March 24, 2014

Siberian Ginseng: A Review of the Literature

The research behind this popular adaptogen
Siberian ginseng is a small, woody shrub native to southeastern Russia, northern China, Korea, and Japan. Although Eleutherococcus senticosus is not related to true ginseng (Panax ginseng), the name Siberian ginseng became popular because the two plants shared some similar properties.

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Related Terms

  • 1',5'-O-dicaffeoylquinic acid, 2,6-dimethoxy-4-[(1E)-3,3-dimethoxy-1-propenyl]phenyl beta-D-glucopyranoside, 2,6-dimethoxy-4-(3-hydroxy-propen-1-yl) phenyl-4-O-alpha-L-rhamno-pyranosyl-(1->6)-beta-D-glucopyranoside, 3-(4-O-beta-D-glucopyranosylferuloyl)quinic acid, 3,4-seco-lupane-20(29)-ene-3,28-dioic acid, 3',5'-O-dicaffeoylquinic acid, 4',5'-O-dicaffeoylquinic acid, 5'-O-caffeoylquinic acid and isomers, (7R,8S)-dihydrodehydrodiconiferyl alcohol 4,9'-di-O-beta-D-glucopyranoside, Acanthopanax senticosus, acanthopanaxoside E (3-O-beta-D-glucuronopyranosyl echinocystic acid 28-O-beta-D-glucopyranoside), acanthosides, ADAPT-232, aglycone, alimoxide, alpha-bisabolol, alpha-longipinene, arabinose, Araliaceae (family), Argoeleuter tablets, benzyl-O-alpha-L-rhamno-pyranosyl (1->6)-beta-D-glucopyranoside, beta-sitosterol, caffeic acid, carbohydrate, chlorogenic acid, Circu-ForteTM, Circulat®, ci wu jia (Chinese), ci wu ju (Chinese), ciwujia (Chinese), ciwujianoside B(1), ciwujianoside C(1), ciwujianoside C(2), ciwujianoside C(3), ciwujianoside C(4), ciwujianoside D(1), ciwujianoside D(2), ciwujianosides, ciwujiatone, complex polysaccharides, copteroside B, devil's bush, devil's shrub, dihydrodehydrodiconiferyl alcohol monopyranose, (E)-anethole, Eleu-kokk®, eleuterozid B, eleuterozid C, eleuterozid D, eleuthera, eleutheran, eleutheran A, eleutheran B, eleutheran C, eleutheran D, eleutheran E, eleutheran F, eleutheran G, eleuthero, eleuthero ginseng, eleutherococc, Eleutherococci radix, Eleutherococcus, eleutheroside B, eleutheroside B1, eleutheroside E, eleutheroside E(1), eleutheroside E(2), eleutherosides, episyringaresinol 4"-O-beta-D-glucopyranoside, erythro-1,2-bis(4-hydroxy-3-methoxyphenyl)-1,3-propanediol, erythro-1-(4-hydroxy-3-methoxy-phenyl)-2-{4-[(E)-3-hydroxy-1-propenyl]-2-methoxy-phenoxy}-1,3-propanediol, essential oil, extractum eleutherococci fluidum, ezoukogi (Japanese), ferulic acid, flavonoids, free phenolic acids, galactose, ginseng, ginsenosides, glucopyranosides, glucose, glucuronic acid, glycans, glycosides, guaia-6,9-dien-4beta-ol, gypsogenin 3-O-beta-D-glucuronopyranoside, Hedera senticosa, hederagenin 3-O-beta-D-glucuronopyranoside 6'-O-methyl ester, hyperin, hyperoside, Hyul-Tong-Ryung, Immuplant tablets, iridoid glycosides, isofraxidin, isofraxidin chiisanoside, isomaltol 3-O-alpha-D-glucopyranoside, Kan Jang®, Kan-Yang, lignans, lycoperodine-l, lyoniresinol, mannose, manyprickle acanthopanax, minerals, monoterpenoids, nicotinamide, oplopanone B, p-coumaric, phenolic acids, p-hydroxybenzoic, phytoestrogen, phytosterols, polyphenols, prickly eleutherococc, protein, protocatechuic acid, rel-5-(1R,5S-dimethyl-3R,4R,8S-trihydroxy-7-oxa-6-oxobicyclo[3,2,1]oct-8-yl)-3-methyl-2Z,4E-pentadienoic acid, rhamnose, rosmarinic acid, Russian root, rutoside, salvadoraside, schisandrin B, senticoside, sesamin, sesquiterpenoids, shigoka, Siberian ginseng wuchaseng extract, silphioside F, spiny eleutherococcus, stigmasterol, sucrose, syringaresinol, diglucoside, syringaresinol-di-O-beta-D-glucoside, syringic acid, syringin, tachioside, Taiga Wurzel, thorny bearer of free berries, thorny pepperpush, thymidine, thymol, tortoside A, touch me not, triterpene saponins, triterpenoid saponins, untouchable, uronic acid, ussuri, ussurian, vanillic, vitamins, wild pepper, wu jia pi, wuchaseng, wu-jia, wujiaseng, xylose.

Select combination products:

  • ADAPT-232 (containing Rhodiola rosea, Schisandra chinensis, and Siberian ginseng), AdMax® (dried ethanol-water extracts from roots of Leuzea carthamoides, Rhodiola rosea, Eleutherococcus senticosus, and fruits of Schisandra chinensis), Aidi Injection (cantharis, Astragalus mempanaceus, Acanthopanax senticosus root, Panax ginseng), Chisan® (extracts of Rhodiola rosea L., Schisandra chinensis Turcz. Baill., and Eleutherococcus senticosus Maxim.), Circulat® (also called Circu-ForteTM) (Siberian ginseng root, Rhaponticum carthamoides root, Panax ginseng root, Panax quinquefolius root, Pfaffia paniculata root, Rhodiola rosea root, Echinacea angustifolia root, Echinacea purpurea root, Ganoderma lucidum, Grifola frondosa, Hydrastis canadensis, Petiveria alliacea, Sutherlandia frutescens, Tabebuia avellanedae bark, Uncaria tomentosa root, Angelica sinensis root, Crataegus oxycantha fruit, Croton lechleri bark resin, Gingko biloba leaf, Hydrocotyle asiatica, Ruscus aculeatus root, Vaccinium myrtillus fruit), HT008-1 (composed of Panax ginseng, Siberian ginseng, Angelica sinensis, and Scutellaria baicalensis), Hyul-Tong-Ryung (Salvia miltiorrhiza, chrysanthemum, Acanthopanax senticosus, Cinnamomi ramulus, Eucommiae cortex, licorice, Puerariae radix, Crataegi fructus, Cassiae semen, safflower, peony root, dong quai), ImmunoGuard® (Andrographis paniculata Nees, Eleutherococcus senticosus Maxim., Schizandra chinensis Baill., and Glycyrrhiza glapa L. extracts), Kan Jang® (Echinacea purpurea, Adhatoda vasica, and Eleutherococcus senticosus), Kan-Yang (Andrographis and Siberian ginseng).

Background

  • Siberian ginseng (Eleutherococcus senticosus, also known as Acanthopanax senticosus) is a small, woody shrub native to southeastern Russia, northern China, Korea, and Japan. Although Eleutherococcus senticosus is not related to true ginseng (Panax ginseng), the name Siberian ginseng became popular because the two plants shared some similar properties.
  • Use of Siberian ginseng may date back over 2,000 years in China. Traditionally, Siberian ginseng has been used as an adaptogen, a compound that increases one's ability to adapt to environmental factors, including physical and emotional stress. Overall, there is currently little clinical evidence on the use of Siberian ginseng for this purpose or to treat any medical condition in humans.
  • Siberian ginseng is called ci wu ju in traditional Chinese medicine (TCM). In TCM, Siberian ginseng is used to invigorate qi; strengthen the spleen; nourish the kidney; provide energy and vitality; and treat high blood pressure, inflammation, respiratory tract infections, ischemic heart disease, spasms, and hepatitis. In traditional Russian medicine, Siberian ginseng is used to stimulate the immune system. Shigoka, the Siberian ginseng rhizome, is a traditional medicine used as a tonic in northeastern Asia and far eastern Russia. It has also been used in traditional Korean medicine as a tonic and adaptogen to strengthen qi. Siberian ginseng is among the five adaptogens most commonly used by Western herbalists.
  • Siberian ginseng has been added to yogurt products. Eleutherosides, active components of Siberian ginseng, have withstood pasteurization. Siberian ginseng is also called "eleuthero" in some products.

Scientific Evidence

Uses

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. 

Grade*
Adaptogen

Siberian ginseng has traditionally been used as an adaptogen, a compound that increases one's ability to adapt to environmental factors, including physical and emotional stress. Studies have investigated the effect of Siberian ginseng on increasing energy, reducing fatigue, and on enhancing exercise performance. Additional research is needed in this area.

C
Cancer

Siberian ginseng root has been suggested as part of a holistic approach to the treatment of prostate cancer. Preliminary evidence suggests that a combination therapy that includes Siberian ginseng may increase survival time in patients with advanced cancer. Additional research is needed in this area.

C
Cognitive function

Preliminary evidence suggests that a combination product (containing Siberian ginseng, Rhodiola rosea, and Schisandra chinensis) improved cognitive function in females. Additional studies of Siberian ginseng alone are needed.

C
Diabetic foot ulcers

Preliminary evidence suggests that a combination therapy that contains Siberian ginseng had a beneficial effect on diabetic foot ulcers. Additional studies of Siberian ginseng alone are needed.

C
Exercise performance enhancement

Siberian ginseng has been traditionally used as an exercise performance enhancement agent. Results of clinical studies have been mixed. Additional research is needed in this area.

C
Familial Mediterranean Fever

Preliminary research suggests that a combination product containing Siberian ginseng may reduce symptoms of familial Mediterranean fever. Further studies of Siberian ginseng alone are needed.

C
Fatigue

Preliminary research suggests that Siberian ginseng may reduce the severity and duration of fatigue in patients with less severe chronic fatigue syndrome. However, the results of other studies are not in agreement. Additional research is needed in this area.

C
Genital herpes

Limited research suggests that Siberian ginseng may reduce the severity, duration, and frequency of outpeaks of genital herpes after three months of use. Further research is required before conclusions can be made.

C
Immunomodulation

The effect of Siberian ginseng, alone and in combination with other herbal ingredients, has been investigated, with mixed results. Additional research is needed in this area.

C
Influenza

Research suggests that a combination treatment containing Siberian ginseng may contribute to quicker recovery and reduce the risk of postinfluenza complications. Further studies on the effect of Siberian ginseng alone are needed.

C
Low blood pressure (neurocirculatory)

Preliminary data suggest that use of Siberian ginseng extract may increase blood pressure in individuals with neurocirculatory low blood pressure. Further evidence is required before conclusions can be made.

C
Menopause

Preliminary research on a combination product containing Siberian ginseng suggests a lack of an effect on reducing menopausal symptoms, such as hot flashes. Further studies with Siberian ginseng alone are needed.

C
Osteoarthritis

In patients with knee osteoarthritis, a combination product (containing Panax notoginseng, Rehmannia glutinosa, and Siberian ginseng) improved pain and physical function. Research on the effect of Siberian ginseng alone is needed.

C
Osteoporosis

A combination therapy containing low-dose calcium, vitamin D3, Rehmannia glutinosa, and Siberian ginseng was more effective in treating decreasing bone mineral density in postmenopausal women than high doses of calcium and vitamin D3 alone. Research on the effect of Siberian ginseng alone is needed.

C
Pneumonia

Preliminary research suggests that use of a combination product containing Siberian ginseng may reduce the need for antibiotics in patients with pneumonia. Additional studies on the effect of Siberian ginseng alone are needed.

C
Quality of life

A small, preliminary study suggested that Siberian ginseng may not improve quality of life in the elderly. Additional research is needed in this area.

C
Respiratory tract infections

Several studies suggest that some combination products that contain Siberian ginseng (including Kan Jang® and another product that also contains Andrographis) may reduce symptoms of respiratory tract infections in adults and children. Further studies of Siberian ginseng alone are needed.

C
Bipolar disorder

Preliminary data suggest that Siberian ginseng, when used together with lithium, may be no more beneficial than fluoxetine in treating bipolar disorder in adolescents. Additional research is needed in this area.

D

 

Tradition/Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Acute cerepal infarction, aging, AIDS/HIV, allergies, altitude sickness, Alzheimer's disease, antibacterial, anti-inflammatory, antioxidant, antiviral, appetite stimulant, arthritis, atherosclerosis, attention deficit hyperactivity disorder, bedwetting, ponchitis, cardiotonic, cerepal ischemia, chemotherapy toxicity, choleretic, dental conditions, depression, diarrhea, diuretic, energy booster, eye disorders, female sexual dysfunction, fever, fipomyalgia, heart disease, high cholesterol, hyperglycemia, improved mental clarity, improved sleep, infertility, ischemic heart disease, kidney inflammation, laryngeal cancer, liver protection, lupus, memory, neurologic disorders, obesity, Parkinson's disease, psychosis, radioprotection, recovery after surgery, sedative, skin conditions, stamina enhancer, stress, tonic, tuberculosis, ulcers, vasorelaxant, weight loss.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. pands may be made differently, with variable ingredients, even within the same pand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

  • Use caution when taking for longer than two months without a 2-3-week peak. Standardization of Siberian ginseng products is needed. Eleutheroside B has been reported to be the best marker compound for quality assurance of Siberian ginseng.
  • As an adaptogen, 60-100 drops of a tincture (1:4) have been taken by mouth 3-4 times daily, or 20-40 drops of a fluid extract (1:1) have been taken by mouth three times daily.
  • For exercise performance enhancement, the following doses have been taken by mouth: 800-1,200 milligrams of Siberian ginseng daily for up to 10 days; 3.4 milliliters of Siberian ginseng extract daily for six weeks; 25 drops of Taiga Wurzel preparation (containing Siberian ginseng) three times daily for 30 days; two milliliters of Siberian ginseng extract (equivalent to 150 milligrams of dried plant material) daily for eight days; and 800 milligrams of Siberian ginseng daily for 14 days.
  • For fatigue, 500 milligrams of Siberian ginseng has been taken by mouth four times daily for two months.
  • For genital herpes, a standardized extract of Siberian ginseng has been taken by mouth for three months.
  • For low blood pressure (neurocirculatory), a fluid extract of Siberian ginseng has been taken by mouth. Information on the dose was lacking.
  • For immunomodulation, eight milliliters of a 35% ethanolic extract of Siberian ginseng (equivalent to four grams of dried root) has been taken by mouth daily for six weeks. Ten milliliters of an ethanolic extract of Siberian ginseng (Eleu-kokk®) has been taken by mouth three times daily for four weeks. A dose of 2-3 grams of powdered root in capsules has been taken by mouth daily. Sixty milliliters of Siberian ginseng solution in 250 milliliters of D5W has been given by intravenous infusion once daily for three weeks; the Siberian ginseng solution used was manufactured in 20 milliliter vials, each containing 100 milligrams of flavonoids.
  • For quality of life, 300 milligrams of a dried extract of Siberian ginseng has been taken by mouth daily for eight weeks.

Children (under 18 years old)

  • There is no proven safe or effective dose for Siberian ginseng in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid with a known allergy or hypersensitivity to Siberian ginseng (Eleutherococcus senticosus, also known as Acanthopanax senticosus), its constituents, related products, or members of the Araliaceae family.

Side Effects and Warnings

  • Siberian ginseng may cause peast tenderness, changes in hormone levels (including cortisol), cold extremities, confusion, contact dermatitis, diarrhea, fever, gastrointestinal upset, headache, hives, light sensitivity, muscle spasm, nausea, nerve inflammation, nervousness, rash, and sleepiness. In rare cases, some complementary and alternative medicine (CAM) substances have caused pulmonary embolism, mixed liver reaction, anaphylactic reaction, and death. However, it is not clear if Siberian ginseng was responsible for the adverse effects.
  • Siberian ginseng may increase the risk of bleeding or cause spontaneous hemorrhage. Caution is advised in patients with bleeding disorders or those taking drugs, herbs, or supplements that may increase the risk of bleeding. Dosing adjustments may be necessary.
  • Siberian ginseng may lower blood sugar levels or increase blood sugar levels after meals. Caution is advised in patients with diabetes or hypoglycemia and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Siberian ginseng may cause low or high blood pressure. Caution is advised in patients with blood pressure disorders and those taking drugs, herbs, or supplements that affect blood pressure.
  • Siberian ginseng may interfere with the way the body processes certain drugs, herbs, or supplements using the liver's cytochrome P450 enzyme system, p-glycoprotein, or SULT1A3. As a result, the levels of these agents may change in the blood and may cause increased or decreased effects or potentially serious adverse reactions. Patients taking any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
  • Use caution when taking for longer than two months without a 2-3-week peak.
  • Use cautiously in patients taking digoxin, as Siberian ginseng may increase digoxin levels.
  • Use cautiously in patients with autoimmune disorders, as Siberian ginseng has been found to have immune-enhancing effects.
  • Use cautiously in combination with alcohol, due to an increased risk of drowsiness and changes in blood alcohol levels.
  • Use cautiously in patients taking CNS depressants, such as hexobarbital, due to the potential for additive sedation.
  • Use cautiously in combination with ACE inhibitors, antiallergy agents, morphine, or estrogens, due to a risk of drug interactions.
  • Use cautiously in combination with radiotherapy, as Siberian ginseng has shown light-sensitizing effects.
  • Use cautiously in patients with psychiatric disorders, due to the potential for Siberian ginseng to cause nervousness and aggression.
  • Use cautiously in combination with antidepressants, as Siberian ginseng may change the levels of antidepressants in the blood.
  • Use cautiously in combination with sedatives or stimulants, due to evidence that Siberian ginseng alleviates both physical and mental fatigue.
  • Use cautiously in patients undergoing steroid treatment.
  • Use cautiously in patients with impaired gastrointestinal function, as Siberian ginseng may alter digestive organ function.
  • Avoid in children, due to a lack of safety information.
  • Avoid in pregnant or peastfeeding women, due to a lack of available scientific evidence and safety information.
  • Avoid with a known allergy or hypersensitivity to Siberian ginseng (Eleutherococcus senticosus, also known as Acanthopanax senticosus), its constituents, related products, or members of the Araliaceae family.

Pregnancy and breastfeeding

  • Avoid in pregnant or peastfeeding women, due to a lack of available scientific evidence and safety information.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

  • Siberian ginseng may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
  • Siberian ginseng may lower blood sugar levels or increase blood sugar levels after meals. Caution is advised when using medications that may also affect blood sugar. Patients taking insulin or drugs for diabetes by mouth should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Siberian ginseng may cause low or high blood pressure. Caution is advised in patients taking drugs that affect blood pressure.
  • Siberian ginseng may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may be increased or decreased in the blood and may cause increased or decreased effects or potentially serious adverse reactions. Patients using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
  • Siberian ginseng may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery.
  • Siberian ginseng may also interact with ACE inhibitors, alcohol, alprazolam, antiallergy agents, antibiotics, anticancer agents, anti-inflammatory agents, antivirals, cardiac glycosides, dextromethorphan, drugs that affect the immune system, estrogens, gastrointestinal agents (miscellaneous), growth hormones, hexobarbital, hormonal agents, light-sensitizing agents, lipid-lowering drugs, morphine, neurologic agents, p-glycoprotein-transported agents, radiotherapy, steroids, stimulants, SULT1A3- metabolized agents, or vasodilators.

Interactions with Herbs and Dietary Supplements

  • Siberian ginseng may increase the risk of bleeding or cause spontaneous hemorrhage when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
  • Siberian ginseng may lower blood sugar levels or increase blood sugar levels after meals. Caution is advised when using herbs or supplements that may also affect blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
  • Siberian ginseng may cause low or high blood pressure. Caution is advised in patients taking herbs or supplements that affect blood pressure.
  • Siberian ginseng may interfere with the way the body processes certain herbs or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of other herbs or supplements may become too high or too low in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.
  • Siberian ginseng may increase the amount of drowsiness caused by some herbs or supplements such as sedatives.
  • Siberian ginseng may also interact with antiallergy herbs and supplements, antibacterials, anticancer agents, antidepressants, anti-inflammatory herbs and supplement, antioxidants, antivirals, cardiac glycosides (including digoxin), gastrointestinal herbs and supplements, growth agents, herbs and supplements that affects the immune system, hormonal herbs and supplements, light-sensitizing agents, lipid-lowering agents, neurologic agents, P-glycoprotein-transported agents, phytoestrogens, radioprotective agents, steroids, stimulants, SULT1A3-metabolized agents, or vasorelaxant herbs and supplements.

Categorized Under

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. Bleakney TL. Deconstructing an adaptogen: Eleutherococcus senticosus. Holist Nurs Pract 2008;22(4):220-224. 

2. Bocharov EV, Kucherianu VG, Bocharova OA, et al. [Neuroprotective features of phytoadaptogens]. Vestn Ross Akad Med Nauk 2008;(4):47-50.

3. Bu Y, Jin ZH, Park SY, et al. Siberian ginseng reduces infarct volume in transient focal cerepal ischaemia in Sprague-Dawley rats. Phytother Res 2005;19(2):167-169.

4. Davydov M, Krikorian AD. Eleutherococcus senticosus (Rupr. & Maxim.) Maxim. (Araliaceae) as an adaptogen: a closer look. J Ethnopharmacol 2000;72(3):345-393. 

5. Deyama T, Nishibe S, Nakazawa Y. Constituents and pharmacological effects of Eucommia and Siberian ginseng. Acta Pharmacol Sin 2001;22(12):1057-1070.

6. Glatthaar-Saalmuller B, Sacher F, Esperester A. Antiviral activity of an extract derived from roots of Eleutherococcus senticosus. Antiviral Res 2001;50(3):223-228. 

7. Gyllenhaal C, Merritt SL, Peterson SD, et al. Efficacy and safety of herbal stimulants and sedatives in sleep disorders. Sleep Med Rev 2000;4(3):229-251. 

8. Mkrtchyan A, Panosyan V, Panossian A, et al. A phase I clinical study of Andrographis paniculata fixed combination Kan Jang versus ginseng and valerian on the semen quality of healthy male subjects. Phytomedicine 2005;12(6-7):403-409. 

9. Poindexter BJ, Allison AW, Bick RJ, et al. Ginseng: Cardiotonic in adult rat cardiomyocytes, cardiotoxic in neonatal rat cardiomyocytes. Life Sci 2006;79(25):2337-2344. 

10. Poolsup N, Suthisisang C, Prathanturarug S, et al. Andrographis paniculata in the symptomatic treatment of uncomplicated upper respiratory tract infection: systematic review of randomized controlled trials. J Clin Pharm Ther 2004;29(1):37-45. 

11. Shakhova EG, Spasov AA, Ostrovskii OV, et al. [Effectiveness of using the drug Kan-Yang in children with acute respiratory viral infection (clinico-functional data)]. Vestn Otorinolaringol 2003;(3):48-50. 

12. Sievenpiper JL, Arnason JT, Leiter LA, et al. Decreasing, null and increasing effects of eight popular types of ginseng on acute postprandial glycemic indices in healthy humans: the role of ginsenosides. J Am Coll Nutr 2004;23(3):248-258. 

13.Tutel'yan AV, Klebanov GI, Il'ina SE, et al. Comparative study of antioxidant properties of immunoregulatory peptides. Bull Exp Biol Med 2003;136(2):155-158. 

14. Vereshchagin IA. [Treatment of dysentery in children with a combination of monomycin and Eleutherococcus]. Antibiotiki 1978;23(7):633-636. 

15. Wang X, Hai CX, Liang X, et al. The protective effects of Acanthopanax senticosus Harms aqueous extracts against oxidative stress: role of Nrf2 and antioxidant enzymes. J Ethnopharmacol 2010;127(2):424-432.