Introduction
Ginseng (Panax ginseng C.A. Meyer) has been revered for its restorative and tonic effects in traditional medicine. For centuries, ginseng has been prescribed to replenish original Qi and resolve deficiency syndrome, which manifests clinically as fatigue and immune vulnerability, especially in tumor patients. Recent research has elucidated the mechanisms behind these traditional uses, revealing the potential of ginseng to impact immune function, alleviate symptoms of sub-health, and combat cancer. This review explores the current body of literature on these topics, focusing on the scientific evidence supporting the multifaceted benefits of ginseng and its extracts.
Immunomodulatory effects of ginseng
Ginseng has been shown to possess immunomodulatory properties, which are crucial for maintaining homeostasis and combating disease. Recent research findings indicate that the active components of ginseng, known as ginsenosides, can influence the functions of immune cells, including regulating the production of cytokines and enhancing the activity of natural killer (NK) cells.1 Similarly, flavonoids and phenolic substances, which are also types of polysaccharide compounds, have anti-fatigue effects, enhance the body’s immunity, and promote hematopoietic function.2 A study by Mahara et al.3 highlighted factors associated with suboptimal health status among adolescents in China, suggesting that ginseng could play a role in immunomodulation to improve health outcomes. Furthermore, the effects of ginsenoside Rg3 on tyrosine hydroxylase and related mechanisms in fatigue rats indicate its potential in modulating stress responses, which are closely tied to immune function.4–6
Immunomodulatory mechanisms
Cytokine network regulation
Ginsenoside Rg1 and Rb1 can significantly inhibit the excessive secretion of pro-inflammatory factors, such as tumor necrosis factor-α and interleukin-6, while promoting the production of the anti-inflammatory factor interleukin-10. This bidirectional regulatory effect is crucial for maintaining immune homeostasis.1 Studies have shown that in inflammatory models induced by lipopolysaccharide, ginsenosides can normalize cytokine levels by up to 40–60%.
NK cell activation pathway
By activating the TLR4/MyD88 signaling pathway, ginsenosides can increase the expression of activation receptors on NK cells (such as NKG2D), thereby enhancing their killing activity by two to three times. A comprehensive review of the literature indicates that ginsenosides can stimulate lymphocyte proliferation, enhance NK cell activity, and modulate antibody production, thus bolstering the immune response.1
The role of the coordinated immune substances
Apart from saponins, the polysaccharide components in ginseng (such as arabinogalactan) can activate complement receptor 3 on the surface of macrophages, enhancing phagocytic function and promoting the proliferation of hematopoietic stem cells. Animal experiments have shown that ginseng polysaccharides enable the white blood cell count of irradiated mice to recover to normal levels five to seven days earlier than usual. Further studies have demonstrated that ginsenosides, polysaccharides, proteins, volatile oils, and other constituents can serve as quality indicators for regulating the immune function of ginseng.7,8
Immunomodulatory effects in the clinical context
The immunomodulatory effects of ginseng are particularly relevant in cancer treatment, where the immune system’s ability to recognize and eliminate tumor cells is critical. The main active component involved is ginsenoside CK.9,10 A study by Baek et al.11 applied metabolomics to investigate the effects of ginseng on Spleen-Qi deficiency syndrome, revealing its potential to modulate immune function in patients treated with ginseng. These findings suggest that ginseng may enhance the body’s natural defenses against disease, support overall health, and potentially improve treatment outcomes for conditions such as cancer.
Quality of life improvement
The impact of ginseng on quality of life has been a significant focus of recent research. A study by Mu et al.12 demonstrated that ginseng extract, specifically the Renshen Yuanqi (RSYQ) Drink, improved sub-health status in young adults, with 85% of participants showing significant improvements in their sub-health scores after a 30-day intervention. The aspects of sub-health that saw the most significant improvements included feelings of sadness and depression, fatigue, and cognitive function, all of which are integral to an individual’s overall quality of life. These findings are supported by earlier research that not only showed ginseng’s ability to relieve chronic fatigue and protect cerebral function, thereby maintaining body homeostasis,13–15 but also reported its whitening and anti-aging benefits.16,17 We can be confident that the numerous benefits of ginseng improve patients’ physical condition in multiple ways and enhance their quality of life.
Clinical studies and observational research
Clinical studies and observational research have been instrumental in elucidating the benefits of ginseng. A study conducted by the School of Traditional Chinese Medicine at Capital Medical University, as detailed in a progress report, focused on the effects of RSYQ Drink on tumor patients. The study, part of a larger collaboration between Capital Medical University and China Medico Corporation, aims to assess the efficacy of ginseng products in improving the sub-health status of high-pressure individuals and tumor patients. Preliminary results indicate that ginseng may help alleviate symptoms of sub-health in tumor patients, with potential implications for improving their quality of life.
While the benefits of ginseng are well documented, its safety and efficacy must be thoroughly assessed. High doses of ginseng have been associated with adverse effects, including nervous system disturbances and interactions with certain medications.18,19 For instance, ginseng may have certain adverse effects on the action of the beta-blocker metoprolol.20,21 Therefore, it is crucial to establish safe dosage ranges for ginseng supplementation, especially in the context of long-term use. The study by Mu et al.12 reported mild adverse effects, such as constipation and headache, which resolved after discontinuation of the supplement. In particular, cancer patients may be taking anticoagulant drugs such as aspirin and warfarin. The combined effect of these drugs with ginseng may increase the risk of bleeding. Additionally, ginsenosides (such as Rk1 and Rg5) may inhibit liver drug-metabolizing enzymes like CYP3A4, thereby increasing toxicity. For targeted therapies such as epidermal growth factor receptor (EGFR) inhibitors and poly ADP-ribose polymerase (PARP) inhibitors, ginseng may have antagonistic effects. As a traditional Chinese medicine (TCM), the simultaneous use of ginseng with aconite and Saussurea involucrata can cause extremely strong toxicity. These findings underscore the need for ongoing monitoring and research to ensure the safe integration of ginseng into healthcare practices.
Quality of life improvement in patient populations
The improvement in quality of life associated with ginseng use is particularly significant for patient populations experiencing fatigue and cognitive decline, such as those undergoing cancer treatment. The study by Mu et al.12 highlighted the positive impact of ginseng extract on sub-health conditions, which are common in high-pressure groups like college students and young professionals. This may be due to ginsenosides, the main active substances in ginseng, having an antidepressant effect.21–23 The aspects of sub-health that saw the most significant improvements included feelings of sadness and depression, fatigue, and cognitive function. These findings are supported by earlier research that showed ginseng’s ability to relieve chronic fatigue and protect cerebral function, thereby maintaining body homeostasis.
Antitumor potential
The antineoplastic effects of ginseng and its extracts are an exciting area of research. While the direct cytotoxic effects of ginseng on tumor cells are not yet fully established, there is evidence to suggest that certain ginsenosides may inhibit tumor growth and metastasis.24–27 For instance, ginseng has shown neuroprotective effects against cancer-related complications. A study by Li et al.14 demonstrated that ginsenoside compound K reduced neuronal damage and improved synaptic dysfunction by targeting Aβ, suggesting a potential role in neuroprotection against cancer-related cognitive impairment. Additionally, ginsenoside Rg3 improves cancer-related fatigue by activating AMPK and enhances patients’ quality of life.28–30
Antitumor potential and mechanisms
While the direct cytotoxic effects of ginseng on tumor cells are not yet fully established, evidence suggests that certain ginsenosides may inhibit tumor growth and metastasis. Multiple studies have shown that the PI3K/AKT pathway is influenced by various ginsenoside factors. Ginsenoside Rg1 and Rb1 regulate macrophage polarization, maintaining the balance between M1 and M2 phenotypes to enhance PI3K/AKT signaling. Ginsenoside Rg3 and Re regulate T cell activation and maintain the dynamic balance between Th1 and Th2. Ginsenoside Rh2 upregulates NKG2D and perforin through the PI3K/AKT/ERK pathway, thereby enhancing NK cell cytotoxicity. A study by Song et al.24 demonstrated that ginsenoside Rh2 inhibits tumor growth and metastasis in prostate cancer by suppressing the PI3K/AKT pathway. Research by Wang et al. indicates that ginsenoside Rb1 regulates cuproptosis through CTR1 ubiquitination, thereby improving hypoxia-reoxygenation injury in H9c2 cells.31–33 These findings suggest that ginsenosides may target specific signaling pathways in cancer cells, offering a potential therapeutic strategy for cancer treatment.34,35
Safety considerations and adverse effects
Despite the promising effects of ginseng, safety must remain a paramount concern. High doses of ginseng have been associated with adverse effects, including nervous system disturbances and interactions with certain medications.18,19 For example, ginseng may alter the effects of the beta-blocker metoprolol.20,36 Using small doses of ginseng can maximize medicinal value while minimizing adverse effects and adverse reactions.37 These findings underscore the need for ongoing monitoring and research to ensure the safe integration of ginseng into healthcare practices.38,39
The illustrated pathway map delineates the proposed immunomodulatory and antitumor mechanisms associated with ginseng and its bioactive constituents (Fig. 1). Ginseng demonstrates bidirectional regulatory effects on T cells and promotes apoptosis in B cells. Furthermore, specific ginsenosides, including Rh1, Rg3, and F1, are implicated in activating and promoting the differentiation of M2 macrophages. The compound F1 is also associated with enhanced NK cell function. Ginseng components, potentially including F1, may influence the activity of matrix metalloproteinases such as MMP9, indicated via MMP21.
Concurrently, ginseng exerts inhibitory effects on the expression of M1 macrophages, potentially acting through mechanisms involving gM1, nitricoxide synthase, and NO1. These immunomodulatory actions occur alongside ginseng’s fundamental properties in TCM, characterized as “Big tonifying Qi”, which encompasses effects such as “Compound pulse solid out”, “Tonifying spleen and lung”, “Calming the mind and intelligence”, and “Nourishing blood”. Collectively, this map integrates these immunological mechanisms with the foundational TCM therapeutic principles attributed to ginseng.
Typical cases and future directions
In 2023, we conducted preliminary research investigating the effects of RSYQ Drink, composed of high-quality ginseng extract, on sub-health status in young college students. Building upon these findings, we aim to expand our research to a larger population. Given ginseng’s traditional use in replenishing Qi and addressing deficiency patterns in TCM, we hypothesize that it may improve sub-health conditions in tumor patients, who are mostly considered to suffer from deficiency syndrome during treatment.
To test this, we refined our study protocol and initiated patient recruitment at the Traditional Chinese Medicine Outpatient Department of Capital Medical University. Prior to study initiation, the research team provided comprehensive explanations of the study objectives and participation procedures to potential participants. Following informed consent, patients completed the Sub-health State Assessment Scale (see Supplementary File 1), which incorporates items derived from the EORTC QLQ-C30 (version 3) and EORTC QLQ-HCC18 instruments. Baseline health status was recorded during initial participation, with subsequent data aggregation and analysis.
RSYQ has demonstrated great efficacy in improving sub-health conditions among tumor patients. For instance, a 62-year-old female patient strictly adhered to the prescribed daily regimen of RSYQ. Sub-health status was assessed using a standardized evaluation scale at baseline and follow-up intervals (days 7, 14, 21, and 30). As illustrated in Figure 2, her sub-health score decreased by nine points after 30 days of treatment compared to baseline, indicating marked improvement.
From this medical case of RSYQ Drink, the future of ginseng research holds promise, with a focus on optimizing assessment scales for sub-health status and expanding trials to include more participants.40,41 The potential for the development of ginseng tonics is optimistic. Statistical analysis was not applied due to the single-case design; future studies will incorporate t-tests and error bars. Further research should aim to elucidate the mechanisms underlying ginseng’s immunomodulatory effects, its impact on quality of life, and its direct antitumor potential.
Conclusions
Ginseng and its extracts show potential for immunomodulation, quality-of-life enhancement, and antitumor applications. Ginseng offers significant advantages for maintaining human health, especially among the elderly population, where its application is more widespread.42 While preliminary findings indicate the multifaceted therapeutic value of ginseng products, clinical validation remains limited. Future research should focus on large-scale, randomized controlled trials to establish the efficacy and safety of ginseng in various patient populations. Additionally, exploring the synergistic effects of ginseng with conventional treatments could unveil new paradigms in integrative medicine. Ginseng’s journey from a traditional remedy to a scientifically validated therapeutic agent is ongoing, and its full potential is yet to be realized.
The content presented in this article still has certain limitations. The relevant clinical trials mentioned have not undergone large-scale controlled trials yet. The small sample size may lead to limitations in the conclusions drawn. Some conclusions, although verified in animal experiments, remain to be confirmed in clinical settings. Overall, this article provides new evidence for research on ginseng and its related components.
Declarations
Funding
This study was supported by the 2024–2026 Chinese Association of Chinese Medicine Young Talent Lifting Project (2024-QNRC2-B08). The “Innovation Program” Youth Talent Support Project of Beijing in 2025.
Conflict of interest
Dr. Jiangning Peng and Dr. Lin Tang are employees of China Medico Corporation. Dr. Ling Yao is an employee of Shenzhen Tsumura Medicine Co., LTD. The other authors have no conflicts of interest to declare.
Authors’ contributions
Conceptualization (HYM), formal analysis (JNP, LY), supervision (LT), and writing – review and editing (HYM, TQW). All authors have approved the final version and publication of the manuscript.