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SUMMARY AND PHARMACEUTICAL COMMENT ( HERBAL MEDICINE 3RD 325

334)

The chemistry of Panax ginseng root is well documented. Research has focused

mainly on the saponin components (ginsenosides), which are generally

considered to be the main active constituents, although pharmacological actions

have been documented for certain non-saponin components, principally

polysaccharides. Many of the pharmacological actions documented for ginseng,

at least in preclinical studies, directly oppose one another and this has been

attributed to

the actions of the individual ginsenosides. For example, ginsenoside Rb1

exhibits CNS-depressant, hypotensive and tranquillising actions whilst

ginsenoside Rg1 exhibits CNSstimulant, hypertensive and anti-fatigue actions.

These opposing actions are thought to explain the adaptogenic reputation of

ginseng, that is the ability to increase the overall resistance of the body to stress

and to balance bodily functions. Preclinical studies have indicated that

preparations of Panax species and/or their isolated constituents have a range of

pharmacological properties; results of these studies provide some supporting

evidence for the traditional uses and adaptogenic properties for certain Panax

species preparations, although pharmacological explanations for the observed

actions are less well understood. Clinical trials of Panax species preparations

have focused on assessing effects related to the reputed adaptogenic properties

of this herbal medicinal product, although rigorous clinical investigations are

limited. Studies have tested different preparations of different Panax species and

different commercial products (which vary qualitatively and quantitatively in

their phytochemical composition) administered according to different dosage

regimens, and to different study populations making interpretation of the results

difficult. At present there is insufficient evidence to

support definitely the efficacy of specific Panax species preparations in the

various indications for which they are used and/or have been tested. Similarly,

there are only limited clinical data on safety

aspects of Panax species preparations. Clinical trials of Panax species root

preparations typically have involved small numbers of patients and been of shortduration, so have the statistical power only to detect very common, acute


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adverse effects. The available evidence suggests that preparations of Panax

species root are well-tolerated when used for limited periods of time at

recommended doses. Rigorous investigation of safety aspects of well-

characterised Panax species root preparations administered orally at different

dosages, including the effects of long-term treatment, is required. In view of the

many pharmacological actions documented, the potential for preparations of

Panax species to interfere with other medicines administered concurrently,

particularly those with similar or opposing effects, should be considered. In

general, and in view of the lack of safety data, it is appropriate to advise against

the long-term or otherwise excessive use of Panax species. The use of Panax

species during both pregnancy and breastfeeding should be avoided.

KLASIFIKASI TANAMAN

DESKRIPSI TANAMAN :

DOSIS :

HERBAL USE :

Ginseng (P. ginseng) is stated to possess thymoleptic, sedative, demulcent and

stomachic properties, and is reputed to be an aphrodisiac. Traditionally, it has

been used for neurasthenia, neuralgia, insomnia, hypotonia, and specifically for

depressive states associated with sexual inadequacy.(G2, G6, G8, G64) P.

ginseng and other Panax species have been used traditionally in Chinese

medicine for many thousands of years. Uses include as a stimulant, tonic,diuretic and stomachic,(15) but typically the different species have different

clinical uses. Traditionally, use has been divided into two categories: short-term

to improve stamina, concentration, healing process, stress resistance,

vigilance and work efficiency in healthy individuals, and long-term to improve

well-being in debilitated and degenerative conditions especially those associated

with old age.


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UJI KLINIK

Clinical studies

Clinical trials of preparations of P. ginseng and other Panax species have focused

on assessing effects related to the reputed adaptogenic properties of this herbal

medicinal product, although rigorous clinical investigations are limited. Studies

have tested different Panax species preparations, including combination herbal

preparations containing P. ginseng, which vary qualitatively and quantitatively in

their phytochemical composition. Furthermore, different preparations have been

administered according to different dosage regimens, and to different study

populations making interpretation of the results difficult. A large body of clinical

research has been published in the Chinese and other Asian literature, making

access difficult, although many of these studies are unlikely to meet

contemporary Western standards in terms of their design, analysis and

reporting.(16) Therefore, at present there is insufficient evidence to support

definitively the efficacy of specific Panax species preparations in the various

indications for which they are used and/or have been tested. Details of several

clinical trials of ginseng (Panax spp.) preparations published in the English

literature are summarised below. Effects on physical performance Several

studies have found that preparations of P. ginseng do not improve physical

performance in healthy adults. In a randomised, double-blind, placebo-controlled

trial, 38 healthy adults received an aqueous extract of P. Ginseng (G115,

Pharmaton SA, Lugano, Switzerland) 200 mg twice daily for eight weeks.(56)

Participants underwent exhaustive exercise testing before and after the

intervention; recovery from exercise was also monitored. At the end of the

study, data from 27 participants were available for analysis. No statistically

significant differences in physical performance and heart rate recovery weredetected between the ginseng and placebo groups.(56) Similar randomised,

double-blind, placebo-controlled studies have found that treatment with P.

ginseng root extract (G115) 200 mg daily for eight weeks had no statistically

significant effects on maximal work performance, oxygen uptake during resting,

exercise and recovery, respiratory exchange ratio, minute ventilation, heart rate

and blood lactic acid concentrations in 19 healthy adult females (p > 0.05 for

each),(57) and no effect on oxygen consumption, respiratory exchange ratio,

minute ventilation, heart rate, blood lactic acid concentrations and perceived


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exertion in 36 healthy adult males who received P. ginseng root extract (G115)

200 or 400 mg daily for eight weeks.(58) In a further randomised, doubleblind,

placebo-controlled trial involving 28 healthy adults, administration of P. ginseng

root extract (not further specified) 200 mg daily for three weeks had no

statistically significant effects on maximal exercise capacity, total exercise time,

work load, plasma lactate concentrations, haematocrit, heart rate and perceived

exertion.(59) As all of these studies involved only small numbers of participants

it is possible that they did not have sufficient statistical power to detect a

difference between the treatment and placebo groups if one exists. Effects on

cognitive performance Several studies have examinedthe effects of preparations

of P. ginseng root, typically thecommercial product G115, alone, or in

combination with other herbal ingredients, on cognitive performance. Generally,

these studies have involved healthy volunteers, and trials evaluating the effects

of P. ginseng root preparations on patients with impaired cognitive function are

lacking. Further research examining the effects of acute and longer-term

administration of preparations of P. ginseng and other Panax species in both

healthy individuals and patients with impaired cognitive function are required.

(60) In a double-blind, placebo-controlled, crossover study involving 15

healthy individuals, P. ginseng root extract (G115) 200 mg as a single oral dose

had significant effects on certain aspects of electroencephalogram recordings,

such as reductions in frontal theta and beta activity, when compared with

placebo.(61) These findings suggest that P. ginseng root extract can directly

modulate cerebroelectrical activity.(61) In a double-blind, placebo-controlled,

crossover study, 30 healthy individuals received capsules containing P. ginseng

extract (G115) 200 or 400 mg as a single dose before undergoing a battery of

tests designed to assess cognitive performance.(62) A statistically significant

improvement in one test of cognitive performance (serial sevens) was observed

with the lower ginseng dose, compared with placebo, but no statistically

significant difference was observed with the higher dose, and there were no

statistically significant differences in other tests of cognitive performance for

either dose.(62) There was a statistically significant improvement in scores for

mental fatigue for both doses when measured after the third battery of tests,

but this finding was not consistent when measured at other timepoints.

In another double-blind, placebo-controlled, crossover study, 28 healthyindividuals received single doses of P. ginseng root extract


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(G115) 200 mg, an ethanolic extract of guarana (Paullinia cupana) 75 mg, both

herbal preparations, or placebo, with a one-week wash-out period between

each; participants undertook a battery of cognitive performance tests before and

after treatments.(63) Administration of P. ginseng root extract, compared with

placebo, led to statistically significant improvements in some (e.g. speed of

attention, speed of memory, secondary memory) but not all (e.g. accuracy of

attention, working memory, Bond-Lader mood scales) tests of cognitive

performance, although improvements were not observed at every timepoint

measured after administration. In some tests, administration of both ginseng

and guarana led to greater improvements than did ginseng alone.(63) In similar

experiments, 20 healthy individuals received single doses of P. ginseng root

extract (G115) 200, 400, 600 mg, or placebo, and a combination of P. ginseng

root extract and Ginkgo biloba leaf

kko ginseng

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