Does Ginseng Help Lung Function?
Based on current evidence, ginseng supplementation appears to modestly improve pulmonary function tests and exercise capacity in patients with COPD, though it should be held 2 weeks before surgery and is not included in standard pulmonary rehabilitation guidelines.
Guideline Recommendations
The most recent American Thoracic Society guidelines for pulmonary rehabilitation (2023) do not include ginseng or any herbal supplements as part of standard evidence-based treatment for chronic respiratory disease 1. Pulmonary rehabilitation remains the cornerstone intervention, consisting of structured exercise training, education, and behavior change for improving physical and psychological outcomes in chronic respiratory disease 1.
From a perioperative safety perspective, the Society for Perioperative Assessment and Quality Improvement (SPAQI) recommends holding Siberian ginseng for 2 weeks before surgery due to potential effects on performance and stress response, though the specific concerns relate to possible diarrhea and other systemic effects 2.
Clinical Evidence for Ginseng in Lung Function
Human Clinical Trials
The strongest clinical evidence comes from a 2002 randomized controlled trial showing that ginseng extract (G115) 100 mg twice daily for 3 months significantly improved multiple pulmonary parameters in patients with moderately-severe COPD 3. Improvements included:
- FVC increased 32.5% above baseline
- FEV1 increased 27.0%
- Maximum voluntary ventilation increased 40.4%
- Maximum inspiratory pressure increased 47.0%
- VO2max increased 37.5%
- No side effects were observed 3
A 2011 systematic review of oral ginseng formulations for stable COPD found modest benefits, with a mean difference of 0.30 L for FEV1 improvement and 9.43% for FEV1% predicted compared to placebo 4. Quality of life measured by St. George's Respiratory Questionnaire improved by 10.32 points when ginseng was added to standard pharmacotherapy 4. However, the review noted that all included studies were of low quality with potential risk of bias, making the degree of benefit uncertain 4.
Mechanistic Studies
Recent preclinical research (2017-2023) has identified potential mechanisms for ginseng's pulmonary effects:
Ginsenoside Rg1 protects against cigarette smoke-induced airway remodeling by suppressing the TGF-β1/Smad3 signaling pathway, which is central to fibrosis and epithelial-mesenchymal transition in COPD 5, 6.
Korean red ginseng prevented lung and brain dysfunction in mice chronically exposed to particulate matter by regulating systemic inflammation through the NF-κB/JNK pathway and preventing pulmonary fibrosis 7.
Ginsenoside AD-1 improved pulmonary fibrosis by regulating the HIF-1α/HSP/TGF-β1 signaling pathway and inhibiting mesenchymal transition 8.
Clinical Interpretation and Caveats
The evidence for ginseng in lung function is promising but limited by study quality and lack of inclusion in major clinical guidelines. The 2002 trial showed impressive improvements, but this has not been replicated in large, high-quality multicenter trials 3. The 2011 systematic review's conclusion that benefits are "uncertain due to potential risk of bias" remains the most balanced assessment 4.
Important Considerations:
Ginseng should not replace evidence-based pulmonary rehabilitation, which has strong recommendation from the American Thoracic Society for adults with COPD, interstitial lung disease, and other chronic respiratory diseases 1.
The perioperative guideline recommendation to hold ginseng 2 weeks before surgery suggests potential systemic effects that warrant caution 2.
Most studies used specific ginseng extracts (G115, ginsenoside Rg1) at defined doses, so benefits may not generalize to all ginseng products 5, 6, 3.
The mechanistic studies, while scientifically interesting, were conducted in animal models and cell cultures, limiting direct clinical applicability 7, 5, 6, 8.
Practical Recommendation
For patients with stable COPD seeking adjunctive therapies, ginseng extract (100-200 mg twice daily) may provide modest improvements in pulmonary function and exercise capacity as an addition to—not replacement for—standard medical therapy and pulmonary rehabilitation 4, 3. However, patients should discontinue use 2 weeks before any planned surgery 2, and expectations should be tempered given the limited quality of supporting evidence 4.