MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

Ginseng plants belong to the genus Panax and include:

  • Panax ginseng (Korean ginseng),
  • Panax notoginseng (South China ginseng),
  • and Panax quinquefolius (American ginseng).

They are said to have a range of therapeutic activities, some of which could render ginseng a potential therapy for viral or post-viral infections. Ginseng has therefore been used to treat fatigue in various patient groups and conditions. But does it work for chronic fatigue syndrome (CFS), also often called myalgic encephalomyelitis (ME)? This condition is a complex, little-understood, and often disabling chronic illness for which no curative or definitive therapy has yet been identified.

This systematic review aimed to assess the current state of evidence regarding ginseng for CFS. Multiple databases were searched from inception to October 2020. All data was extracted independently and in duplicates. Outcomes of interest included the effectiveness and safety of ginseng in patients with CFS.

A total of two studies enrolling 68 patients were deemed eligible: one randomized clinical trial and one prospective observational study. The certainty of evidence in the effectiveness outcome was low and moderate in both studies, while the safety evidence was very low as reported from one study.

The authors concluded that the study findings highlight a potential benefit of ginseng therapy in the treatment of CFS. However, we are not able to draw firm conclusions due to limited clinical studies. The paucity of data warrants limited confidence. There is a need for future rigorous studies to provide further evidence.

To get a feeling of how good or bad the evidence truly is, we must of course look at the primary studies.

The prospective observational study turns out to be a mere survey of patients using all sorts of treatments. It included 155 subjects who provided information on fatigue and treatments at baseline and follow-up. Of these subjects, 87% were female and 79% were middle-aged. The median duration of fatigue was 6.7 years. The percentage of users who found a treatment helpful was greatest for coenzyme Q10 (69% of 13 subjects), dehydroepiandrosterone (DHEA) (65% of 17 subjects), and ginseng (56% of 18 subjects). Treatments at 6 months that predicted subsequent fatigue improvement were vitamins (p = .08), vigorous exercise (p = .09), and yoga (p = .002). Magnesium (p = .002) and support groups (p = .06) were strongly associated with fatigue worsening from 6 months to 2 years. Yoga appeared to be most effective for subjects who did not have unclear thinking associated with fatigue.

The second study investigated the effect of Korean Red Ginseng (KRG) on chronic fatigue (CF) by various measurements and objective indicators. Participants were randomized to KRG or placebo group (1:1 ratio) and visited the hospital every 2 weeks while taking 3 g KRG or placebo for 6 weeks and followed up 4 weeks after the treatment. The fatigue visual analog score (VAS) declined significantly in each group, but there were no significant differences between the groups. The 2 groups also had no significant differences in the secondary outcome measurements and there were no adverse events. Sub-group analysis indicated that patients with initial fatigue VAS below 80 mm and older than 50 years had significantly greater reductions in the fatigue VAS if they used KRG rather than placebo. The authors concluded that KRG did not show absolute anti-fatigue effect but provided the objective evidence of fatigue-related measurement and the therapeutic potential for middle-aged individuals with moderate fatigue.

I am at a loss in comprehending how the authors of the above-named review could speak of evidence for potential benefit. The evidence from the ‘observational study’ is largely irrelevant for deciding on the effectiveness of ginseng, and the second, more rigorous study fails to show that ginseng has an effect.

So, is ginseng a promising treatment for ME?

I doubt it.

4 Responses to Is GINSENG a promising herbal treatment for CFS/ME patients?

  • Question (to the investigators – second study):

    1. How do they define “middle age”? (Older than 50, but younger than what?)
    2. How do they define “moderate fatigue”?

    No definitions?
    No worthwhile outcome can be reported.
    So why report?
    Sigh.

  • Second study: “Due to the lack of statistical significance, we performed sub-group analysis.”

    As I’ve said elsewhere:
    Post hoc subgroup analysis is a pseudoscientific tactic to manufacture positive results. Often deployed in conjunction with convenience sampling.

    • @Pete Attkins
      I prefer the term “fishing trip”, also because this metaphor applies beyond the mere act of fishing: afterwards, the perpetrators and their fans start telling tales in which they not only caught a fish, but that fish is getting bigger and more fierce all the time. Up until the point that the existence of their fish is not only ‘scientifically proven’, but that they themselves are hugely offended if you dare poking holes in their story.

      • Richard, “fishing trip” is so appropriate for the reasons you’ve mentioned.

        The following are rather good (paraphrasing Wikipedia), especially the last one:
        QUOTE
        HARKing is an acronym coined by social psychologist Norbert Kerr that refers to the questionable research practice of hypothesizing after the results are known. Kerr (1998) defined HARKing as “presenting a post hoc hypothesis in the introduction of a research report as if it were an a priori hypothesis”. Hence, a key characteristic of HARKing is that post hoc hypothesizing is falsely portrayed as a priori hypothesizing. HARKing may occur when a researcher tests an a priori hypothesis but then omits that hypothesis from their research report after they find out the results of their test; inappropriate forms of post hoc analysis and/or post hoc theorizing then may lead to a post hoc hypothesis.

        THARKing Transparently hypothesizing after the results are known, rather than the secretive, undisclosed, HARKing that was first proposed by Kerr (1998).

        CHARKing (Rubin, 2017) or “pure HARKing” (Kerr, 1998) refers to the practice of constructing new hypotheses after the results are known and presenting them as a priori hypotheses.

        RHARKing refers to retrieving old hypotheses from the existing literature after the results are known and presenting them as a priori hypotheses (Rubin, 2017).

        SHARKing Suppressing a priori hypotheses after the results of tests of those hypotheses are known. (Kerr, 1998; Rubin, 2017).

        https://en.m.wikipedia.org/wiki/HARKing
        END of QUOTE

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