SUMMARY AND PHARMACEUTICAL COMMENT ( HERBAL MEDICINE 3RD 325 334) The chemistry of Panax ginseng root is well

l documented. Research has focused mainly have on been the saponin components for certain (ginsenosides), non-saponin which are generally principally considered to be the main active constituents, although pharmacological actions documented components, 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 short duration, so have the statistical power only to detect very common, acute

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 wellcharacterised 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.

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 were detected 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

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 healthy individuals received single doses of P. ginseng root extract

(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