Quick Summary

Panax notoginseng (Notoginseng) is a traditional Chinese medicinal herb widely used for cardiovascular, cerebrovascular, and metabolic disorders. Clinical evidence primarily supports its adjunctive use in ischemic stroke, acute myocardial infarction, unstable angina pectoris, and diabetic complications. Preliminary evidence suggests potential benefits for neural repair, modulation of blood circulation, anti-inflammatory effects, antioxidation, and metabolic regulation. However, current clinical trials are often of low to moderate quality, small sample size, and heterogeneous, warranting cautious interpretation and further high-quality research.

What is it?

Notoginseng, scientifically known as Panax notoginseng, is a perennial herbaceous plant native to China. It belongs to the Panax genus, related to ginseng species, and is known for its traditional use in Chinese medicine. The root of the plant is predominantly used in medicinal preparations.

Traditional Uses

Notoginseng has a long history in traditional Chinese medicine (TCM) where it is used to support cardiovascular health, improve blood circulation, and treat trauma-related bleeding. It is also traditionally employed for conditions related to stroke, chest pain (angina), and diabetic complications.

Active Compounds

The main active constituents of Panax notoginseng are saponins, often referred to as Panax notoginseng saponins (PNS). These compounds are thought to contribute to its pharmacological effects, including modulation of inflammation, antioxidative properties, and circulatory benefits.

Potential Benefits with Evidence Levels

  • Acute ischemic stroke: May improve neurological deficits and daily living activities when used adjunctively with standard care. Evidence level: Moderate (Liu Y et al., 2024).
  • Acute myocardial infarction: May improve total effective rate, reduce infarct size, improve cardiac function, and reduce inflammatory markers as an adjunct to conventional treatment. Evidence level: Moderate (Chen P et al., 2024).
  • Unstable angina pectoris: May improve angina symptoms and clinical efficacy when combined with conventional therapy. Evidence level: Low to moderate (Network meta-analysis, 2024).
  • Post-ischemic stroke cognitive impairment: Preliminary evidence suggests potential cognitive function improvement. Evidence level: Preliminary (Systematic Review, 2024).
  • Diabetic complications (nephropathy and peripheral neuropathy): Potential improvements in metabolic control and neurological function when used in TCM combinations. Evidence level: Preliminary to moderate (Hu J et al., 2025).
  • Diabetic wound healing: Enhanced wound healing and angiogenesis shown in preclinical models. Evidence level: Preclinical (Xia F et al., 2026).
  • Hypertensive intracerebral hemorrhage: Improved clinical effective rate and neurological scores with reduced inflammation when combined with Western medicine. Evidence level: Moderate (Zong L et al., 2025).
  • Ulcerative colitis (animal model): Improvements in intestinal barrier function and gut microbiota modulation. Evidence level: Preclinical (Song Y et al., 2025).
  • Cardiovascular disease (ischemic heart failure and coronary artery disease): May improve cardiac function and reduce adverse cardiac events as adjunct therapy. Evidence level: Moderate (Zhou Z et al., 2025).

Side Effects

  • Low incidence of mild adverse reactions reported in clinical trials.
  • No significant increase in adverse events compared to control groups in meta-analyses of ischemic stroke and myocardial infarction.
  • No serious adverse events reported in studies on unstable angina and hypertensive intracerebral hemorrhage.
  • Quality control and potential herb-drug interactions remain important considerations.
  • Acupuncture-related adverse events involving notoginseng-containing regimens are rare and generally mild when performed by trained practitioners.

Drug Interactions

Herb-drug interactions remain a potential concern, especially with anticoagulants, antiplatelet agents, and other cardiovascular drugs. Specific interaction data for Panax notoginseng saponins are limited, which warrants cautious use and further pharmacokinetic and pharmacodynamic investigations.

Who Should Avoid It?

  • People with bleeding disorders or those undergoing surgery should exercise caution due to possible antiplatelet and hemostatic effects.
  • Use during pregnancy and breastfeeding is not well studied; therefore, it is advisable to avoid use unless the potential benefits outweigh the risks and under professional supervision.
  • Individuals taking anticoagulant or antiplatelet medications should consult healthcare providers before use.

Evidence Limitations

  • Many clinical studies have small sample sizes and moderate to high risk of bias.
  • Significant heterogeneity exists in intervention preparations, dosages, and treatment durations.
  • The majority of research has been conducted in China, limiting geographic diversity.
  • Incomplete reporting of adverse events and long-term safety data.
  • Limited high-quality, rigorously designed randomized controlled trials.
  • Preclinical and mechanistic studies predominate in some indications (e.g., wound healing, ulcerative colitis) with few human clinical trials.
  • Some systematic reviews/meta-analyses exhibit redundancy and methodological shortcomings, especially concerning ischemic stroke and cardiovascular outcomes.
  • There is a need for standardized clinical outcome measures and more pragmatic trial designs.

References

Last Reviewed

June 2024

Disclaimer: This information is for educational purposes only and is not intended to replace professional medical advice. Notoginseng and its preparations should be used under the guidance of a qualified healthcare provider. Consult a healthcare professional before starting any new herbal treatment, especially if you have existing medical conditions or are taking other medications.