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Ginseng and Ginseng Herbal Formulas for Symptomatic Management of Fatigue: A Systematic Review and Meta-Analysis.

  • 2023-02-01
  • Journal of integrative and complementary medicine 29(8)
    • Xiaotong Li
    • Mingxiao Yang
    • Yi Lily Zhang
    • Yen-Nien Hou
    • Colleen M Smith
    • Deborah Korenstein
    • Jun J Mao

Study Design

Type
Meta-Analysis
Population
patients with fatigue in randomized clinical trials
Methods
Systematic search of PubMed, Embase, Cochrane, Web of Science, and AMED; inclusion of 19 RCTs; pooled analyses and subgroup analyses
Objectives: Ginseng has been widely used in fatigue management. However, its efficacy on fatigue remains unclear. This study aimed to assess the efficacy and safety of ginseng and ginseng herbal formulas for fatigue in randomized clinical trials (RCTs). Methods: The authors searched PubMed, Embase, Cochrane, Web of Science, and Allied and Complementary Medicine Database (AMED) databases from inception to July 6, 2022. Outcomes included fatigue severity, quality of life (QoL), and adverse events (AEs). Quality of evidence was assessed using the Cochrane Risk of Bias Tool. They pooled all included data and performed subgroup analysis by fatigue type, assessment instrument, and ginseng type. Results: The authors included 19 RCTs. Pooled analyses found no significant reduction in fatigue severity with ginseng versus controls (standardized mean difference 95% confidence interval to 0.11, p = 0.13). In subgroup analysis, there was significant fatigue reduction with the ginseng herbal formula (SMD: -0.39, 95% CI: -0.66 to -0.13, p = 0.004) and chronic fatigue (CF) (SMD: -0.30, 95% CI: -0.56 to -0.03, p = 0.03) compared to controls. Ginseng produced significant reductions in general (i.e., non-disease-specific) fatigue compared to controls (SMD: -0.48, 95% CI: -0.71 to -0.25, p < 0.0001). Ginseng was associated with a trend toward QoL improvement (p = 0.05) and did not increase AEs compared with controls. Effect sizes were small. Conclusion: Ginseng herbal formulas improved fatigue severity compared to controls, especially among patients with CF, but with a small effect size. Rigorous RCTs as well as guidelines for standard ginseng usage are needed to further evaluate the effects of ginseng for fatigue and ensure proper use.

Research Insights

  • Ginseng→Improved Quality of Life

    Ginseng was associated with a trend toward QoL improvement (p = 0.05)

    Effect
    Neutral
    Effect size
    Small
  • Ginseng→Reduced Fatigue

    Pooled analyses found no significant reduction in fatigue severity with ginseng versus controls (standardized mean difference [SMD]: -0.36, 95% confidence interval [CI]: -0.82 to 0.11, p = 0.13).

    Effect
    Neutral
    Effect size
    Small
  • Ginseng→Reduced Fatigue Severity

    Ginseng produced significant reductions in general (i.e., non-disease-specific) fatigue compared to controls (SMD: -0.48, 95% CI: -0.71 to -0.25, p < 0.0001).

    Effect
    Beneficial
    Effect size
    Moderate

Adverse Events Reported

  • Ginseng→Overall tolerability

    Ginseng was associated with a trend toward QoL improvement (p = 0.05) and did not increase AEs compared with controls.

    Finding
    No significant difference
    Significant
    Yes
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