The clearing-up of misunderstanding on body temperature changes and heat responses after Panax ginseng or Panax quinquefolium intake

Abstract

The roots of Panax ginseng, known as Korean ginseng, have been widely used worldwide for treating many diseases and general health maintenance. Korean ginseng is perceived as safe owing to its natural origin, extensive historical uses, and accumulated scientific clinical studies in humans. According to oriental medicine theory, Panax ginseng is categorized as having warm properties, while Panax quinquefolium, called American ginseng, is classified as having cool properties. Based on this, it is said that Panax ginseng might cause an elevation of body temperature, such as sensations of warmth or heat, whereas Panax quinquefolium provides cooling effects. However, scientific evidence for comparing these parallel thermogenic effects of two species is scarce. This focused review summarizes clinical trials and animal studies regarding the heat responses of two Panax species. This review aims to provide an overview of current scientific data on the thermogenic effects inducing a heat sensation and a hot feeling of Korean ginseng and American ginseng.

Graphical abstract

1. Introduction

Panax ginseng C. A. Meyer (PG) has been used for centuries in traditional medicine as a remedy for various ailment [[1], [2], [3], [4]]. In traditional Chinese medicine (TCM), medicinal ginseng refers to the dried tubers and roots of PG of the Araliaceae family. This herbal medicine has a rich history, being recorded in ancient medicinal books such as the Shen Nong Ben Cao Jing (around AD 200) and other medical books [5]. In ancient times, ginseng was considered a valuable medicinal material for nourishing the body, treating physical weakness, and enhancing bodily functions [6]. Phytochemical and pharmacological studies on ginseng have identified various pharmacologically active compounds [[7], [8], [9]], such as ginsenosides [10,11], polysaccharides [[12], [13], [14]], and volatile oil esters [15]. Studies have shown pharmacological effects of ginseng, such as adaptogenic effects [16], improvement of blood circulation [17,18], immune-modulatory [[19], [20], [21]], strong cognitive [22], and anti-oxidative effects, all of which have increased its medicinal value of ginseng [23]. Ginseng intake has good safety records built from many scientific clinical studies in humans and from long traditional uses [24,25]. In addition, it has not only been used for medicinal purposes but as a healthy ingredient in wine, tea, and many food dishes, supporting its safety for human uses [26]. There are two different species of ginseng commonly used under the same name as ginseng to the public: PG and Panax quinquefolium (PQ). Oriental medicine categorizes the root of PG as having a warm property, while the leaves of PG are classified as having a cool property [27]. In contrast, PQ is described as a cool property [28]. PQ, which is known as American ginseng, was first discovered in Canada in 1716, following the introduction of PG to Europe by Father Jartoux during his visit to Manchuria in the Qing dynasty [29]. Therefore, it appears that the classification of PQ as having cool properties is relatively recent compared to that of PG. Based on this classification, PG is stimulating and may cause a hot sensation, while PQ tends to have cooling effects. The traditional medicinal book prescribes ‘Clear summer heat and augment qi decoction’ for summer heat, which contains ginseng [30]. There are two different prescriptions for this “QingShuYiQiTang (清暑益氣湯)”. Li Donghuan uses PG, while Wang Mengying uses PQ. According to this theory, PG intake increases body temperature, whereas PQ can lower body temperature. Given that body temperature is very well maintained through homeostasis, this theory requires further validation regarding its effect. Regarding the definition of “heat”, fever is the behavior of the body to raise its temperature and promote the activity of the immune system due to the body's inflammatory response [31]. The term “Shanghuo (上火)” refers to a mild illness in TCM and Chinese folklore; swollen throat, red eyes, toothache, and other symptoms caused by consuming too much spicy and greasy food, burn-out, stressful life, seasonal change or late nights [32,33]. The symptoms of “Shanghuo” affect multiple parts of the body and can be broadly categorized as follows; (1) digestive system: dry stool, constipation, morning diarrhea, vomiting; (2) endocrine system: increased thirst; (3) immune system: nasal sores and boils, sore and swollen throat, skin eruptions; (4) urinary system: dark-colored urine; (5) nervous system: irritability, dizziness, nervousness, insomnia, agitation, headache; (6) circulatory system: palpitations, nosebleeds; (7) other symptoms: red and dry eyes, nasal dryness, increased ocular discharge with heat sores, oral ulcers, swollen and sore gums, angular cheilitis, tongue soreness [[33], [34], [35]]. The concept of “Seungyeol (昇熱)” used in Korea, on the other hand, tends to describe a hot face with a feverish sensation or heat due to stressful emotion, and does not refer to high body temperature. “Shanghuo” has little to do with changes in body temperature, and “Seungyeol” is different with “Shanghuo”. Several points need clarification regarding the effects of ginseng. First, does the heat response occur solely with PG and not with PQ? Second, does this response genuinely manifest at normal recommended dosages? Finally, what data exists to support the cooling effects of PQ? This focused review summarizes English-published studies using the PubMed search engine to provide scientific evidence on the effects of PG and PQ concerning body temperature and heat response. Studies on heat response or metabolic changes associated with the thyroid were excluded because these conditions are diseases rather than temporary discomforts or complaints. Ginseng is generally considered safe, with only a few mild and reversible side effects reported [36]. However, as its use and popularity grow, there is increasing demand for information on the safe use of ginseng. This mini review presents current knowledge regarding ginseng and heat response, evaluating the scientific basis for the warm and cooling properties of PG and PQ.

2. Animal studies of ginseng for heat response

Studies of ginseng on heat changes in animal models are summarized in Table 1, Table 2. A study from 1996 showed that PG at a dose of 2 μg/g showed cold tolerance and recovery from hypothermia [37]. PQ of 10 mg/kg showed a beneficial effect on cold tolerance and increased thermogenesis, with ginsenoside-Rg1 being the key ingredient for the response [38]. These two reports show that both PG and PQ are effective in fighting cold temperatures. Park et al. (2014) compared PQ and PG of both single dose (1 g/kg) and four weeks of 0.2 g/kg/day on body temperature, oxygen consumption, and activity [39]. The authors argued that a high single dose of PQ injection significantly reduced night-time body temperature. No other significant difference was observed. Another comparative study of PG and PQ also didn't observe body temperature change, although PG is better at maintaining body temperature under low-temperature environments [40]. The study conducted by Xu and Dou (2016) investigated the effects of different types of ginsengs on energy metabolism in mice. Changes in physical characteristics and energy metabolism indexes were examined after administration of PG (4.5 g/kg/day), PQ (3.0 g/kg/day), RG (4.5 g/kg/day), and ginseng leaves (4.5 g/kg/day), to mice twice a day for 31 days [34]. Authors stated that PG and RG enhanced energy metabolism measured by oxygen consumption, carbon dioxide production, heat production, and energy expenditure. However, the data shows that only PG but not RG enhances oxygen consumption and energy expenditure during the night only after 30 days. The rectal temperature for PG was higher than the control group at 25 days, and PQ also showed significantly higher temperatures compared to the control. It seems that the rectal temperature varies from mouse to mouse, as indicated by the temperature of the control group. The authors suggested PG and RG have inherent thermogenic properties, potentially linked to increased energy metabolism and ‘drying’ effects, and liver Na⁺-K⁺-ATPase activity may serve as a crucial indicator of ginseng's ‘fireness’ syndrome. In some measurements, RG was not significantly different from PQ. Moreover, PQ did not show a notable cooling effect at low doses when compared to PG.

Table 1.

Animal studies of ginseng on body heat response.

Subjects	Ginseng	Dosage, duration	Measurement	Results	Ref
Wistar albino rats (male), n = 38	PG	0.1–2.0 μg/g, single injection (PO)	Body temperature maintenance	Body temperature recovered	[37]
SD rats (male), young (3–8 months, n = 14), old (26–28 months, n = 8)	PQ	5–20 mg/kg, single injection (IP)	Cold tolerance, thermogenesis	Increased body temperature and thermogenesis	[38]
ICR mice (male), n = 22	PG, RG, PQ	Acute: 1000 mg/kg/day, single Chronic: 200 mg/kg/day, 4 weeks (PO)	Body temperature	NS	[39]
ICR mice (male), n = 24	PG, PQ	300 mg/kg, single injection (PO)	Different models: 1.Hyperthermic 2.Normothermic 3.Hypothermic	PG maintained body temperature in a cold environment	[40]
KM mice (male), n = 150	PG, RG, PQ	PG, RG: 4.5 g/kg/day, 31 days PQ: 3.0 g/kg/day, 31 days (PO)	Rectal temperature	PG vs. control p < 0.05, ↑ RG vs. control p < 0.05, ↑ PQ vs. control, NS	[34]
SD rats (male), n = 8	PG	200 mg/kg/day, 4 weeks (PO)	Body temperature	NS	[41]
CD-1 (ICR) mice (male), n = 30	PG	0.075 g/ml PG 0.1 ml/10 g/day, 20 days (PO)	Thermogenic capacity	Increased RMR	[42]
Wistar rats (male), n = 200	RG, PQ	RG, PG: 6.64 g/kg/day, 30 days PQ: 4.42 g/kg/day, 30 days (PO)	Rectal temperature	RG and PG vs. control p < 0.05 ↑ PQ vs. control p < 0.05 ↓	[43]

NS: not significant; PG: Panax ginseng; RG: red ginseng; PQ: Panax quinquefolium.

RMR: resting metabolic rate; PO: Oral; IP: Intraperitoneal; ↑: increased; ↓:decreased.

Table 2.

Summary of measured and observed phenomena on the body heat response animal studies.

Ginseng	Measurements	Observed phenomena	Ref
PG	•Rectal temperature •Appearance change •Liver Na + -K+-ATPase activity •Oxygen consumption, carbon dioxide production •Saliva secretion •Urine and manure excretion	•Cold tolerance and recovery from hypothermia •Rectal temperature higher than the control group (p < 0.01)) •IgA, IgG and IL-6 levels increased (p < 0.05) •Increased nocturnal oxygen consumption and CO2 production •Lactobacillaceae and Prevotella was abundant	[37] [39] [40] [34] [41] [42]
RG	•Rectal temperature •Appearance change •Liver Na + -K+-ATPase activity •Oxygen consumption, carbon dioxide production •Saliva secretion •Urine and manure excretion •Blood pressure and heart rate •IgA, IgG, IL-6 level •Gut microbiome	•Rectal temperature higher than the control group (p < 0.01) •IgA, IgG and IL-6 levels increased (p < 0.05)	[39] [34] [43]
PQ	•Body temperature •Appearance change •Liver Na + -K+-ATPase activity •Oxygen consumption, carbon dioxide production •Saliva secretion •Urine and manure excretion •Blood pressure and heart rate •IgA, IgG, IL-6 level •Gut microbiome	•High dose of PQ reduced night-time body temperature (p < 0.05) •Lactobacillus was dominant, and its abundance was higher than control group (p < 0.05)	[38] [39] [40] [34] [43]

PG: Panax ginseng; RG: red ginseng; PQ: Panax quinquefolium.

Cho et al. (2017) examined the changes in body temperature using PG prepared at different steaming times. Increasing steaming time led to changes in ginsenoside composition. The administration of 0.2 g/kg ginseng extracts of 3, 6, and 9 h steaming for 4 weeks did not significantly affect body temperature, blood pressure, or thermogenesis-related factors in rats compared to the control. In addition, a 5-day treatment of ginsenosides 10 mg/kg of PG and 9 h steamed RG did not show any difference [41]. The study concluded that the potential undesirable effects of PG on body temperature could not be solely explained by the difference in ginsenoside composition. Wu et al. (2020) compared the differences in the thermogenesis of PG and leaves of PG [42]. The rest metabolic rate was lower in ginseng leaves and higher in PG compared to control. Respiration was significantly increased in PG compared to the control, but the opposite was observed with ginseng leaves. The dosage was 0.75 g/kg and administered daily for 18 days. This dosage may be different from the other publications in that the preparation of the extract was done in-house.

Dou group (2022) investigated the effects of PG, PQ, and RG in Wistar rats, administering 6.64 g/kg/day of PG or RG and 4.42 g/kg/day of PQ for 30 days. The authors suggested that PG showed fireness symptoms, while the ginseng leaves showed the opposite. The rectal temperature of PQ was significantly lower compared to the control in week 4. The level of IL-6 was measured each week, and at the end of week 4, an increase in IL-6 was observed with PG and ginseng leaves and not RG and PQ, indicating immune activation and potential inflammation [43]. PG and PQ modulated gut microbiota imbalance and ginseng leaves can even decrease bacterial diversity. The authors suggested that although the adverse effects of ginseng are mild and reversible, they should be monitored.

In summary, several studies have attempted to prove the difference in PG and PQ using animal models on either immediate or latent heat response. It appears to have some effect on adaptation to the combating cold stress of PG depending on dosage and duration of use. The effect on metabolism and maintenance of hemostasis studies will aid in understanding the effect of PG on metabolic diseases such as diabetes and atherosclerosis.

3. Clinical studies of ginseng on body heat response

The impact of ginseng on heat response can be judged by testing some physiological indicators after taking ginseng, such as body temperature, blood pressure, and markers related to energy metabolism. First, to understand ginseng's heat response, related clinical studies have been summarized in Table 3, Table 4. Lee et al. (2012) tested the safety of ginseng by dividing 170 subjects into three groups given different doses of ginseng extract and a placebo. The three groups were given 500 mg ginseng extract capsules, 1000 mg extract capsules and a placebo to be taken twice a day for four weeks. Blood parameters, biochemistry tests, urinalysis, and adverse symptoms were measured and recorded at the end of the treatment. The results showed that the blood and biochemical tests were within normal limits at baseline. Subjects in all groups experienced different adverse effects, such as hot flashes, lack of energy, and insomnia. Hot flashes were reported in 3–4 cases in each group, but this could be due to menopausal women in the participants. The differences between the groups were not significant (p = 0.895). These adverse symptoms were judged to be mild and self-resolving. Several physiological tests and other data from the study showed that there was no significant change in the physiological parameters of the volunteers who took the ginseng extract. At the same time, there was no significant difference in the occurrence of adverse effects among the groups, and resolved spontaneously after discontinuation [44]. Zhang et al. (2019) divided 180 subjects equally into three groups and administered red ginseng of PG (steamed and dried ginseng; RG) 1.8 g/day, 3.6 g/day, and placebo, respectively, for four weeks. During this period, specific symptoms (body temperature, dry mouth, dry eyes, sore throat, etc.) and the degree of symptoms were recorded daily for the fire-heat symptoms scale. According to the experiment results, all groups showed a gradual decrease in fire symptom scores over time during the 4-week treatment period. The difference before and after treatment was significant (p < 0.05). The study analyzed whether taking RG would cause heat response by combining scores from symptoms judged the changes of each index with time, and concluded that RG did not have much effect on heat response [35]. Zhao et al. (2020) evaluated the effects and mechanisms of RG on energy metabolism by assessing levels of enzymes related to respiration and energy metabolism and serum metabolite levels. After taking 3 g of RG per day for 16 consecutive days, 30 subjects who met the TCM criteria for determining “Shanghuo” (at least one major symptom and two minor symptoms) underwent a blood test to detect the levels of relevant metabolites and enzymes in the blood. The results showed an increase in metabolite indices in the samples of the experimental group, an increase in the level of succinate dehydrogenase, an important enzyme in the tricarboxylic acid cycle, and a significant increase in the activity of AMPK. The authors concluded that RG promotes energy metabolism and induces thermogenesis in the body by accelerating the tricarboxylic acid cycle and increasing the activity of AMPK. The study used a before-and-after controlled experimental method and did not have a placebo control group. The placebo effect cannot be ruled out. The results showed that taking ginseng can enhance metabolism, but this is not directly related to some of the symptoms of “Shanghuo” (headache, sore throat, dry mouth) [33]. Park et al. (2022) showed that the head and face temperatures of the ginseng experimental group were not affected in the comparison experiments of RG, black ginseng (three to nine times steamed and dried ginseng; BG), and placebo. In a randomized, double-blind trial, 160 subjects were given 2 g of the corresponding ginseng per day for 6 weeks and were tested for blood and lipid metabolism and adverse effects. The results showed that there was no significant change in the head and face temperatures and metabolic parameters of the volunteers. Twenty-three people experienced adverse reactions, but the difference between the groups was not significant (p = 0.705), and there were no serious adverse reactions. This paper concluded that BG and RG did not have a significant effect on metabolism and body temperature [45].

Table 3.

Clinical studies of ginseng on body heat response.

Clinical design	Subjects	Ginseng	Dosage and duration	Measurement	Results	Ref
Double-blind randomized controlled trial	41 males and 129 females aged 18-60	PG	1 g/day (n = 56), 2 g/day (n = 57), placebo (n = 57), 4 weeks	Questionnaire of adverse reactions, hematology, chemistry, and urinalysis test	NS	[44]
Double-blind randomized controlled trial	55 males and 125 females aged 18-60	RG	A: 1.8 g/day (n = 60), B: 3.6 g/day (n = 60), C: placebo (n = 60), 4 weeks	Total fire-heat score	A vs C: NS B vs C: NS	[35]
Before-after intervention trial	14 males and 16 females aged 18-60	RG	3 g/day, 16 days	Serum metabolic products	Increased SDH activity and mRNA expression of AMPK, PGC-1α and NRF1 (p < 0.05)	[33]
Double-blind randomized controlled trial	166 males and females aged 20-64	BG, RG	A: BG (n = 58) B: RG (n = 55) C: placebo (n = 53) 2 g/day, 6 weeks	Head, face, tympanic temperature	A vs C: NS B vs C: NS	[45]

PG: Panax ginseng; NS: not significant; BG: black ginseng; RG: red ginseng; SDH: Succinate Dehydrogenase; AMPK: adenosine monophosphate-activated protein kinase; PGC-1α: PPARγ Coactivator 1 Alpha; NRF1: Nuclear Respiratory Factor 1.

Table 4.

Summary of measured and observed phenomena on the body heat response clinical trials.

Ginseng	Measured	Observed phenomena	Ref
PG	•Adverse reaction •Hematology test (white blood cells, segmented cells, monocytes, lymphocytes, red blood cells, etc.) •Biochemistry test (total protein, albumin, albumin/globulin ratio, total bilirubin, etc.) •Urinalysis test (glucose, bilirubin, ketones, specific gravity, blood, pH, protein, etc.)	•Only minor adverse reactions •No significant change from baseline in each group	[44]
RG	•Body temperature •Adverse reaction •Metabolic makers (serine, valine, heptacosane, xylose, glycerol 1-monostearate, etc.) •SDH enzyme activity •Expression of AMPK, PGC-1α and NRF1 mRNA	•Body temperature: NS •Only minor adverse reactions •Elevated 15 metabolites •Reduced cholesterol (p < 0.05) •Higher SDH enzyme activity(p < 0.05) •Increased AMPK, PGC-1α and NRF1 mRNA (p < 0.05)	[35] [33] [45]
BG	•Body temperature •Adverse reaction	•Body temperature: NS •Only minor adverse reactions	[45]
PQ	No data

PG: Panax ginseng; NS: not significant; BG: black ginseng; RG: red ginseng; SDH: Succinate Dehydrogenase; AMPK: adenosine monophosphate-activated protein kinase; PGC-1α: PPARγ Coactivator 1 Alpha; NRF1: Nuclear Respiratory Factor 1.

In summary, the use of 1–3 g of ginseng does not influence body temperature or fever, although the number of clinical experimental studies on ginseng is only a few. In addition, a meta-analysis of these studies was not possible because the measurements differ from each study, and it was not possible to estimate the overall effect of clinical studies in Table 3. With the currently available data on healthy people, no data showed significant changes in body, head, or face temperature.

4. Discussion

Panax has 11 different species. PG is the species used traditionally. According to global fresh ginseng production of 86,223 tons is valued to be approximately $5900 million, spent approximately 48.6 % in China, 42.2 % in South Korea, 8.1 % in Canada, 0.9 % in the USA, 0.1 % in Japan, and 0.1 % in other countries [46]. PG and PQ are exported worldwide, produced mostly in four countries: South Korea, China, Canada, and the USA. The world's largest consumers of ginseng are China, Hong Kong, Taiwan, Singapore, and Korea. Over 10,000 papers have shown health-promoting effects of PG, such as flu prevention, immune-boosting, anti-fatigue, memory improvement, antioxidant activity, blood circulation improvement, menopause symptom relief, anti-diabetes, prevention, and treatment of atopic dermatitis. The ginseng market is expanding as a health food, medicine, cosmetics [47], and pet food [48]. With this expansion, it is important to differentiate the PG, PQ, and RG. It should be used more accurately for medicinal or health-promoting purposes rather than all under the name of ginseng. This review aimed to understand the upper body hot feeling response of PG and PQ. As described in the results, it is hard to conclude that only PG but not PQ induces hot feelings, especially in the upper body. A recent review by the Yuan group summarized 44 controlled clinical studies showing obvious beneficial effects of ginseng with no obvious adverse effect [49]. Especially some clinical studies from the Mayo Clinic and MD Anderson Center carefully measured safety issues and tolerability profiles. Furthermore, toxicological analyses regarding subacute and subchronic investigations also show no noticeable toxic effects [50]. PG, PQ, and other Panax species should be regarded as different herbal preparations, and each should be judged by its scientific data, and comparison should be made only comparable data is available. Herbal extracts can vary due to different preparation methods. Therefore, toxicological and functional studies should utilize standardized preparations that include information on concentration, dosage, and duration. This is essential for expanding the use of ginseng among consumers and patients, whether for medicinal purposes, as an adjunct therapy, or as an ingredient in cosmetics. The reported benefits of ginseng should be carefully considered in relation to the sources used in its preparation, such as RG, PG, or PQ. A search for the keyword ‘PQ’ yields approximately 700 results in PubMed, while ‘PG’ shows around 10,416 results. This suggests that most ginseng research has been conducted using PG. As mentioned, with the discovery of similar species in North America in 1716, PQ slowly emerged in the market. PQ is given cool properties, and advertisers suggest that it may be particularly suitable for hot climates such as the southern part of China and southeast Asia. It is ironic that an article published in a Korean newspaper on February 1, 1923, states that Korean ginseng is more popular in the southern regions of China than in the northern region [51]. Additionally, eating hot boiling chicken soup with ginseng and red date is a traditional practice in Korea on the 3 hottest days of the year (initial summer, mid-summer, and last summer) based on the lunar calendar. This event is called “yi yeol chi yeol (以熱治熱)”, which means ‘fight fire with fire’. This ginseng chicken soup is high in protein and improves circulation, helping to balance body temperature with the external temperature [52]. Studies from Univ. Ottawa showed that warm liquids adjust body temperature better on hot days than cold drinks, possibly by promoting perspiration [53].

The balance between yin (cool, water, and calming energy) and yang (warm, fire, and invigorating energy) is central to traditional oriental philosophy. In TCM, PQ is believed to enhance yin energy, helping to cool the body and alleviate heat-related conditions such as fever or discomfort from hot weather. In contrast, PG is thought to promote yang energy, improving blood circulation and stabilizing internal ‘heat’ [39]. This heat is often associated with conditions like stress, menopause, or high blood sugar [54]. TCM theory believes that eating too much ‘warm’ food, such as red dates, mutton, longan, etc., can lead to a condition known as “Shanghuo” [55]. Despite these considerations, individuals continue to consume these so-called ‘warm’ foods in their diets. Ginseng is a potent nutraceutical drug that is used to fight fatigue and improve metabolism [56] and recognized as a ‘warm’ food in TCM theory. To maximize the safety of taking ginseng, the first step is to ensure the proper dosage, generally speaking, adults take 1.5 g–6 g per day [57]. Moreover, in TCM, other Chinese herbal medicines are co-prescribed with ginseng based on the “emperor-minister-assistant-courier (君臣佐使)" principle to alleviate the discomfort caused by the ginseng. For example, Coptidis Rhizoma can be used in combination [58]. For individuals with robust metabolic activity, which manifests as heat syndrome (熱證) or hyperactivity of the liver (肝陽上亢), further consumption of ginseng that is ‘warm’ may have adverse effects on their bodies [35,57]. The Sasang medicine of Korean traditional medicine categorizes people's physique into four groups, Taeyangin (太陽人), Soyangin (少陽人), Taeeumin (太陰人), and Soeumin (少陰人). Taking ginseng is recommended for the Soeumin [59]. Details are depicted in Fig. 1. From the results of the clinical studies discussed in the previous section, none of the four clinical trials regarding the body temperature after ginseng consumption showed significant change. Zhao et al. (2020) showed that ginseng can increase AMPK activity, improving energy metabolism efficiency, and thus enabling the body to produce more energy and heat [33]. Like the state after exercise, the elevated energy metabolism after taking may increase heat production and produce a feeling of heat without any significant change in body temperature, which might have misled perception that taking ginseng causes fever. We have summarized the comparison of the TCM and clinical results on PG and PQ in Table 5. In summary, modern clinical and toxicological studies have shown ginseng is a safe herb when used within the recommended dosage.

Fig. 1.

Sasang constitutional medicine-Sasang Human Theory. The four types of people are categorized according to the different states of their organs in the Sasang constitutional medicine. It describes the psychological, physical, and dietary habits of these four groups of people.

Table 5.

Compares TCM and scientific results on PG and PQ.

	TCM	Scientific Results
Classification	PG: Warm (熱性); raises body heat PQ: Cool (涼性); lowers body heat	No significant body temperature changes
Body Temperature Changes	PG increases heat sensation PQ stabilizes or cools	No measurable changes in clinical trials
Symptoms or Effects	Heat sensations like “Shanghuo”(上火) or “Seungyeol”(昇熱) for PG users	Mild, rare hot sensations unrelated to heat regulation
Dosage Recommendations	1.5 g–6 g/day depending on body constitution	Standard dosages show no adverse effect
Adverse Reactions	PG may exacerbate heat-related conditions	Reactions like hot sensations are reversible and rare

TCM: traditional Chinese medicine; PG: Panax ginseng; PQ: Panax quinquefolium.

5. Conclusion

This review collates animal experiments as well as clinical trials on ginseng concerning body temperature. These results show that ginseng does not significantly affect body temperature or heat response. Clinical trials on the safety of ginseng have shown that taking proper ginseng dosage does not cause any serious adverse reactions. If a person is allergic to a PG or PQ ingredient, the adverse reaction will subside when they stop taking it. In conclusion, as a natural medicine with a rich history of use, ginseng has a high safety profile, but it should be taken under the guidance of traditional and modern medicine as with all other alternative and complementary medicine.