdam, Harwood Scientific Publishers, 2000.
  4. Hasegawa H: Proof of the Mysterious Efficacy of Ginseng: Basic and Clinical Trials: Metabolic Activation of Ginsenoside: Deglycosylation by Intestinal Bacteria and Esterification With Fatty Acid. J Pharmacol Sci 2004; 95(2):153-157.
  5. Sticher O: Saponine; in: Hänsel R, Sticher O, (eds): Pharmakognosie, Phytopharmazie. Heidel­berg, Springer  Verlag, 2009, pp 943-989.
  6. Monographie BGA/BfArM (Kommission E): Ginseng root (Ginseng radix). Bundesanzeiger 1991; 11(ATC-Code: N07XF).
  7. Barton DL, Liu H, Dakhil SR, Linquist B, Sloan JA, Nichols CR, McGinn TW, Stella PJ, Seeger GR, Sood A, Loprinzi CL: Wisconsin Ginseng (Panax quinquefolius) to Improve Cancer-Related Fatigue: A Randomized, Double-Blind Trial, N07C2. J Natl Cancer Inst 2013.
  8. High KP, Case D, Hurd D, Powell B, Lesser G, Falsey AR, Siegel R, Metzner-Sadurski J, Krauss JC, Chinnasami B, Sanders G, Rousey S, Shaw EG: A randomized, controlled trial of Panax quinquefolius extract (CVT-E002) to reduce respiratory infection in patients with chronic lymphocytic leukemia. J Support Oncol 2012; 10(5):195-20
  9. Fulder S: Book of Ginseng. Rochester, 1993.
  10. Jia L, Zhao Y, Liang XJ: Current Evaluation of the Millennium Phytomedicine- Ginseng (II): Collected Chemical Entities, Modern Pharmacology, and Clinical Applications Emanated from Traditional Chinese Medicine. Curr Med Chem 2009; 16(22):2924-2942.
  11. Kitts DD, Hu C: Efficacy and safety of ginseng. Public Health Nutr 2000; 3(4A):473-485.
  12. Panossian A, Wikman G, Wagner H: Plant adaptogens. III. Earlier and more recent aspects and concepts on their mode of action. Phytomedicine 1999; 6(4):287-300.
  13. WHO. WHO monographs on medicinal plants commonly use in the Newly Independent Sta­tes (NIS).  2010. Geneva, WHO Press.
  14. Rasheed N, Tyagi E, Ahmad A, Siripurapu KB, Lahiri S, Shukla R, Palit G: Involvement of monoamines and proinflammatory cytokines in mediating the anti-stress effects of Panax quinquefolium. J Ethnopharmacol 2008; 117(2):257-262.
  15. Radad K, Moldzio R, Rausch WD: Ginsenosides and their CNS targets. CNS Neurosci Ther 2011; 17(6):761-768.
  16. Panossian A, Wikman G: Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress-Protective Activity. Pharmaceuticals 2010; 3:188-224.
  17. Chen CK, Muhamad AS, Ooi FK: Herbs in exercise and sports. J Physiol Anthropol 2012; 31:4.
  18. Liu TG, Huang Y, Cui DD, Huang XB, Mao SH, Ji LL, Song HB, Yi C: Inhibitory effect of ginsenoside Rg3 combined with gemcitabine on angiogenesis and growth of lung cancer in mice. BMC Cancer 2009; 9:250.
  19. Zhang Q, Kang X, Yang B, Wang J, Yang F: Antiangiogenic effect of capecitabine combined with ginsenoside Rg3 on breast cancer in mice. Cancer Biother Radiopharm 2008; 23(5):647-653.
  20. Dougherty U, Mustafi R, Wang Y, Musch MW, Wang CZ, Konda VJ, Kulkarni A, Hart J, Dawson G, Kim KE, Yuan CS, Chang EB, Bissonnette M: American ginseng suppresses Western diet-promoted tumorigenesis in model of inflammation-associated colon cancer: role of EGFR. BMC Complement Altern Med 2011; 11:111.
  21. Du J, Cheng B, Zhu X, Ling C: Ginsenoside Rg1, a novel glucocorticoid receptor agonist of plant origin, maintains glucocorticoid efficacy with reduced side effects. J Immunol 2011; 187(2):942-950.
  22. He BC, Gao JL, Luo X, Luo J, Shen J, Wang L, Zhou Q, Wang YT, Luu HH, Haydon RC, Wang CZ, Du W, Yuan CS, He TC, Zhang BQ: Ginsenoside Rg3 inhibits colorectal tumor growth through the down-regulation of Wnt/ss-catenin signaling. Int J Oncol 2011; 38(2):437-445.
  23. Gao JL, Lv GY, He BC, Zhang BQ, Zhang H, Wang N, Wang CZ, Du W, Yuan CS, He TC: Ginseng saponin metabolite 20(S)-protopanaxadiol inhibits tumor growth by targeting multiple cancer signaling pathways. Oncol Rep 2013; 30(1):292-298.
  24. Wang CZ, Li B, Wen XD, Zhang Z, Yu C, Calway TD, He TC, Du W, Yuan CS: Paraptosis and NF-kappaB activation are associated with protopanaxadiol-induced cancer chemoprevention. BMC Complement Altern Med 2013; 13:2.
  25. Marles RJ, Farnsworth NR: Antidiabetic plants and their active constituents. Phytomedicine 1995; 2(2):137-189.
  26. European Pharmacopoeia Commission. Ginseng dry extract quantified. Monograph No.2356 13A/T (08) 81 ANP. 2010.
  27. Lu P, Su W, Miao ZH, Niu HR, Liu J, Hua QL: Effect and mechanism of ginsenoside Rg3 on posto­perative life span of patients with non-small cell lung cancer. Chin J Integr Med 2008; 14(1):33-36.
  28. Chen ZJ, Cheng J, Huang YP, Han SL, Liu NX, Zhu GB, Yao JG: [Effect of adjuvant chemotherapy of ginsenoside Rg3 combined with mitomycin C and tegafur in advanced gastric cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2007; 10(1):64-66.
  29. Huang JY, Sun Y, Fan QX, Zhang YQ: [Efficacy of Shenyi Capsule combined with gemcitabine plus cisplatin in treatment of advanced esophageal cancer: a randomized controlled trial]. Zhong Xi Yi Jie He Xue Bao 2009; 7(11):1047-1051.
  30. Barton DL, Soori GS, Bauer BA, Sloan JA, Johnson PA, Figueras C, Duane S, Mattar B, Liu H, Atherton PJ, Christensen B, Loprinzi CL: Pilot study of Panax quinquefolius (American gin­seng) to improve cancer-related fatigue: a randomized, double-blind, dose-finding evalua­tion: NCCTG trial N03CA. Support Care Cancer 2010; 18(2):179-187.
  31. Kim JH, Park CY, Lee SJ: Effects of sun ginseng on subjective quality of life in cancer patients: a double-blind, placebo-controlled pilot trial. J Clin Pharm Ther 2006; 31(4):331-334.
  32. Younus J, Collins A, Wang X, Saunders M, Manuel J, Freake C, Defen P. A double blind placebo controlled pilot study to evaluate the effect of ginseng on fatigue and quality of life in adult chemo-naïve cancer patients. Proc Am Soc Clin Oncol 22[2947]. 2003. 23-7-2008.
  33. Torbey E, Rafeh NA, Khoueiry G, Kowalski M, Bekheit S: Ginseng: a potential cause of long QT. J Electrocardiol 2010; 44(3):357-358.
  34. Chang YS, Seo EK, Gyllenhaal C, Block KI: Panax ginseng: a role in cancer therapy? Integr Can­cer Ther 2003; 2(1):13-33.
  35. Seely D, Dugoua JJ, Perri D, Mills E, Koren G: Safety and efficacy of panax ginseng during pregnancy and lactation. Can J Clin Pharmacol 2008; 15(1):e87-e94.
  36. Shin S, Jang JY, Park D, Yon JM, Baek IJ, Hwang BY, Nam SY, Yun YW, Kim KY, Joo SS, Kim YB: Korean red ginseng extract does not cause embryo-fetal death or abnormalities in mice. Birth Defects Res B Dev Reprod Toxicol 2010; 89(1):78-85.
  37. Toxicology and Carcinogenesis Studies of Ginseng (CAS No. 50647-08-0) in F344/N Rats and B6C3F1 Mice (Gavage Studies): Natl Toxicol Program Tech Rep Ser 2011;(564):1-150.
  38. Brown R: Potential interactions of herbal medicines with antipsychotics, antidepressants and hypnotics. Eur J Herbal Med 1997; 3:25-28.
  39. Wiklund IK, Mattsson LA, Lindgren R, Limoni C: Effects of a standardized ginseng extract on quality of life and physiological parameters in symptomatic postmenopausal women: a double-blind, placebo-controlled trial. Swedish Alternative Medicine Group. Int J Clin Pharmacol Res 1999; 19(3):89-99.
  40. Izzo AA, Ernst E: Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs 2009; 69(13):1777-1798.
  41. Goey AK, Mooiman KD, Beijnen JH, Schellens JH, Meijerman I: Relevance of in vitro and clini­cal data for predicting CYP3A4-mediated herb-drug interactions in cancer patients. Cancer Treat Rev 2013.
  42. Hermann R, von RO: Clinical evidence of herbal drugs as perpetrators of pharmacokinetic drug interactions. Planta Med 2012; 78(13):1458-1477.
  43. Malati CY, Robertson SM, Hunt JD, Chairez C, Alfaro RM, Kovacs JA, Penzak SR: Influence of Panax ginseng on cytochrome P450 (CYP)3A and P-glycoprotein (P-gp) activity in healthy participants. J Clin Pharmacol 2012; 52(6):932-939.
  44. Sheen E, Triadafilopoulos G: Adverse effects of long-term proton pump inhibitor therapy. Dig Dis Sci 2011; 56(4):931-950.
  45. Lee J, Lee E, Kim D, Lee J, Yoo J, Koh B: Studies on absorption, distribution and metabolism of ginseng in humans after oral administration. J Ethnopharmacol 2009; 122(1):143-148.
  46. Bilgi N, Bell K, Ananthakrishnan AN, Atallah E: Imatinib and Panax ginseng: a potential interac­tion resulting in liver toxicity. Ann Pharmacother 2010; 44(5):926-928.
  47. ConsumerLab.com. Product Review: Ginseng Supplements. https://www.consumerlab.com/reviews/Ginseng_Supplements/ginseng/ accessed: 26.07.2013.
  48. Ernst E (2004) Prescribing herbal medications appropriately. J Fam Pract 53: 985–988
  49. Cui Y et al. Association of ginseng use with survival and quality of life among breast cancer patients. Am J Epidemiol. 2006 Apr 1;163(7):645-53. Epub 2006 Feb 16
  50. Zhu J et al. Treat Non-small Cell Lung Cancer with Shenyi Capsule plus Chemotherapy:A Systematic Review. Journal of Liaoning University of Traditional Chinese Medicine 2009-09 (http://en.cnki.com.cn/Article_en/CJFDTOTAL-LNZY200909001.htm)
  51. Hu S et al. A Meta-analysis of Ginsenoside Rg3 for Non-small Cell Lung Cancer. Clin Oncol Cancer Res (2011) 8: 175–180 DOI 10.1007/s11805-011-0578-4