To hear the claims made for ginseng is to be thrust into one of two positions: either a romantic awe of this God-given root which is a most amazing panacea or a total cynicism concerning a root which symbolizes man's capacity to make a fool of himself.

--Stephen Fulder, Ph.D., The Tao of Medicine

This is a 48-year-old gentleman with headaches, nasal congestion, lower back pain . . ." I began.

"Symptoms, schmymptoms," my mentor, Dr. Tang, interrupted.

He said it authoritatively, but with a kindly twinkle in his eye. He delighted in doing this. It was his way of getting me back on track.

Once again, as so often happened in my early days of studying Chinese traditional medicine, I had made the mistake of presenting a patient's case the way that I had learned in medical school: by starting with the symptoms.

"Take the pulse," Dr. Tang instructed. "Examine the tongue. Find the source of disharmony. If you cure the root cause of the problem, all of those symptoms that you're preoccupied with will take care of themselves. Your patient's headaches might come from an energy disturbance in the gallbladder or kidneys or liver or somewhere else. You must find the cause, Dr. Tim."

He was right, of course. He was always right.

Dr. Tang was a seventh-generation Chinese doctor whose practice spanned five decades. Taoist medicine was in his genes. He would take a patient's pulse, examine a patient's eyes, tongue, face, skin, tone of voice--everything, including subtle essences that defy description. His objective: to divine the disharmonies in energy that had instigated the patient's illness. Sure, he kept track of symptoms. But like most Chinese doctors, he viewed them in the context of the whole person, not in isolation.

Early in my studies, I realized that Chinese traditional medicine espoused a totally different perspective of illness than mainstream Western medicine. With Dr. Tang's gentle prodding, I learned how to recognize aberrant energy patterns, the essence of Chinese diagnosis.

I also learned that "symptoms, schmymptoms" was Dr. Tang's way of saying, "Look, you have a choice. You can focus on the symptoms and prescribe powerful drugs to suppress them. Or you can use the subtler methods that I'm teaching you to diagnose the energy imbalance underlying the symptoms so you can isolate the root cause of illness. The symptoms may change, but the root cause will not. If you focus on just symptoms, you'll never discover the cause. And if you never treat the cause, your treatments will ultimately fail. Sooner or later, new symptoms will pop up to replace the old ones you suppressed. Use herbs and acupuncture to gently nudge the body's energy back into balance. Then the body will keep itself healthy."

Dr. Tang would usually underscore his message by quoting from the Nei Ching, the world's oldest medical textbook: "Only the inferior doctor treats the symptoms. The superior doctor understands the cause of the symptoms and restores harmony."

After more than two decades of studying and practicing Chinese traditional medicine, I know this principle holds true. And it can be taken one step further: With experience, a Chinese doctor can diagnose an energy imbalance before the symptoms have manifested themselves. Then he can prescribe preventive therapies to correct the imbalance and keep the patient healthy.

In ancient China, a patient paid his doctor for services only if he didn't get sick. The best doctor--the "superior doctor"--detected and corrected any disharmony of energy before it produced symptoms.

Elixir from the East

Over the course of several thousand years, practitioners of Chinese traditional medicine have developed an arsenal of powerful herbal remedies. The Chinese expect much more from a remedy than we Westerners do: It must go far beyond relieving symptoms to correcting the energy imbalance that drives the symptoms. It must also restore internal harmony while strengthening the body. And it absolutely cannot have toxic properties.

No herb meets these stringent requirements better than ginseng. Chinese doctors consider ginseng one of their premier prescriptives for keeping people healthy. In fact, they recommend ginseng more than any of the 1,500 other Chinese herbal remedies.

In Asian countries, where people rely on herbs for health and healing, ginseng reigns as the most prized plant of all. Millions take the herb daily for its rejuvenating, anti-stress, and anti-aging properties.

These days, Westerners are discovering the numerous benefits of ginseng for themselves. As our bodies endure the nonstop assault of stress, environmental toxins, poor diet, and other hazards of modern life, we need a natural restorative that fosters internal harmony while building resistance to disease before it appears. Ginseng fills the bill perfectly.

Homegrown Healing

Two species of ginseng exist. One, Panax quinquefolius (or American ginseng), grows naturally in cool woodlands from the Canadian provinces of Quebec and Manitoba to Alabama, Arkansas, Florida, and Louisiana. The other, Panax ginseng (or Asian ginseng), is native to Manchuria (a region of northeast China) and to North and South Korea. Nowadays, you'd be hard-pressed to find the herb growing naturally anywhere in Asia, since residents there have virtually picked the forests clean.

Because of worldwide demand, virtually all Panax ginseng is commercially grown in Canada, China, Japan, North Korea, Russia, South Korea, and the United States. After thorough drying, most of the American crop is exported to Hong Kong and from there distributed throughout Asia and the world.

A small perennial, Panax ginseng requires rich soil and shade to grow. A quality plant takes five to seven years to mature from seed. The older the plant, the more potent--and thus the more valuable--it becomes.

Be wary of so-called Siberian ginseng, or Eleutherococcus senticosus. This herbal imposter is often passed off as the equivalent of Panax ginseng. Truth be told, Siberian ginseng isn't ginseng at all. It has a fraction of the potency of the real thing. Chinese herbalists have known about Siberian ginseng for hundreds of years. They don't hold it in the same high regard as Panax ginseng.

An Herb for the Ages

The name ginseng comes from the Chinese jen-shen--jen meaning "human" or "person," and shen meaning "essence" or "spirit." The Chinese believe that the ginseng root contains a human's essence because its branches look like arms and legs. In fact, the more the root resembles a human, the greater its therapeutic powers.

For more than 5,000 years, the Chinese have revered and coveted Panax ginseng. For them, the herb symbolizes health, strength, and long life. Indeed, the Chinese emperor Shen Nung anointed ginseng number one among the hundreds of herbs in use when he compiled the Pen Tsao Ching, the oldest existing record of herbal remedies.

In this country, Native Americans taught early American settlers about ginseng's medicinal properties. By the 1700s, enterprising settlers were shipping the herb to China. In 1773, the sloop Hingham sailed out of Boston Harbor for the Far East with 55 tons of ginseng root on board. In 1862, more than 600,000 pounds of the herb were exported, with almost all of the shipment going to China.

Ginseng farming took off in the United States between 1895 and 1903. Spurred by foreign demand for the herb, profiteers formed companies to grow ginseng on a massive scale. In 1904, a ginseng leaf disease devastated many plantations, bringing a burgeoning industry to its knees.

By all accounts, the boom is on again. Farmers from Canada to Alabama are growing huge quantities of high-quality ginseng and sending it to Asian countries. Buyers from Hong Kong size up North American crops and purchase the rights to them years before they're mature enough to harvest.

Much of the ginseng on the global market has been grown in the United States. Ironically, the ginseng that's available in the United States is, for the most part, imported from Asia.

The Secret Ingredients

Ginseng contains many biologically active substances, the most notable of which are the ginsenosides. These compounds enable the body to better respond to stress and to better resist the effects of external stressors, be they physical, emotional, chemical, or environmental. Scientists have so far identified at least 13 distinct ginsenosides in ginseng, each with unique pharmacological activity. The higher the herb's total ginsenoside content, the higher its quality and potency.

Because the active ingredients in ginseng help the body adapt to whatever life throws its way, herbalists classify ginseng as (appropriately enough) an adaptogen. A universal remedy, the herb provides broad-spectrum support to improve physical and mental performance, strengthen immunity, increase resistance to disease, and thus promote all-over health. (The Latin Panax means "all-healing," as in panacea.)

Labels aside, ginseng does have a knack for reversing conditions characterized by exhaustion and a lack of zest for life. Chinese doctors often recommend the herb to people who are facing stressful situations or events. It helps to minimize and even prevent the cumulative damage that is bound to result from long-term stress. Those who have been subjected to prolonged physical or mental exertion--such as the Russian cosmonauts, who routinely use the herb on space missions--praise ginseng's anti-stress effects.

As an herbal remedy, ginseng has proven effective in treating insomnia and depression as well as hangovers and other conditions of overindulgence. Some folks take the herb as a natural upper to raise their spirits, foster a more positive outlook, and enhance memory, alertness, and concentration.

These days, ginseng is attracting a lot of attention because of its potential as an anti-aging agent. A growing body of scientific evidence supports the widely held belief that ginseng can not only promote health and vitality but also prolong life.

Ginseng has earned a place in the Anti-Aging Supplement Program because of its profound Renewal-promoting effects. The herb acts as an all-around restorative and fortifier. It stimulates activity in the immune and endocrine (hormone-producing) systems. It combats stress, anxiety, and fatigue. It revitalizes the blood vessels, thus improving circulation. It boosts brain health. It protects against heart disease and cancer. And in women, it minimizes menopausal discomfort.

In Asian countries, people who can afford ginseng usually take the herb every day. They believe that ginseng protects against degenerative disease and extends life span.

Mining for Scientific Findings

Demanding scientific proof that ginseng works seems like something of a double standard. For five millennia before science wielded its seal of approval, billions of people took ginseng simply because they felt rejuvenated by it. That's more proof than any prescription or over-the-counter drug can claim. In his book Light of Asia, noted traveler and author Sir Edwin Arnold sums up ginseng's dilemma nicely: "According to the Chinese, Asiatic ginseng is the best and most potent of all cordials, stimulants, tonics, stomachics, cardiacs, febrifuges, and above all, will best renovate and invigorate failing forces. It fills the heart with hilarity, while its occasional use will, it is said, add a decade to human life. Can all the generations of Orientals who have praised heaven for ginseng's manly benefits have been totally deceived? Was humanity ever quite mistaken when half of it believed in something never puffed and never advertised?"

Nevertheless, thanks to decades of scientific scrutiny, the previously "unsubstantiated" anecdotal and empirical claims about ginseng now have mounds of research to back them up. This is especially welcome news for those in the medical and scientific communities, who tend to prefer hard evidence to softer claims such as "invigorates failing forces," "strengthens the vital spirit," "fortifies the beast," and "dissolves pituitous tumors."

Put under even the most powerful microscope, ginseng passes muster. We now have unequivocal proof that the herb benefits the body in numerous ways. In addition to the Renewal-promoting effects mentioned in the previous section, ginseng stimulates protein synthesis, which speeds healing; revives blood cells after exposure to radiation; safeguards the liver against exposure to toxins; improves metabolism of carbohydrates; lowers blood cholesterol and triglyceride levels, which helps prevent heart disease; and supports functioning of the central nervous system.

Much of the scientific examination of ginseng has focused on six specific areas: immune enhancement, cancer prevention and treatment, protection against radiation, heart disease prevention and treatment, brain health, and stress tolerance. Let's look at each of these areas in turn.

A Proven Immune Booster

For those of us interested in slowing the aging process and maximizing longevity, the positive impact of ginseng on the immune system holds the greatest promise. Hundreds of studies have shown that the combination of chemical compounds in ginseng enhances immunity in a variety of ways.

In one study conducted at the Central Drug Research Institute and King George's Medical College in Lucknow, India, researchers infected two groups of mice with a lethal virus. One group had received ginseng for 5½ days prior to viral exposure, while the other did not. Treatment continued for 3½ days after viral exposure. Thirty-five percent of the ginseng-takers survived, compared with none of the non-ginseng-takers. What's more, the ginseng-takers were later found to have developed immunity to the virus.

This study suggests that long-term consumption of ginseng can inhibit age-related immune decline. The herb provides a significant degree of protection against the infectious diseases to which older individuals are especially susceptible.

Combating the Killer C

Ginseng makes a potent cancer-fighter as well, and not just because of its immune-boosting power. As a team of South Korean researchers found, the herb can also defuse the effects of carcinogens.

In their study, the researchers divided 600 mice into six groups. Two groups were exposed to one of the following common carcinogens: aflatoxin (a mold commonly found on peanuts) and urethane (found in convenience-food and fast-food containers). Another two groups were exposed to one of the same carcinogens, but these mice also received ginseng. The remaining two groups served as controls.

After 6 to 12 months, a time that simulates long-term carcinogen exposure in humans, the researchers counted and measured the tumors in each mouse. The mice that received ginseng consistently developed fewer tumors than the mice that didn't receive ginseng. What's more, the tumors in the ginseng-takers were 20 to 25 percent smaller than the tumors in the non-ginseng-takers. These results validated the researchers' hypotheses that long-term supplementation of ginseng increases resistance to cancer and that ginseng can successfully inhibit the incidence and invasiveness of cancer.

In a similar study conducted at Kyung Hee University in Seoul, South Korea, researchers applied dimethylbenzanthracene--a highly carcinogenic substance--to the cheeks of 40 hamsters. Then 20 of the animals received ginseng in their drinking water (one gram of herb per liter of water), while the other 20 did not. Again, the ginseng-takers had smaller, slower-growing tumors than the non-ginseng-takers.

Japanese researchers have uncovered evidence that certain chemical compounds in ginseng, called saponins, not only inhibit the growth of cancer cells but actually cause them to revert to their normal state.

Arresting the Effects of Radiation

A series of studies conducted by the department of medicine and hygiene of the Radiation Center of Osaka, Japan, has conclusively demonstrated that ginseng protects against damage caused by radiation exposure. Ginseng extracts almost completely prevent internal hemorrhaging and stimulate the recovery of red blood cells, white blood cells, and blood platelets. The herb's proven ability to promote protein synthesis, which in turn speeds healing, also contributes to its protective effects.

In one of the Osaka studies, researchers exposed two groups of mice to lethal doses of radiation. One group also received injections of purified ginseng extract, while the other group received injections of a saline solution. Among the ginseng-takers, the 30-day survival rate varied depending upon how much of the herb was given and when it was given. The mice that received the largest dose of ginseng had the highest survival rate--82 percent. Likewise, the mice that received the herb beginning 24 hours before radiation exposure and continuing for 2½ hours after exposure fared best. Among the mice that received the saline solution, none survived. Administering the herb just one day after radiation exposure did nothing to improve survival rate.

Tuning Up the Ticker

Japanese experiments involving both animals and humans indicate that ginseng lowers total cholesterol, low-density lipoprotein cholesterol (the bad kind), and triglycerides, while elevating high-density lipoprotein cholesterol (the good kind). By shaping up a person's blood-lipid profile in this way, ginseng effectively reduces the risk of heart disease.

Incidentally, hospital emergency rooms throughout China use ginseng as part of the standard protocol for treating shock induced by heart attack or hemorrhage. Extensive research has shown that, in such cases, the herb can restore blood pressure and normalize heart function.

Maximizing Mind Power

Scientists seem especially intrigued by ginseng's influence over brain function. Italian researchers, for instance, have concluded that the herb enhances an array of cognitive qualities and skills: It extends attention span, increases math aptitude, sharpens deductive reasoning, and shortens decision-making and auditory reaction times.

Japanese researchers have found that rats perform tasks better and make fewer mistakes when given ginseng. And Bulgarian researchers report that, in humans, the herb delays the onset of mental and physical fatigue. It accomplishes this through its actions on the immune system, the central nervous system, and other components of the body.

Your Stress Defense

Ginseng strengthens the body's resistance to stress by acting on what physiologists call the pituitary-adrenal axis. The ginsenosides in the herb trigger the release of adrenocorticotropic hormone (ACTH) from the pituitary gland, which is located at the base of the brain. ACTH travels through the bloodstream to the adrenal glands, which are perched atop the kidneys, and instructs them to manufacture and release corticosteroid hormones. The greater the availability of corticosteroids in the bloodstream, the greater the body's ability to withstand the effects of stress.

When researchers at the University of Buenos Aires in Argentina subjected mice to high heat and electric shock, they found that the rodents that were predosed with ginseng were less likely to die from exposure to the extreme stressors.

A similar experiment performed by Indian researchers showed that rats given ginseng better tolerated cold temperatures and high altitudes. Thankfully, more humane experiments involving both animals and humans have confirmed ginseng's ability to stave off stress.

In my medical practice, I often see patients who have extreme physical or emotional stress. As a result, their adrenal glands don't secrete enough corticosteroid hormones to sustain normal function (a condition known as hypoadrenocorticism). I usually prescribe ginseng, along with a combination of pantothenic acid (a B vitamin), potassium-magnesium aspartate, and adrenal extract. I also advise people to wean themselves from caffeine and sugar, which artificially stimulate the adrenal glands. Invariably, these patients report that they feel less tired and tense and more energized. Their bodies are better able to handle the effects of stress.

The Anti-Aging Aphrodisiac?

More than a few ginseng aficionados contend that the herb enhances sexual desire and performance. While science has yet to delve deeply into this delicate subject, history offers testaments of its own.

Ancient Vedic scriptures contain hymns that graphically describe ginseng's legendary libido-stimulating properties: "Ginseng aids in bringing forth the seed that is poured into the female that forsooth is the way to bring forth a son. . . . The strength of the horse, the mule, the ram, even the strength of the bull, ginseng bestows on him. This herb will make thee so full of lusty strength that thou shall, when thou art excited, exhale heat as a thing on fire." Whoa.

Of course, some have cast doubt on whether ginseng really acts as an aphrodisiac. Perhaps William Byrd, an eighteenth-century plantation owner, captured the critics' viewpoint best when he wrote, "(Ginseng) will make a man live a great while, and very well while he does live . . . however, 'tis of little use in feats of love, as a great prince once found, who hearing of its invigorating quality, sent as far as China for some of it, though his ladies could not boast of any advantage thereby."

Indeed, early indications are that science will ultimately prove Byrd right. Ginseng may improve sexual desire and performance simply by virtue of enhancing overall health. If the herb has any libido-boosting properties, they're modest at best.

There's More in Store

Other areas of ginseng research show great promise as well. Researchers at Harvard Medical School, for example, have discovered that ginseng stimulates the synthesis of DNA, RNA, and protein in humans. This breakthrough may help to explain why ginseng slows the aging process, since DNA and RNA regulate the synthesis of the enzymes that control all of the body's biochemical reactions. Plus, by stimulating the synthesis of DNA, ginseng may promote DNA repair and thus minimize free radical damage.

For women who are going through or past menopause, ginseng may provide a natural, gentle antidote to declining estrogen levels. In studies, ginseng exhibits mild phytoestrogenic activity, making it an ideal antidote for the hot flashes, mood swings, and other symptoms associated with declining estrogen production. I often prescribe Panax ginseng extract, along with soy products and other sources of natural estrogen, to female patients who have such symptoms. Ginseng's mildness provides a sharp contrast to the toxic estrogenic blast from unnatural hormones such as Premarin.

Safe . . . and Then Some

Like most herbs, ginseng is eminently safe. All nations permit its unrestricted sale. In the United States, ginseng has even earned GRAS (generally regarded as safe) status from the Food and Drug Administration--and it is one of the few substances truly deserving of the honor.

Efforts to determine a toxic dose for ginseng have instead reaffirmed the herb's harmlessness. Perhaps the most extensive investigation of ginseng's safety and effectiveness has been orchestrated by I. I. Brekhman, director of the pharmacology and experimental therapy laboratory at the Institute of Biologically Active Substances in Vladivostok, Russia. Brekhman has published seven volumes of reports and findings on ginseng, the culmination of 15 years of research.

In his attempt to establish a toxic dose for the herb, Brekhman made a remarkable discovery. Mice that were not given ginseng survived an average of 660 days, while mice that were given a supposedly lethal dose of the herb survived an average of 800 days before succumbing to an overdose. Even the lethal dose had extended the lives of the test animals. Brekhman's findings suggest that if a person took too much ginseng, he'd still fare better in the long run than if he hadn't taken the herb at all.

Toxicity aside, ginseng can produce harmless, reversible side effects in highly sensitive people. Signs of overstimulation include irritability, insomnia, and elevated blood pressure and can be exaggerated if the herb is taken with another stimulant--most notably, caffeine.

Quality, Not Quantity

While toxicity isn't an issue with ginseng, choosing the right supplement is. Walk by the supplement display at your local health food store or drugstore, and you'll likely see an array of ginseng products: whole root, sliced root, powdered root, capsules, tinctures, teas, chewing gum, candy, snuff, and even cigarettes.

As I mentioned earlier, the United States exports most of its homegrown ginseng to Hong Kong. From there, the herb is distributed throughout Asia and the world. Most of the ginseng sold in this country comes from South Korea, where it has been cultivated for more than 1,000 years. The Korean people take great pride in their ginseng, and their government regulates its production. Korean Red, a Panax ginseng, carries the government seal--a symbol of purity and potency that's recognized and respected around the world. Unfortunately, counterfeit knock-offs have shown up on the market.

While Panax ginseng contains a variety of active compounds, including vitamins, minerals, and flavonoids (a group of phytochemicals), its potency is measured by its ginsenoside content. High-quality whole ginseng root weighs in with about 4 percent ginsenoside compounds. The most active of these compounds, and therefore the one that's used for standardization, is the highly prized ginsenoside Rg1. A standardized ginseng product retains less active, but nonetheless very important, ginsenoside compounds in direct relative proportion to Rg1. In other words, the more Rg1 in a product, the greater the quantities of the "supporting" ginsenosides.

Commercial ginseng products vary greatly in ginsenoside content. When tested, many show little or no ginsenoside activity. They're made with the lowest-grade ginseng root, then diluted and blended with inert ingredients so that virtually none of the active ginsenoside compounds remain.

The only surefire way to know a quality ginseng product from an inferior one is through pharmacological analysis--not exactly a do-it-yourself endeavor. You could ask a store employee for a recommendation, but unless he's aware of the variations in potency, he may unintentionally steer you toward something worthless.

Of all of the ginseng products on the market, your best bets are whole root and capsules of standardized extract. These forms surpass the others in terms of availability, practicality, and effectiveness.

With whole roots, potency varies widely. Older roots tend to have the highest ginsenoside concentrations, but they also tend to be prohibitively expensive. The most prized root of all, called Tung-Pei Wild Imperial Ginseng, is at least 100 years old and costs about $20,000. That's per root.

For every root of Tung-Pei Wild Imperial Ginseng, you'll find plenty of roots that are less expensive but are of poor quality. Selecting the right specimen requires professional assistance. I recommend that you consult a Chinese doctor, an herbalist, or another trained and trustworthy herbal practitioner who can help you find the perfect root. (Some say that the Chinese know ginseng like the French know wine: Neither can be fooled by an inferior-grade product.)

Your other option--and, in my opinion, the better option--is capsules of standardized ginseng extract. A standardized extract guarantees potency as well as a dependably consistent dose.

How do you know that you're getting a quality ginseng product? Read the label. It should say something like this: "Panax ginseng. Standardized to contain X percent (for example, 5 to 20 percent) saponins calculated as ginsenoside Rg1." It should also specify the dose per capsule, as in "100 milligrams (or mg.)." These phrases tell you exactly what you're getting in each capsule, so you don't have to guess whether you're hitting the mark in terms of your optimum intake.

The Ideal Dosage

The usual recommended dosage for capsules of standardized ginseng extract is 25 to 75 milligrams of ginsenoside Rg1 per day. You may have to do some simple calculations, using information provided on a product's label, to determine how much Rg1 you're getting per capsule. All you have to do is multiply milligrams of standardized extract by percent Rg1.

Suppose, for example, you have a capsule that contains 100 milligrams of standardized ginseng extract and 7 percent ginsenoside Rg1. Multiply 100 by 0.07, and you get 7. So each capsule contains 7 milligrams of Rg1. Taking two such capsules twice each day adds up to 28 milligrams of Rg1 daily, which falls at the low end of the dosage range.

If you're taking pure ginseng root, the recommended dosage is 500 to 6,000 milligrams daily (see "Nothing but the Root"). Again, ginsenoside content can vary greatly from one root to another, so you're not assured of a consistent potency.

No matter whether you choose capsules of standardized ginseng extract or pure ginseng root, keep in mind that exceeding the recommended dosage won't bolster the herb's therapeutic benefits. A little does the job; more just wastes money.

How often you take ginseng depends upon your age. Generally, the older you are, the more the herb can benefit you. My recommendations:

• If you are over age 60 or have a chronic illness, take ginseng every day.

• If you are between ages 40 and 60, take ginseng for one to two months, stop for one month, then repeat.

• If you're under age 40, take ginseng as needed--when you're under considerable stress, for example.

In fact, regardless of your age, you can use ginseng at any time as a natural stimulant to combat the effects of fatigue or stress. You may also want to tap into the herb's immune-enhancing properties during the fall and winter months, when resistance to disease runs low. (Most Chinese doctors advise against taking ginseng while you have a fever, a cold, or the flu. You can resume use of the herb once your symptoms subside, to rebuild your immune system.)

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As we've seen, ginseng can do wonders for mental function. But it can't compete with ginkgo. In fact, no substance--manmade or nature-made--can match ginkgo for revitalizing and maximizing mental performance. You'll read all about this anti-aging herb in the next chapter.