Эффективность женьшеня в медицине: доказательная база ограничена, а риски взаимодействий требуют внимания врачей

Ginseng has long been used as a medicinal plant, but evidence for its many claimed health benefits varies considerably. Clinicians should also be aware of potential drug interactions and safety concerns. Several plant species are marketed as “ginseng,” and Panax ginseng C.A. Meyer, also known as Asian or Korean ginseng, is the most important medicinal species. American ginseng (Panax quinquefolius) and Siberian ginseng (Eleutherococcus senticosus) are also available. However, Siberian ginseng does not belong to the genus Panax. This distinction is clinically relevant because findings from one species cannot necessarily be applied to another. The root is the part of the plant that is most often used for health purposes. White ginseng is dried after harvesting, whereas red ginseng is steamed or heated. The origin and age of the root, along with the processing and extraction methods, can substantially affect its active compounds. “Ginseng” therefore refers to a range of products rather than a single standardized medicinal preparation. Active Compounds and Pharmacologic Effects Ginsenosides are the main pharmacologically important compounds in ginseng. These saponins contain numerous individual substances. The root also contains polysaccharides, polyacetylenes, peptides, amino acids, flavonoids, and other compounds. Experimental studies have attributed the anti-inflammatory, antioxidant, immunomodulatory, neuroprotective, and metabolic effects of ginsenosides. The proposed mechanisms include effects on cytokines, oxidative stress, mitochondrial function, glucose metabolism, vascular endothelium, and several neurotransmitter systems. However, many of these findings have been obtained from cell culture or animal studies. Although they provide evidence of biologically plausible mechanisms, they do not establish a clinically relevant benefit in humans. In addition, the concentrations of individual ginsenosides can vary substantially depending on the starting material and manufacturing process. Therefore, results from studies of standardized extracts cannot necessarily be applied to commercially available dietary supplements. Fatigue A common claim is that ginseng increases alertness, improves performance, and reduces fatigue. For cancer-related fatigue (CRF), there is some evidence of its potential benefits. A systematic review and meta-analysis of randomized controlled trials found positive effects of ginseng on CRF, along with improvements in quality of life. However, these findings should be interpreted cautiously. The studies showed high variability because they differed substantially in their design, preparation, doses, cancer types, and treatment durations. Therefore, for individuals with CRF, a standardized ginseng preparation may provide a limited additional benefit when relevant contraindications and potential drug interactions have been considered. However, for nonspecific fatigue and everyday exhaustion, the evidence is considerably weaker than many promotional claims suggest. Physical Performance Ginseng has traditionally been used to improve physical performance and endurance. A meta-analysis found possible benefits for some measures of physical performance, but the authors emphasized the limited validity of the evidence available to date. Much of the evidence comes from preclinical studies, whereas human studies are often small, short-term, and vary widely in methodology. Therefore, individuals should not expect substantial improvement in physical performance. Ginseng is not a substitute for structured exercise, adequate sleep, a balanced diet, or treatment of an underlying medical cause of fatigue. Cognition Ginseng is also widely promoted as a “brain booster.” Systematic reviews and meta-analyses have found small positive effects in some cognitive domains, particularly memory. A 2024 meta-analysis reported a statistically significant but overall weak effect on several memory measures. A 2025 meta-analysis that included eight studies reached a similar conclusion, finding that ginseng may improve certain cognitive measures. However, the evidence remains limited. These studies used different preparations and assessed different outcomes, and many measured only the short-term effects. The evidence is therefore insufficient to recommend ginseng for the treatment of dementia or mild cognitive impairment or for the prevention of cognitive decline. Respiratory Infections “Boosting the immune system” is another common claim associated with ginseng. Studies have examined its effects on immune cells, cytokines, and the frequency of respiratory infections. A review found that some preparations may help prevent upper respiratory tract infections, although the evidence varies substantially between preparations. Recent randomized studies on Korean red ginseng have examined immune responses, including T and B cells, natural killer cells, and immunoglobulins. These findings suggest possible immunomodulatory effects, but changes in individual immune markers do not necessarily translate into clinically relevant benefits. Whether ginseng reduces infections, infection-related complications, or antibiotic use has not been convincingly established. Therefore, the current evidence is insufficient to recommend it for routine infection prevention. Glucose Metabolism Some individuals use ginseng to improve their blood glucose levels and insulin sensitivity. Systematic reviews and meta-analyses found moderate improvements in some measures, particularly fasting blood glucose and insulin resistance in some studies. However, these findings are inconsistent. The preparations, doses, study durations, and patient populations varied substantially, making the results difficult to compare. Current evidence is insufficient to recommend ginseng as a treatment for diabetes. Cardiometabolic Effects Ginseng has also been studied for potential effects on cardiovascular risk factors. Meta-analyses suggest possible benefits for individual parameters, including systolic blood pressure, total and low-density lipoprotein cholesterol, and inflammatory markers, such as C-reactive protein and interleukins. However, the observed effects were generally modest. Current evidence does not support the use of ginseng to treat hypertension, dyslipidemia, or cardiovascular disease. Ginseng should not replace standard antihypertensive, lipid-lowering, or cardioprotective treatment. Safety and Interactions Clinical studies generally suggest that ginseng is well tolerated in the short term. Reported side effects include insomnia, nervousness, headaches, gastrointestinal symptoms, changes in blood pressure, palpitations, and skin reactions. Long-term safety is less well established, particularly in individuals with multiple chronic conditions or those taking several medications, as well as during pregnancy, breastfeeding, and childhood. Potential interactions between anticoagulants and antiplatelet agents warrant particular attention. A systematic review of the interactions between warfarin and foods, medicinal plants, and dietary supplements identified several potential interactions. The possible effects of ginseng on warfarin efficacy have been previously reported. Previous reviews have also described potential interactions between P ginseng and warfarin, and between ginseng and the monoamine oxidase inhibitor phenelzine. Isolated cases of manic symptoms have been reported with phenelzine. Caution is advised in individuals with diabetes because ginseng may affect glucose metabolism. When taken with glucose-lowering medications, particularly insulin or sulfonylureas, additive effects should be considered. Data on potential interactions with newer drug classes, such as GLP-1 receptor agonists and SGLT2 inhibitors, remain limited. These combinations are not necessarily contraindicated; however, careful medication review is advisable, with closer glucose monitoring when needed. Conclusion: Potential Benefits and Limitations Clinical Takeaways - Among the conditions studied, evidence for ginseng in tumor-associated fatigue appears comparatively promising. Patients who may benefit are those who use a standardized formulation without relevant contraindications or potential drug interactions. - Ginseng may offer minor, short-term benefits for memory and focus, though evidence remains limited. However, evidence does not support its use to treat dementia or prevent cognitive decline. - For individuals with recurrent minor respiratory infections, ginseng may be considered as a supplementary measure. Proven preventive measures including vaccination, adequate sleep, smoking cessation, regular exercise, good hygiene, and guideline-based management of chronic diseases remain important. - Caution is advised for individuals taking multiple medications, particularly anticoagulants or antiplatelet drugs, and for those with unstable cardiovascular disease, poorly controlled diabetes, or psychiatric vulnerability. - Ginseng should be used with caution during pregnancy and breastfeeding because safety data are limited. The bottom line is that ginseng is neither ineffective nor a universal “adaptogen” with proven benefits across a wide range of conditions. Some specific clinical uses show promise, but the effects are generally modest and the studies are heterogeneous. Evidence suggests that the effects vary by preparation. Ginseng should not be viewed as a substitute for established therapies. If used, it may serve as an adjunct for patients with a specific indication, provided that relevant contraindications and potential drug interactions have been considered. This story was translated from Medscape’s German edition.