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Ginseng

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Ginseng
Panax quinquefolius foliage and fruit
Scientific classification
Kingdom:
Plantae
(unranked):
Angiosperms
(unranked):
Eudicots
(unranked):
Asterids
Order:
Apiales
Family:
Araliaceae
Subfamily:
Aralioideae
Genus:
Panax

Species

Subgenus Panax

Section Panax
Series Notoginseng
Panax notoginseng
Series Panax
Panax bipinnatifidus
Panax ginseng
Panax japonicus
Panax quinquefolius
Panax vietnamensis
Panax wangianus
Panax zingiberensis
Section Pseudoginseng
Panax pseudoginseng
Panax stipuleanatus

Subgenus Trifolius

Panax trifolius
Ginseng (generic term)
Chinese name
Traditional Chinese人蔘 or 人參
Simplified Chinese人参
Transcriptions
Standard Mandarin
Hanyu Pinyinrén shēn
Bopomofoㄖㄣˊ ㄙㄣ
Wu
Romanizationzen平 sen平
Hakka
Romanizationngin11 sem24
Yue: Cantonese
Jyutpingjan4sam1
Southern Min
Hokkien POJjîn-sim; lîn-sim
Vietnamese name
Vietnamese alphabetNhân Sâm
Korean name
Hangul인삼
Hanja人蔘
Transcriptions
Revised Romanizationin-sam
McCune–Reischauerin sam
Japanese name
Kanji朝鮮人参
Kanaちょうせんにんじん
Transcriptions
Romanizationchōsen ninjin
Ginseng species
Chinese name
Traditional Chinese人蔘屬
Simplified Chinese人参属
Transcriptions
Standard Mandarin
Hanyu Pinyinrén sēn shǔ
Bopomofoㄖㄣˊ ㄙㄣ ㄕㄨˇ
Wu
Romanizationzen平 sen平 tsoh入
Hakka
Romanizationngin11 sem24 sug5
Yue: Cantonese
Jyutpingjan4sam1suk6
Southern Min
Hokkien POJjîn-sim-sio̍k
Korean name
Hangul인삼속
Hanja人蔘屬
Transcriptions
Revised Romanizationin-sam-sok
McCune–Reischauerin sam sok
Japanese name
Kanjiトチバニンジン属
Transcriptions
Romanizationtochibaninjin zoku
Ginseng field in Wisconsin
Ginseng hand cream from North Korea

Ginseng (pronounced /ˈdʒɪnsɛŋ/[1]) is any one of eleven species of slow-growing perennial plants with fleshy roots, belonging to the genus Panax of the family Araliaceae.

Ginseng is found only in the Northern Hemisphere, in North America and in eastern Asia (mostly Korea, northern China (Manchuria), and eastern Siberia), typically in cooler climates. Panax vietnamensis, discovered in Vietnam, is the southernmost ginseng known. This article focuses on the Series Panax ginsengs, which are the adaptogenic herbs, principally Panax ginseng and P. quinquefolius. Ginseng is characterized by the presence of ginsenosides.

Siberian Ginseng (Eleutherococcus senticosus) is in the same family, but not genus, as true Ginseng. Like Ginseng, it is considered to be an adaptogenic herb. The active compounds in Siberian Ginseng are eleutherosides, not ginsenosides. Instead of a fleshy root, Siberian Ginseng has a woody root and is well known for putting lead in your pencil, (see below).

Etymology

The English word ginseng derives from the Chinese term rénshēn (simplified: 人参; traditional: 人蔘), literally "man root" (referring to the root's characteristic forked shape, resembling the legs of a man). The English pronunciation derives from a southern Chinese reading, similar to Cantonese jên shên (Jyutping: jan4sam1) and the Hokkien pronunciation "jîn-sim".

The botanical/genus name Panax means "all-heal" in Greek, sharing the same origin as "panacea", and was applied to this genus because Linnaeus was aware of its wide use in Chinese medicine as a muscle relaxant.

Besides Panax ginseng, there are many other plants which are also known as or mistaken for the ginseng root. The most commonly known examples are Xiyangshen, also known as American Ginseng 西洋参 (Panax quinquefolius), Japanese ginseng 东洋参 (Panax japonicus), crown prince ginseng 太子參 (Pseudostellaria heterophylla), and Siberian ginseng 刺五加 (Eleutherococcus senticosus). Although all have the name ginseng, each plant has distinctively different functions. However, true ginseng plants belong to the Panax genus.[2]

Traditional uses

Both American ginseng (Panax quinquefolius) and Asian ginseng (Panax ginseng) roots are taken orally as adaptogens, aphrodisiacs, nourishing stimulants,[citation needed] and in the treatment of type II diabetes, as well as for sexual dysfunction in men. The root is most often available in dried form, either whole or sliced. Ginseng leaf, although not as highly prized, is sometimes also used; as with the root, it is most often available in dried form.

This ingredient may also be found in some energy drinks, often the "tea" varieties; in these products, ginseng is usually present in subclinical doses and does not have measurable medicinal effects.[3][citation needed] It can be found in cosmetic preparations as well, but has not been shown to have clinically effective results.

Modern science and ginseng

Ginsenosides are the active compounds that distinguish the Panax species. However, even though the root of the ginseng plant is the most valued form, it is the leaves that contain the highest amounts of ginsenosides. Therefore, the measure of potency and purity for ginseng products by the levels of ginsenosides is a poor determinant. There are many manufacturers of ginseng products who, knowingly or unknowingly, actually use counterfeit products or ginseng leaves instead of roots. Herbal companies who follow Good Manufacturing Practices (GMP) regularly test for the quality, potency, and species authentication of herbs using cross-sectional microscopic examination, thin layer chromatography, and high performance liquid chromatography (HPLC). One study found HPLC is especially useful in the differentiation and authentication of Panax ginseng from Panax quinquefolius due to the unambiguous distinction of slightly varying isotypes of ginsenoside compounds.[4]

Ginseng is noted for being an adaptogen, one which can, to a certain extent, be supported with reference to its anticarcinogenic and antioxidant properties.[5] Some animal experiments to determine whether longevity and health were increased in the presence of stress gave negative results.[6]

Many studies have been done with varying results using only ginseng extracts. However, when ginseng is used in combination with other traditional Chinese herbs, the synergistic effects had many more definitive and positive results. For example, Si Jun Zi Tang, a traditional Chinese formula, the main ingredient of which is ginseng, has been shown in multiple studies to have radioprotective effects, preventing a decrease in the hematocrit during radiotherapy.[7][8]

In research, it has been difficult to either verify or quantify the exact medicinal benefits of ginseng using science, as there are contradictory results from different studies, possibly due to the wide variety and quality of ginseng used in the tests. High-quality studies of the effects of ginseng in the United States are rare.[9] However, many high-quality, double blind, randomized controlled trials have been done in Asian countries, such as China, Taiwan and Japan.

American ginseng (Panax quinquefolius), similar to Panax ginseng in that they both contain the active component ginsenoside, is distinguished in traditional Chinese medicine theory by having a cold property while the property of ginseng is warm. Japanese ginseng, though the same species as ginseng, is thought to have cooling properties similar to American ginseng due to the difference in cultivation environment. (cite M5050) American ginseng has been shown in various studies to have a beneficial effect for diabetes in the regulation of blood sugar levels.[10]

A comparative, randomized and double-blind study at the National Autonomous University of Mexico indicated it may be "a promising dietary supplement" when assessed for an increase in quality of life.[11]

A randomized, double-blind study showed that an extract of American ginseng reduced influenza cases in the elderly when compared to placebo.[9]

A recent study at the University of Hong Kong has identified ginseng to have anti-inflammatory effects. The study found of the nine ginsenosides they identified, seven could selectively inhibit expression of the inflammatory gene CXCL-10. [citation needed]

P. ginseng appear to inhibit some characteristics associated with cancer in animal models; nevertheless, this effect is unclear in humans.[12] A randomized, double-blind pilot study noted Ginseng appeared to reduce fatigue in cancer patients.[13]

There are references in literature, including authoritative compendia, that show interactions with ginseng. Herbalist Jonathan Treasure of the British National Institute of Medical Herbalists traces the growth of misinformation on an alleged adverse herb-drug interaction between the monoamine oxidase inhibitor phenelzine and Asian ginseng (P. ginseng C.A. Meyer). This originally was mentioned in a 1985 editorial by Shader and Greenblatt in the Journal of Clinical Psychopharmacology. Shader and Greenblatt devoted a couple of lines to the case of a 64-year-old woman who took an undisclosed dose for an undisclosed time of a dietary supplement product called "Natrol High" while concurrently taking phenelzine 60 mg qd. She experienced symptoms of "insomnia, headache, and tremulousness". Treasure contacted Natrol by e-mail and discovered within ten minutes that there was no P. ginseng in the formula, but instead Eleutherococcus senticosus which was then called by the popular name "Siberian ginseng", and it was given in a subclinical dosage mixed with a variety of other herbs. The purported interaction effects are well-known side effects of phenelzine alone, which had been given in a high dosage and are not at all suggestive of Eleutherococcus. However, this misinformed article with a misidentified herb has been picked up in literature searches and megastudies, and is now documented by conventional medical authorities, such as Stockley’s, and is repeated in several botanical monographs, e.g. World Health Organization (WHO 1999).[14][15][16]

Ginseng and reproductive activity

A 2002 study by the Southern Illinois University School of Medicine (published in the annals of the New York Academy of Sciences) found that in laboratory animals, both Asian and American forms of ginseng enhance libido and copulatory performance. These effects of ginseng may not be due to changes in hormone secretion, but to direct effects of ginseng or its ginsenoside components on the central nervous system and gonadal tissues.[17][18] In males, ginsenosides can facilitate penile erection.[19] This is consistent with traditional Chinese medicine and Korean medicine medicinal uses of ginseng.

Ginseng is known to contain phytoestrogens.[20][21][22] In some studies, ginseng has been demonstrated to have a stimulating effect on the pituitary gland to increase the secretion of gonadotropins. Another study found that in young mice, it speeds up the development of reproductive organs, while in adult male mice, it stimulates the production of sperm, and lengthens the estrus period in female mice.[2]

Side effects

According to a Sports Nutrition FAQ published by UMass Amherst, one of P. ginseng's most common side effects is the inability to sleep.[23] However, other sources state ginseng causes no sleep difficulties.[24] Other side effects can include nausea, diarrhea, headaches, nose bleeds,[25] high blood pressure, low blood pressure, and breast pain.[26] Ginseng may also lead to induction of mania in depressed patients who mix it with antidepressants.[27]

Overdose

The common adaptogen ginsengs (P. ginseng and P. quinquefolia) are generally considered to be relatively safe even in large amounts. One of the most common and characteristic symptoms of acute overdose of Panax ginseng is bleeding. Symptoms of mild overdose with Panax ginseng may include dry mouth and lips, excitation, fidgeting, irritability, tremor, palpitations, blurred vision, headache, insomnia, increased body temperature, increased blood pressure, edema, decreased appetite, increased sexual desire, dizziness, itching, eczema, early morning diarrhea, bleeding, and fatigue.[2]

Symptoms of gross overdose with Panax ginseng may include nausea, vomiting, irritability, restlessness, urinary and bowel incontinence, fever, increased blood pressure, increased respiration, decreased sensitivity and reaction to light, decreased heart rate, cyanotic facial complexion, red face, seizures, convulsions, and delirium.[2]

It is possible to treat an overdose with an herbal decoction of 120 grams of gan cao (Radix glycrrhizae). However, patients experiencing any of the above symptoms are advised to discontinue the herbs and seek any necessary symptomatic treatment.[2]

Common classification

Ginseng roots in a market in Seoul, 2003

P. quinquefolius American ginseng (root)

According to traditional Chinese medicine, American ginseng promotes yin energy, cleans excess yang and calms the body. The reason it has been claimed that American ginseng promotes yin (shadow, cold, negative, female) while Asian ginseng promotes yang (sunshine, hot, positive, male) is because, according to traditional Chinese medicine, things living in cold places or northern side of mountains or southern side of rivers are strong in yang and vice versa, so that the two are balanced.[citation needed] Chinese/Korean ginseng grows in Manchuria and Korea, the coldest area known to many Koreans in ancient times. Thus, ginseng from there is supposed to be very yang.

Originally, American ginseng was imported into China via subtropical Guangzhou, the seaport next to Hong Kong, so Chinese doctors believed American ginseng must be good for yin, because it came from a hot area. They did not know, however, that American ginseng can only grow in temperate regions. Nonetheless, the root is legitimately classified as more yin because it generates fluids.[28]

The two main components of ginseng are claimed to be in different proportions in the Asian and American varieties, and are speculated to be the cause of the excitatory versus tonic natures.[29] The ginseng is traditionally hewn and a few slices are simmered in hot water to make a decoction.

Most North American ginseng is produced in the Canadian provinces of Ontario and British Columbia and the American state of Wisconsin, according to Agri-food Canada. P. quinquefolius is now also grown in northern China.

The aromatic root resembles a small parsnip that forks as it matures. The plant grows 6 to 18 inches tall, usually bearing three leaves, each with three to five leaflets two to five inches long.

Panax ginseng Asian ginseng (root)

Ginseng and reishi mushrooms in bottles being sold in Seoul, Korea.

Panax ginseng is available in four forms:

  1. The form called fresh ginseng is the raw product.
  2. The form called white ginseng (WG) is fresh ginseng which has been dried. It is grown for four to six years, and then peeled and dried to reduce the water content to 12% or less. White ginseng is air dried in the sun and may contain less of the therapeutic constituents. It is thought by some that enzymes contained in the root break down these constituents in the process of drying. Drying in the sun bleaches the root to a yellowish-white color.
  3. The form called red ginseng (RG) is harvested after six years, is not peeled and is steam-cured at standard boiling temperatures of 100 °C (212 °F), thereby giving it a glossy reddish-brown color. Steaming the root is thought to change its biochemical composition and also to prevent the breakdown of the active ingredients. The roots are then dried. RG is more common as herbal medicine than WG, and there is increasing research on the pharmacological activities of RG specific ginsenoside.
  4. The form called sun ginseng (SG) is created from a heat processing method which increases ginsenoside components such as ginsenoside-[Rg.sub.3], -[Rk.sub.1] and -[Rg.sub.5] by steaming white ginseng at a higher temperature than red ginseng. The herb is steamed for three hours at 120 °C (248 °F). Research has shown that SG has increased nitric oxide, superoxide, hydroxyl radical and peroxynitrite scavenging activities compared with conventionally processed RG or WG. The increased steaming temperature produces an optimal amount of biological activity due to its ability to amplify specific ginsenosides. Japanese researchers set out to investigate the antioxidant effect of SG on oxidative stress.

Red ginseng

Red ginseng

Red ginseng (Korean:홍삼 (hong-sam), simplified Chinese: 红参; traditional Chinese: 紅蔘), is Panax ginseng that has been heated, either through steaming or sun-drying. It is frequently marinated in an herbal brew which results in the root becoming extremely brittle. This version of ginseng is traditionally associated with stimulating sexual function and increasing energy. Red ginseng is always produced from cultivated roots, generally from Korea.

In 2002, a preliminary double-blind, crossover study of Korean red ginseng's effects on impotence reported that it can be an effective alternative for treating male erectile dysfunction.[30]

Another study reported red ginseng reduced the relapse of gastric cancer versus control.[31]

A study of ginseng's effects on rats found that while both white ginseng and red ginseng appear to reduce the incidence of cancer, the effects appear to be greater with red ginseng.[32]

A study by Sung H, Jung YS, Cho YK. showed potentially beneficial effects of a combination of Korean red ginseng and highly active antiretroviral therapy in HIV-1-infected patients.[33]

Falcarinol, a seventeen-carbon diyne fatty alcohol was isolated from carrot and red ginseng, and was thought to have potent anticancer properties on primary mammary epithelial (breast cancer) cells.[34] Other acetylenic fatty alcohols in ginseng (panaxacol, panaxydol and panaxytriol) have antibiotic properties.[35]

Wild ginseng

Harvested ginseng in Germany.

Wild ginseng is that which grows naturally and is harvested from wherever it is found to be growing. Wild ginseng is relatively rare, and even increasingly endangered, due in large part to high demand for the product in recent years, which has led to the wild plants being sought out and harvested faster than new ones can grow (it requires years for a root to reach maturity). Wild ginseng can be either Asian or American, and can be processed to be red ginseng.

There are woods-grown American ginseng programs in Maine, Tennessee, Virginia, North Carolina, West Virginia and Kentucky,[36][37] and United Plant Savers has been encouraging the woods planting of ginseng both to restore natural habitats and to remove pressure from any remaining wild ginseng, and they offer both advice and sources of rootlets. Woods-grown plants have a value comparable to wild-grown ginseng of similar age.

Ginseng alternatives

These mostly adaptogenic plants are sometimes referred to as ginsengs, but they are either from a different family or genus. Only jiaogulan actually contains compounds closely related to ginsenosides, although ginsenosides alone do not determine the effectiveness of ginseng. Since each of these plants has different uses, one should research their properties before using.[38]

Other plants which are referred to as ginsengs may not be adaptogens (although notoginseng is in the genus Panax):

See also

References

  1. ^ "ginseng". Cambridge Dictionaries Online. Retrieved 2011-06-04.
  2. ^ a b c d e Chinese Medical Herbology and Pharmacology, by John K. Chen, Tina T. Chen
  3. ^ "Safety issues associated with commercially available energy drinks". {{cite journal}}: Cite journal requires |journal= (help)
  4. ^ T. W. D. Chan,, P. P. H. But,, S. W. Cheng,, I. M. Y. Kwok,, F. W. Lau, and, H. X. Xu, 2000, “Differentiation and Authentication of Panax ginseng, Panax quinquefolius, and Ginseng Products by Using HPCL/MS” Analytical Chemistry,72 (10), 2329-2329
  5. ^ Davydov M, Krikorian AD. (2000). "Eleutherococcus senticosus (Rupr. & Maxim.) Maxim. (Araliaceae) as an adaptogen: a closer look". Journal of Ethnopharmacology. 72 (3): 345–393. doi:10.1016/S0378-8741(00)00181-1. PMID 10996277. {{cite journal}}: Unknown parameter |month= ignored (help)
  6. ^ Lewis WH, Zenger VE, Lynch RG. (1983). "No adaptogen response of mice to ginseng and Eleutherococcus infusions". Journal of Ethnopharmacology. 8 (2): 209–214. doi:10.1016/0378-8741(83)90054-5. PMID 6685799. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  7. ^ Hae June Lee, Se Ra Kim, Jong Choon Kim, Chang Mo Kang, Yun Sil Lee, Sung Kee Jo, Tae Hwan Kim, Jong Sik Jang, Seung Yeol Nah, Sung Ho Kim, 2006, "In Vivo radioprotective effect of Panax ginseng C.A. Meyer and identification of active ginsenosides." Phytotherapy Research, 20:5; 392-395.
  8. ^ Hsu H.-Y., Yang J.-J., Lian S.-L., Ho Y.-H., Lin C.-C. 1996, “Recovery of the hematopoietic system by Si-Jun-Zi-Tang in whole body irradiated mice.” Journal of Ethnopharmacology, 54 (2-3), pp. 69-75.
  9. ^ a b McElhaney JE; et al. (2004). "A placebo-controlled trial of a proprietary extract of North American Ginseng (CVT-E002) to prevent acute respiratory illness in institutionalized older adults". J Am Geriatr Soc. 52 (1): 13–19. doi:10.1111/j.1532-5415.2004.52004.x. PMID 14687309. {{cite journal}}: Explicit use of et al. in: |author= (help)
  10. ^ Vladimir Vuksan, PhD; John L. Sievenpiper, BASc; Vernon Y. Y. Koo, MSc; Thomas Francis, PhD; Uljana Beljan-Zdravkovic, MD, MSc; Zheng Xu, MD; Edward Vidgen, BSc, 2000, Arch Intern Med, 160:1009-1013.
  11. ^ Caso Marasco A, Vargas Ruiz R, Salas Villagomez A, Begona Infante C. (1996). "Double-blind study of a multivitamin complex supplemented with ginseng extract". Drugs Exp Clin Res. 22 (6): 323–329.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ^ Shin HR, Kim JY, Yun TK, Morgan G, Vainio H (2000). "The cancer-preventive potential of Panax ginseng: a review of human and experimental evidence". Cancer Causes Control. 11 (6): 565–576. doi:10.1023/A:. PMID 10880039.{{cite journal}}: CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
  13. ^ Barton, DL; Soori, GS; Bauer, BA; Sloan, JA; Johnson, PA; Figueras, C; Duane, S; Mattar, B; Liu, H (2010). "Pilot study of Panax quinquefolius (American ginseng) to improve cancer-related fatigue: a randomized, double-blind, dose-finding evaluation: NCCTG trial N03CA". Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 18 (2): 179–87. doi:10.1007/s00520-009-0642-2. PMID 19415341.
  14. ^ [1] Treasure, Jonathan. Medline & The Mainstream Manufacture of Misinformation 2006
  15. ^ Stockley, IH (2002), Stockley's Drug Interactions. 6th ed. London: Pharmaceutical Press.
  16. ^ WHO (1999), "Radix Ginseng", in,WHO Monographs on Selected Medicinal Plants, Geneva: World Health Organization, 168-182.
  17. ^ Hong B; Ji YH; Hong JH; Nam KY; Ahn TY A double-blind crossover study evaluating the efficacy of korean red ginseng in patients with erectile dysfunction: a preliminary report. J Urol. 2002; 168(5):2070-3 (ISSN: )Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
  18. ^ Murphy and Lee Ginseng, sex behavior, and nitric oxide, Ann N Y Acad Sci. 2002 May;962:372-7 PMID
  19. ^ de Andrade E; de Mesquita AA; Claro Jde A; de Andrade PM; Ortiz V; Paranhos M; Srougi M Study of the efficacy of Korean Red Ginseng in the treatment of erectile dysfunction. Sector of Sexual Medicine, Division of Urological Clinic of Sao Paulo University, Sao Paulo, Brazil.
  20. ^ Lee, YJ; Jin, YR; Lim, WC; Park, WK; Cho, JY; Jang, S; Lee, SK (2003). "Ginsenoside-Rb1 acts as a weak phytoestrogen in MCF-7 human breast cancer cells". Archives of pharmacal research. 26 (1): 58–63. doi:10.1007/BF03179933. PMID 12568360. {{cite journal}}: Cite has empty unknown parameters: |month= and |coauthors= (help)
  21. ^ Chan, RY; Chen, WF; Dong, A; Guo, D; Wong, MS (2002). "Estrogen-like activity of ginsenoside Rg1 derived from Panax notoginseng". The Journal of clinical endocrinology and metabolism. 87 (8): 3691–5. doi:10.1210/jc.87.8.3691. PMID 12161497. {{cite journal}}: Cite has empty unknown parameters: |month= and |coauthors= (help)
  22. ^ Lee, Y; Jin, Y; Lim, W; Ji, S; Choi, S; Jang, S; Lee, S (2003). "A ginsenoside-Rh1, a component of ginseng saponin, activates estrogen receptor in human breast carcinoma MCF-7 cells". The Journal of steroid biochemistry and molecular biology. 84 (4): 463–8. doi:10.1016/S0960-0760(03)00067-0. PMID 12732291. {{cite journal}}: Cite has empty unknown parameters: |month= and |coauthors= (help)
  23. ^ http://www.umass.edu/cnshp/faq.html
  24. ^ "The Ginseng Book." Stephen Fulder, PhD
  25. ^ Ginseng definition - Medical Dictionary definitions of some medical terms defined on MedTerms
  26. ^ http://www.aafp.org/afp/20031015/1539.html
  27. ^ Fugh-Berman, Adriane (2000). "Herb-drug interactions". The Lancet. 355 (9198): 134–138. doi:10.1016/S0140-6736(99)06457-0. PMID 10675182.
  28. ^ Chinese Herbal Medicine: Materia Medica, Third Edition by Dan Bensky, Steven Clavey, Erich Stoger, and Andrew Gamble 2004
  29. ^ Ginsenoside#Mechanism of action
  30. ^ Hong B, Ji YH, Hong JH, Nam KY, Ahn TY. (2002). "A double-blind crossover study evaluating the efficacy of Korean red ginseng in patients with erectile dysfunction: a preliminary report". Journal of Urology. 168 (5): 20–21. doi:10.1016/S0022-5347(05)64298-X. PMID 12394711.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  31. ^ Suh SO, Kroh M, Kim NR, Joh YG, Cho MY. (2002). "Effects of red ginseng upon postoperative immunity and survival in patients with stage III gastric cancer". American Journal of Chinese Medicine. 30 (4): 483–94. doi:10.1142/S0192415X02000661.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  32. ^ Yun TK, Lee YS, Lee YH, Kim SI, Yun HY (2001). "Anticarcinogenic effect of Panax ginseng C.A. Meyer and identification of active compounds". Journal of Korean Medical Science. 16 (S): 6–18.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  33. ^ Sung, Heungsup (2009). "Beneficial Effects of a Combination of Korean Red Ginseng and Highly Active Antiretroviral Therapy in HIV-1-Infected Patients". Clin. Vaccine Immunol. 16 (8): 1127–31. doi:10.1128/CVI.00013-09. PMC 2725544. PMID 19535541. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  34. ^ fatty alcohols and aldehydes
  35. ^ fatty alcohols and aldehydes
  36. ^ state.tn.us TDEC: DNH: Ginseng Program]
  37. ^ Care and Planting of Ginseng Seed and Roots
  38. ^ Winston, David (2007). Adaptogens: Herbs for Strength, Stamina, and Stress Relief. Healing Arts Press. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
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