I have mentioned Ginseng in several posts, but have not done one doing a deep dive into it. Asian Ginseng has a reported benefit (40%) on the surveys and sSupplementation helped 56% in one PubMed study (2005)

• “Fatigue among subjects assigned to either placebo or Siberian ginseng was substantially reduced during the study, but differences between treatment groups were not statistically significant in the full sample.” [2004] – so the effect is small (if at all).
• “Ratings on the Visual Analogue Scale (VAS) revealed a reduction in pain (of Fibromyalgia) in the P. ginseng group (p < .0001), an improvement in fatigue (p < .0001) and an improvement in sleep (p < .001), with respect to baseline characteristics, but there were no differences between the three groups. With respect to anxiety, improvements occurred in the P. ginseng group compared to baseline (p < .0001); P. ginseng reduced the number of tender points and improved patients’ quality of life (using the Fibromyalgia Impact Questionnaire – FIQ); however, there were no differences between groups. “[2013]
• “consumption of white or red Korean ginseng (WG or RG) powder significantly increased the number of total bacteria and Lactobacillus strains compared to the control group.” [2014]

The main impact of ginseng appears to be on coagulation (and thus improved oxygen delivery resulting in less pain caused by cellular hypoxia).

• ” herbal medicines that inhibit platelet function (e.g., garlic, ginseng, or ginkgo)”  [2015]
• The influence of herbal medicine on platelet function and coagulation: a narrative review [2015]. “ginseng, green tea, and St John’s wort were found to have potential interactions with warfarin.”
• Study on improving blood flow with Korean red ginseng substances using digital infrared thermal imaging and Doppler sonography: randomized, double blind, placebo-controlled clinical trial with parallel design[2013].

Bottom Line

The amount of information on ginseng is less than ideal. It appears to have only a limited impact on the microbiome. I ascribe most of its positive effects are due to improving blood flow.

Cost to benefit appear low, so I would place it low on desired herbs and supplements.There are other items that are cheaper, just as effective on improving blood flow and more effective in shifting the microbiome.