Article

Study of the Efficacy of Korean Red Ginseng in the Treatment of Androgenic Alopecia

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Abstract

Alopecia is a common form of hair loss in both male and female, affecting approximately ten million Koreans. Although medical treatments have been developed to treat alopecia, these treatments still have limitations due to complications that come with these treatments. In contrast, Korean red ginseng has been shown to have a stimulating effect on hair follicle and it has already been added to hair treatment products as a safe ingredient. This study was conducted to objectively evaluate the efficacy of Korean red ginseng in the treatment of alopecia. 40 patients suffering from androgenic alopecia were recruited and randomly divided into the experimental (20 patients) and control (20 patients) groups. The experimental group took Korean red ginseng extract (3,000 mg/day) for 24 weeks while the control group took a placebo. The changes of hair counts, thickness, and density were evaluated with Folliscope. Patient satisfaction was evaluated through a questionnaire, and clinical photographs were rated by dermatologists. The result of the study showed that Korean red ginseng effectively increased hair density and thickness. Patient satisfaction and evaluation of photographs by dermatologists also confirmed the effectiveness of Korean red ginseng in the treatment of alopecia.

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... Twenty-eight trials originated from Korea , and two trials were conducted in Thailand [26] and the United Kingdom [27]. Sixteen studies [28,[32][33][34][35][36][37][38][39][40][41][44][45][46][47]53] were published in Korean, and 14 trials [26,27,[29][30][31]42,43,[48][49][50][51][52]54,55] were written in English. ...
... The key data from studies in healthy persons are summarised in Table 1 [26][27][28][29][30][31][32][33][34], and the data regarding other various conditions are summarised in Table 2 . The included RCTs used ginseng powder either in raw (4 studies) [35,38,53,55] or in capsules (22 studies) [26][27][28][29]31,32,34,36,37,[39][40][41][43][44][45][46][47][48][50][51][52]54] and extract preparation (2 studies) [33,42], while two studies [30,49] did not report the preparation type of ginseng. They addressed a wide range of conditions: generally healthy (i.e., studies in healthy individuals) [26][27][28][29][30][31][32][33][34], erectile dysfunction [35][36][37][38][39][40], gastric cancer [41,43], colon cancer [42], gastrointestinal carcinoma [44], chronic gastritis [45], diabetes mellitus [46,47], androgenic alopecia [48], coronary artery [49], dry mouth [50], glaucoma [51], obesity [52], metabolic syndrome [53], dyspepsia and indigestion [54] and Alzheimer's disease [55]. ...
... The included RCTs used ginseng powder either in raw (4 studies) [35,38,53,55] or in capsules (22 studies) [26][27][28][29]31,32,34,36,37,[39][40][41][43][44][45][46][47][48][50][51][52]54] and extract preparation (2 studies) [33,42], while two studies [30,49] did not report the preparation type of ginseng. They addressed a wide range of conditions: generally healthy (i.e., studies in healthy individuals) [26][27][28][29][30][31][32][33][34], erectile dysfunction [35][36][37][38][39][40], gastric cancer [41,43], colon cancer [42], gastrointestinal carcinoma [44], chronic gastritis [45], diabetes mellitus [46,47], androgenic alopecia [48], coronary artery [49], dry mouth [50], glaucoma [51], obesity [52], metabolic syndrome [53], dyspepsia and indigestion [54] and Alzheimer's disease [55]. ...
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This systematic review was performed to summarise randomised clinical trials (RCTs) assessing the efficacy and safety of ginseng in the Korean literature. The study involved systematic searches conducted in eight Korean Medical databases. The methodological quality of all of the included studies was assessed using the Cochrane Risk of Bias tool. We included all RCTs on any type of ginseng compared to placebo, active treatment or no treatment in healthy individuals or patients regardless of conditions. In total, 1415 potentially relevant studies were identified, and 30 randomised clinical trials were included. Nine RCTs assessed the effects of ginseng on exercise capacity, cognitive performance, somatic symptoms, quality of life, and sleeping in healthy persons. Six RCTs tested ginseng compared with placebo for erectile dysfunction, while another four studies evaluated the effects of ginseng against no treatment for gastric and colon cancer. Two RCTs compared the effect of red ginseng on diabetes mellitus with no treatment or placebo, and the other nine RCTs assessed the effects of ginseng compared with placebo or no treatment on various conditions. The methodological caveats of the included trials make their contribution to the current clinical evidence of ginseng somewhat limited. However, the 20 newly added trials (66.7% of the 30 trials) may provide useful information for future trials. Ginseng appears to be generally safe, and no serious adverse effects have been reported. The clinical effects of ginseng have been tested in a wide range of conditions in Korea. Although the quality of RCTs published in the Korean literature was generally poor, this review is useful for researchers to access studies that were originally published in languages that they would otherwise be unable to read and due to the paucity of evidence on this subject.
... 9 In addition to these murine studies, a human in vivo study by Kim et al. reported that the hair density of androgenetic alopecia patients increased following the oral administration of RGE, although the study did not determine if the difference between the ginseng and placebo groups was statistically significant. 11 Regardless, none of these studies proposed a mechanism that explains the effects of red ginseng. ...
... Although no definitive evidence has been reported from human in vivo studies, several animal and human in vitro studies describe the hair growth-promoting effects of red ginseng and its ginsenosides. 8,9,11,18 However, there are no well-established mechanisms that explain these beneficial effects on hair growth. The present study confirmed the hair growth-promoting effects of RGE and ginsenoside-Rb1 through mouse in vivo and human ex vivo studies. ...
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Abstract Ginseng has been shown to promote hair growth in several recent studies. However, its effects on human hair follicles and its mechanisms of action have not been sufficiently elucidated. This study aimed to investigate the hair growth-promoting effects of red ginseng extract (RGE) and its ginsenosides. The proliferative activities of cultured human hair follicles treated with RGE and ginsenoside-Rb1 were assessed using Ki-67 immunostaining. Their effects on isolated human dermal papilla cells (hDPCs) were evaluated using cytotoxicity assays, immunoblot analysis of signaling proteins, and the determination of associated growth factors. We examined the ability of RGE and ginsenosides to protect hair matrix keratinocyte proliferation against dihydrotestosterone (DHT)-induced suppression and their effects on the expression of androgen receptor. The in vivo hair growth-promoting effect of RGE was also investigated in C57BL/6 mice. Both RGE and ginsenoside-Rb1 enhanced the proliferation of hair matrix keratinocytes. hDPCs treated with RGE or ginsenoside-Rb1 exhibited substantial cell proliferation and the associated phosphorylation of ERK and AKT. Moreover, RGE, ginsenoside-Rb1, and ginsenoside-Rg3 abrogated the DHT-induced suppression of hair matrix keratinocyte proliferation and the DHT-induced upregulation of the mRNA expression of androgen receptor in hDPCs. Murine experiments revealed that the subcutaneous injection of 3% RGE resulted in more rapid hair growth than the negative control. In conclusion, RGE and its ginsenosides may enhance hDPC proliferation, activate ERK and AKT signaling pathways in hDPCs, upregulate hair matrix keratinocyte proliferation, and inhibit the DHT-induced androgen receptor transcription. These results suggest that red ginseng may promote hair growth in humans.
... These whole animal studies used an oral dosing protocol, making the study of particular relevance to humans, since the doses used are commonly ingested by people. The findings of mouse in vivo studies were consistent with the clinical findings of Kim et al. [97], who reported that orally administered Korean Red Ginseng enhanced hair density and thickness in alopecia patients with a dosage of 3000 mg/day for 24 weeks. ...
... These whole animal studies used an oral dosing protocol, making the study of particular relevance to humans, since the doses used are commonly ingested by people. The findings of mouse in vivo studies were consistent with the clinical findings of Kim et al. [97], who reported that orally administered Korean Red Ginseng enhanced hair density and thickness in alopecia patients with a dosage of 3000 mg/day for 24 weeks. [94]). ...
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This paper demonstrates that ginseng mixtures and individual ginseng chemical constituents commonly induce hormetic dose responses in numerous biological models for endpoints of biomedical and clinical relevance, typically providing a mechanistic framework. The principal focus of ginseng hormesis-related research has been directed toward enhancing neuroprotection against conditions such as Alzheimer’s and Parkinson’s Diseases, stroke damage, as well as enhancing spinal cord and peripheral neuronal damage repair and reducing pain. Ginseng was also shown to reduce symptoms of diabetes, prevent cardiovascular system damage, protect the kidney from toxicities due to immune suppressant drugs, and prevent corneal damage, amongst other examples. These findings complement similar hormetic-based chemoprotective reports for other widely used dietary-type supplements such as curcumin, ginkgo biloba, and green tea. These findings, which provide further support for the generality of the hormetic dose response in the biomedical literature, have potentially important public health and clinical implications.
... Many researchers believe that KRG has potential as a therapeutic modality for treatment of many dermatologic diseases. Our previous study showed that KRG may be helpful in treatment of androgenic alopecia [21]. However, there are no studies about the correlation between AA and KRG. ...
... t differences between these data in the two groups (p>0.05). ILI, intra-lesional injection; KRG, Korean red ginseng. In both of two groups, the hair thickness increased after treatment. However, there were no statistically signifi cant differences between these data in the two groups (p>0.05). ILI, intra-lesional injection; KRG, Korean red ginseng. [21]. However, there are no studies about the correlation between AA and KRG. Kim et al. [22] reported a potent effect on the recovery of hair follicles by KRG through its combined effects on proliferation and apoptosis of cells in the hair follicle in mouse animal models. These hair growth-promoting effects are associated with components of ...
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Alopecia areata (AA) is an autoimmune disease that can affect any hair-bearing area. AA is known to be caused by immunological disorder but still, the pathogenesis is not fully understood. Many therapeutic modalities have been used to treat alopecia areata, with variable efficacy and safety profiles. Unfortunately, none of these agents is definitely curative or preventive alone. We studied hair growth efficacy and safety of Korean red ginseng (KRG) in AA comparing corticosteroid intra-lesional injection (ILI) alone patient group with ILI with KRG taking patient group using Folliscope 2.5 for 12 wk. Herein, we would like to report the efficacy of KRG in the treatment of AA and recommend KRG as a useful complimentary food for gaining efficacy of treatment for AA.
... topical [32] Clinical and in vitro study androgenic in vivo 4 successive days EGCG stimulated hair growth / EGCG stimulates hair growth via its proliferative and antiapoptotic effects on DPCs, and may prolong the anagen stage [32], selective inhibition of 5α-reductase [31], antioxidant properties [29], and the stimulating effect on normal cell growth [ [41] androgenic 6 months stimulated hair growth, slowed down hair loss itching (in 1 out of 98 subjects) inhibition of 5α-reductase, germacrone acting anti-inflammatory [44] and antiandrogenic in vitro and in vivo [45], increases skin penetration of minoxidil [47] paradoxically promotes hair growth on male scalp and at the same time inhibits underarm (axillary) hair growth in females [42,46] Panax ginseng C.A. Meyer / Chinese red ginseng root extract topical traditionally [51] androgenic / prevented hair loss, improved hair growth. ...
... In Korea, ginseng is traditionally used to prevent hair loss and to improve hair growth. Red ginseng root is supposed to be effective in the treatment of androgenic baldness [51]. For the healing action of Panax ginseng, saponin glycosides, namely ginsengosides appear to be responsible. ...
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Though hair does not serve any crucial physiological function in modern humans, it plays an important role in our self-esteem. Androgenic baldness (androgenic alopecia) and circular/spot baldness (alopecia areata) are the most common forms of hair loss. Many active ingredients of synthetic origin are available for treatment; however, they have a number of limitations. Their effectiveness and safety are questionable and the amount of time needed to achieve the effect is both long and unclear. This has increased interest in finding an alternative approach against hair loss using preparations containing plants and/or their isolated active ingredients. A number of studies (mostly randomized, placebo-controlled) of plants and preparations made of plants have been performed to confirm their effectiveness in treating hair loss. The plants with the most evidence-based effect against alopecia are Curcuma aeruginosa (pink and blue ginger), Serenoa repens (palmetto), Cucurbita pepo (pumpkin), Trifolium pratense (red clover), and Panax ginseng (Chinese red ginseng). The assumed mechanism of action is predominately inhibition of 5α-reductase, with enhanced nutritional support and scalp blood circulation playing a role as well.
... There has been mounting evidence suggesting that ginseng and its major bioactive constituents, ginsenosides, promote hair growth by enhancing proliferation of dermal papilla and preventing hair loss via modulation of various cell-signaling pathways [11][12][13]. While the role of 5α-reductase enzyme in the hair-loss process has been well-documented [14,15], the emerging biochemical mechanisms of hair-follicle proliferation and the hair-loss process unravel new targets for designing novel therapeutics for the management of hair loss and alopecia ( Figure 1). ...
... Average hair density and hair thickness were significantly increased upon addition of KRG with ILI, suggesting that KRG may be considered as a useful complimentary food for gaining efficacy in the treatment for AA [66]. Kim et al. reported the effectiveness of Korean red ginseng in increasing the thickness and density of hair in human volunteers [11]. Moreover, combination treatment with topical minoxidil and oral KRG is more effective than topical minoxidil treatment alone for promoting hair growth. ...
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The functional aspect of scalp hair is not only to protect from solar radiation and heat/cold exposure but also to contribute to one’s appearance and personality. Progressive hair loss has a cosmetic and social impact. Hair undergoes three stages of hair cycle: the anagen, catagen, and telogen phases. Through cyclical loss and new-hair growth, the number of hairs remains relatively constant. A variety of factors, such as hormones, nutritional status, and exposure to radiations, environmental toxicants, and medications, may affect hair growth. Androgens are the most important of these factors that cause androgenic alopecia. Other forms of hair loss include immunogenic hair loss, that is, alopecia areata. Although a number of therapies, such as finasteride and minoxidil, are approved medications, and a few others (e.g., tofacitinib) are in progress, a wide variety of structurally diverse classes of phytochemicals, including those present in ginseng, have demonstrated hair growth-promoting effects in a large number of preclinical studies. The purpose of this review is to focus on the potential of ginseng and its metabolites on the prevention of hair loss and its underlying mechanisms.
... The red ginseng has been reported to promote hair growth in animal models by preventing apoptosis of hair follicle cells and inhibiting 5-α reductase [10,11]. It also increases the hair follicle density and size in the patients with androgenetic alopecia [12]. The functional main ingredients are saponins (ginsenosides), polysaccharides and phenolic compounds. ...
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An abnormal hair-growth cycle induces hair loss, which affects psychological distress and impairs life quality. Red ginseng marc (RGM) is usually discarded as a byproduct after extracting red ginseng, but several studies have shown that the RGM still has bioactive components including ginsenosides. Therefore, the hair-growth effects of fermented RGM (fRGM) and traditional polyherb formula (PH) were examined in C57BL/6 mice. The dorsal hairs of mice were depilated, and they were topically treated with fRGM or PH at 400, 200 and 100 mg/kg or the combination of both middle doses (combi) once a day for two weeks. The hair-covering regions were significantly increased with higher doses of fRGM and PH and in combi groups, compared with the control treated with distilled water. Hair length, thickness and weight also increased in the treatment groups. In particular, the fRGM and PH increased the anagen-phased hair follicles, the follicular diameters and the dermal thickness. Immunostains for Ki-67 showed the anagen-phased cell division in the treatment groups. The beneficial effects were greater in the high doses of fRGM and PH and the combi groups. These suggest hair-growth-promoting effects of fRGM, PH and the combination by enhancing the hair-growth cycle.
... Many researchers believe that KRG has potential for use as a new therapeutic modality for treatment of dermatologic disease. Our previous study showed that KRG may be helpful in treatment of androgenic alopecia [25]. However, there are certain limitations of correlation between AD and KRG. ...
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In order to determine the efficacy of functional foods, objective measurement of the severity of atopic dermatitis (AD) after taking foods is important. The aim of this study was to conduct an objective evaluation of whether Korean red ginseng (KRG) might be helpful for improvement of skin condition and serum IgE in patients with AD. Thirty atopic patients (18 females and 12 males) participated in this study. Patients took KRG for 16 weeks. Bioengineering methods, including the corneometer and evaporimeter, were used at the start of the study and after 8 weeks and 16 weeks. In addition, we assessed serum IgE levels and the severity scoring of the atopic dermatitis (SCORAD) index. Transepidermal water loss and skin hydration showed significant improvement after 16 weeks. A significant decrease in the SCORAD index, as well as in serum IgE level, was observed after 16 weeks. Our results demonstrated that KRG may be helpful as a functional food for patients with AD.
... In a study of mouth dryness patients, red ginseng improved mouth dryness in the secondary analysis of menopausal women out of the participants [120]. Red ginseng intake for 24 weeks increased both hair density and hair thickness in both male-pattern hair loss and female-pattern hair loss patients [121]. ...
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Ginseng has been traditionally used for several millennia in Asian countries, including Korea, China, and Japan, not only as a nourishing and tonifying agent but also as a therapeutic agent for a variety of diseases. In recent years, the various effects of red ginseng including immunity improvement, fatigue relief, memory improvement, blood circulation improvement, antioxidation, mitigation of menopausal women's symptoms, and anticancer an effect have been reported in clinical as well as basic research. Around the world, there is a trend of the rising consumption of health functional foods on the level of disease prevention along with increased interest in maintaining health because of population aging and the awareness of lifestyle diseases and chronic diseases. Red ginseng occupies an important position as a health functional food. But till now, international ginseng monographs including those of the World Health Organization have been based on data on white ginseng and have mentioned red ginseng only partly. Therefore, the red ginseng monograph is needed for component of red ginseng, functionality certified as a health functional food in the Korea Food and Drug Administration, major efficacy, action mechanism, and safety. The present red ginseng monograph will contribute to providing accurate information on red ginseng to agencies, businesses, and consumers both in South Korea and abroad.
... In addition, ginseng rhizome and ginsenoside-Ro have been shown to exhibit inhibitory activity against 5α-reductase and enhance hair regrowth in a mouse model of androgenic alopecia (Murata et al., 2012). Although clinical trials have found that consumption of Korean RGE improves hair density and thickness in patients with alopecia (Kim et al., 2009;Oh and Son, 2012), the molecular mechanisms of red ginseng on anagen induction have not been fully elucidated. ...
Article
This study aimed to investigate the underlying mechanisms of red ginseng extract (RGE) on regulating hair growth and hair follicle development. Results from in vitro studies showed that RGE treatment simultaneously enhanced viability and inhibited apoptosis in human hair dermal papilla cells. Moreover, RGE administration promoted telogen-to-anagen transition, prolonged anagen in hair follicular cycling, and increased the size of hair follicles and skin thickness in a C57BL/6 mouse model. Furthermore, RGE treatment significantly upregulated the expression of β-catenin, phospho-glycogen synthase kinase 3β, cyclin D1, cyclin E, and Bcl-2, phospho-extracellular signal-regulated protein kinase, and phospho-Akt, which are associated with promoting hair growth. In addition, RGE enhanced skin health by activation of antiox-idant defense systems. Our data demonstrates that hair regenerative mechanisms of RGE may be mediated by stimulating dermal papilla cell proliferation and enhancing skin functions.
... Korean red ginseng powder and fermented red ginseng improved the effective sleep time and sleep efficiency [41][42][43]. Korean red ginseng powder improved somatic symptoms [48], hair thickness and hair density [49]. It did not improve dry mouth symptoms in xerostomatic patients, but an intergroup analysis showed improvement in dry mouth symptoms in menopausal females [47]. ...
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Background:Panax ginseng C.A. Meyer is one of the most frequently used herbs in the world. The roots of Panax ginseng have been used as a traditional tonic and medicine for thousands of years in Korea and China. Today, ginseng root is used as a dietary supplement and complementary medicine and for adjuvant therapeutics worldwide. The efficacy of ginseng has been studied in a wide range of basic research and clinical studies. However, it has been reported that the results from clinical studies are conflicting, and they depend on the parameters of the protocol design including the conditions of the participants and the types of ginseng used such as red ginseng, white ginseng, fermented ginseng and cultured ginseng. [...].
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Background: Female pattern hair loss (FPHL), or androgenic alopecia, is the most common type of hair loss affecting women. It is characterised by progressive shortening of the duration of the growth phase of the hair with successive hair cycles, and progressive follicular miniaturisation with conversion of terminal to vellus hair follicles (terminal hairs are thicker and longer, while vellus hairs are soft, fine, and short). The frontal hair line may or may not be preserved. Hair loss can have a serious psychological impact on women. Objectives: To determine the efficacy and safety of the available options for the treatment of female pattern hair loss in women. Search methods: We updated our searches of the following databases to July 2015: the Cochrane Skin Group Specialised Register, CENTRAL in the Cochrane Library (2015, Issue 6), MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1872), AMED (from 1985), LILACS (from 1982), PubMed (from 1947), and Web of Science (from 1945). We also searched five trial registries and checked the reference lists of included and excluded studies. Selection criteria: We included randomised controlled trials that assessed the efficacy of interventions for FPHL in women. Data collection and analysis: Two review authors independently assessed trial quality, extracted data and carried out analyses. Main results: We included 47 trials, with 5290 participants, of which 25 trials were new to this update. Only five trials were at 'low risk of bias', 26 were at 'unclear risk', and 16 were at 'high risk of bias'.The included trials evaluated a wide range of interventions, and 17 studies evaluated minoxidil. Pooled data from six studies indicated that a greater proportion of participants (157/593) treated with minoxidil (2% and one study with 1%) reported a moderate to marked increase in their hair regrowth when compared with placebo (77/555) (risk ratio (RR) = 1.93, 95% confidence interval (CI) 1.51 to 2.47; moderate quality evidence). These results were confirmed by the investigator-rated assessments in seven studies with 1181 participants (RR 2.35, 95% CI 1.68 to 3.28; moderate quality evidence). Only one study reported on quality of life (QoL) (260 participants), albeit inadequately (low quality evidence). There was an important increase of 13.18 in total hair count per cm² in the minoxidil group compared to the placebo group (95% CI 10.92 to 15.44; low quality evidence) in eight studies (1242 participants). There were 40/407 adverse events in the twice daily minoxidil 2% group versus 28/320 in the placebo group (RR 1.24, 95% CI 0.82 to 1.87; low quality evidence). There was also no statistically significant difference in adverse events between any of the individual concentrations against placebo.Four studies (1006 participants) evaluated minoxidil 2% versus 5%. In one study, 25/57 participants in the minoxidil 2% group experienced moderate to greatly increased hair regrowth versus 22/56 in the 5% group (RR 1.12, 95% CI 0.72 to 1.73). In another study, 209 participants experienced no difference based on a visual analogue scale (P = 0.062; low quality evidence). The assessments of the investigators based on three studies (586 participants) were in agreement with these findings (moderate quality evidence). One study assessed QoL (209 participants) and reported limited data (low quality evidence). Four trials (1006 participants) did not show a difference in number of adverse events between the two concentrations (RR 1.02, 95% CI 0.91 to 1.20; low quality evidence). Both concentrations did not show a difference in increase in total hair count at end of study in three trials with 631 participants (mean difference (MD) -2.12, 95% CI -5.47 to 1.23; low quality evidence).Three studies investigated finasteride 1 mg compared to placebo. In the finasteride group 30/67 participants experienced improvement compared to 33/70 in the placebo group (RR 0.95, 95% CI 0.66 to 1.37; low quality evidence). This was consistent with the investigators' assessments (RR 0.77, 95% CI 0.31 to 1.90; low quality evidence). QoL was not assessed. Only one study addressed adverse events (137 participants) (RR 1.03, 95% CI 0.45 to 2.34; low quality evidence). In two studies (219 participants) there was no clinically meaningful difference in change of hair count, whilst one study (12 participants) favoured finasteride (low quality evidence).Two studies (141 participants) evaluated low-level laser comb therapy compared to a sham device. According to the participants, the low-level laser comb was not more effective than the sham device (RR 1.54, 95% CI 0.96 to 2.49; and RR 1.18, 95% CI 0.74 to 1.89; moderate quality evidence). However, there was a difference in favour of low-level laser comb for change from baseline in hair count (MD 17.40, 95% CI 9.74 to 25.06; and MD 17.60, 95% CI 11.97 to 23.23; low quality evidence). These studies did not assess QoL and did not report adverse events per treatment arm and only in a generic way (low quality evidence). Low-level laser therapy against sham comparisons in two separate studies also showed an increase in total hair count but with limited further data.Single studies addressed the other comparisons and provided limited evidence of either the efficacy or safety of these interventions, or were unlikely to be examined in future trials. Authors' conclusions: Although there was a predominance of included studies at unclear to high risk of bias, there was evidence to support the efficacy and safety of topical minoxidil in the treatment of FPHL (mainly moderate to low quality evidence). Furthermore, there was no difference in effect between the minoxidil 2% and 5% with the quality of evidence rated moderate to low for most outcomes. Finasteride was no more effective than placebo (low quality evidence). There were inconsistent results in the studies that evaluated laser devices (moderate to low quality evidence), but there was an improvement in total hair count measured from baseline.Further randomised controlled trials of other widely-used treatments, such as spironolactone, finasteride (different dosages), dutasteride, cyproterone acetate, and laser-based therapy are needed.
Article
Numerous agents (approximately 90) are shown to stimulate hair growth in cellular and animal models in a hormetic-like biphasic dose response manner. These hormetic dose responses occur within the framework of direct stimulatory responses as well as in preconditioning experimental protocols. These findings have important implications for experimental and clinical investigations with respect to study design strategies, dose selection and dose spacing along with sample size and statistical power issues. These findings further reflect the general occurrence of hormetic dose responses within the biological and biomedical literature that consistently appear to be independent of biological model, level of biological organization (i.e., cell, organ, and organism), endpoint, inducing agent, potency of the inducing agent, and mechanism.
Chapter
Since an important commercial interest lies in the nutritional value of various vitamin and amino acid supplements, an important question that arises is whether increasing the content of an already adequate diet with specific amino acids, vitamins, and/or trace elements may further promote hair growth and pigmentation. Pharmacy aisles and Internet drugstores are full of nutritional supplements promising full, thick, luscious hair for prices that range from suspiciously cheap to dishearteningly exorbitant. It would appear that unless hair loss is due to a specific nutritional deficiency, there is only so much that nutritional therapies can do to enhance hair growth and quality. However, there are internal and external factors, such as aging and environmental stressors, that influence hair health to such a degree that nutritional therapy may boost hair that is suffering from these problems. Protein is the main component of hair with the primary component of the hair fiber being keratin that is made from amino acids. The most abundant of these is cysteine which gives the hair fiber much of its strength through the linking of the sulfur in cysteine molecules of adjacent keratin proteins together in disulfide bonds. Meanwhile, the hair follicle exhibits a high rate of metabolism. As a group, B complex vitamins are important for metabolic functions and therefore required to utilize other nutrients like carbohydrates and amino acids: biotin (vitamin H), calcium pantothenate (B5), niacinamide (B3), folic acid, and vitamins B6 (pyridoxal phosphate) and B12 (cobalamin). Further insights into the role of oxidative stress could open additional strategies for interventions into age-dependent hair and pigmentation loss. Specifically, the body possesses endogenous defense mechanisms, such as antioxidative enzymes (superoxide dismutase, catalase, glutathione peroxidase) and nonenzymatic antioxidative molecules (vitamins E and C, glutathione, ubiquinone), protecting it from free radicals. With age, the production of free radicals increases, while the endogenous defense mechanisms decrease. This imbalance leads to the progressive damage of cellular structures, ultimately resulting in the aging phenotype.
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This chapter discusses important bioactive compounds of ingredients that are commonly found in the Eastern diet that may affect the risk of erectile dysfunction (ED). These compounds include ginsenosides found in Panax ginseng, curcumin derivatives found in curry powder, capsaicin found in chilies, and folate abundant in dark leafy green vegetables. Proposed mechanisms of action of these compounds on reducing the risk of ED include increased nitric oxide bioavailability and plasma serotonin levels.
Article
Radix panax ginseng (Panax ginseng C.A. Meyer, Araliaceae, RPG) has been documented to possess hair growth activity and widely used to treat alopecia, while no report has been issued to date on the effect of Fructus panax ginseng (FPG) on hair regeneration. To investigate the effects of FPG extract on the proliferation of human hair dermal papilla cells (DPCs) and on the promotion of hair regeneration in C57BL6 mice, cell proliferation was evaluated in cultured DPC by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and measured the expressions of Bcl-2 and Bax by immunoblot assay. We also compared the effects of topical FPG extract (1 and 10 mg/ml, 100 μl/d) with the effects of minoxidil as a positive control (5%, 100 μl/d) or vehicle control (30% ethanol) on the depilation-induced hair cycling in 7 week-old-C57BL/6 mice. FPG extract significantly increased the proliferation of DPCs in dose and time dependent manners (P<0.05, P<0.01 and P<0.001). FPG extract also enhanced Bcl-2 expression and decreased Bax expression compared with control (P<0.01). Moreover, significant elongations of anagen phase during hair cycle after application of FPG were evaluated by photographical and histological observations. FPG extract improves the cell proliferation of human DPCs through anti apoptotic activation. Topical administration of FPG extract might have hair regeneration activity for the treatment of hair loss.
Article
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To pical minoxidil solution 2% stimulates new hair growth and helps stop the loss of hair in men with androgenetic alopecia and women with female pattern hair loss. Results can be variable, and historic experience suggests that higher concentrations of topical minoxidil may enhance efficacy. The purpose of this 48-week, double-blind, placebo-controlled, randomized, multicenter trial was to compare the efficacy and safety of 5% topical minoxidil with 2% topical minoxidil and placebo in the treatment of female pattern hair loss. A total of 381 women (18-49 years old) with female pattern hair loss applied 5% topical minoxidil solution (n = 153), 2% topical minoxidil solution (n = 154), or placebo (vehicle for 5% solution; n = 74) twice daily. Primary efficacy variables were change in nonvellus hair count at week 48, and patient and investigator assessments of change in hair growth/scalp coverage at week 48. After 48 weeks of therapy, 5% topical minoxidil was superior to placebo for each of the 3 primary efficacy measures. The 2% topical minoxidil group demonstrated superiority over placebo for hair count and investigator assessment of hair growth/scalp coverage at week 48; differences in patient assessment of hair growth at week 48 were not significantly different from placebo. The 5% topical minoxidil group demonstrated statistical superiority over the 2% topical minoxidil group in the patient assessment of treatment benefit at week 48. Both 5% and 2% topical minoxidil helped improve psychosocial perceptions of hair loss in women with female pattern hair loss. An increased occurrence of pruritus, local irritation, and hypertrichosis was observed with 5% topical minoxidil versus 2% topical minoxidil and placebo. In this 48-week study of 381 women with female pattern hair loss, 5% topical minoxidil was superior to placebo on each of the 3 primary efficacy end points: promoting hair growth as measured by change in nonvellus hair count and patient/investigator assessments of hair growth and scalp coverage. Application of 2% topical minoxidil was superior to placebo for assessments of nonvellus hair counts and investigator assessment of hair growth/scalp coverage at week 48; differences in patient assessment of hair growth at week 48 were not significantly different from placebo. At week 48, the 5% topical minoxidil group demonstrated statistical superiority over the 2% topical minoxidil group in the patient assessment of treatment benefit. Both concentrations of topical minoxidil were well tolerated by the women in this trial without evidence of systemic adverse effects. With the introduction of numerous herbal remedies for hair loss, of which most have not been tested in randomized, double-blind, placebo-controlled trials, it is important to describe well-controlled trials that demonstrate the efficacy and safety of topical drugs.
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Background and aim: Androgenetic alopecia (AGA) is undoubtedly the most common form of hair loss in males. It is a condition which may cause cosmetic and psychosocial problems in androgen-dependent cases. In this open, randomized and comparative study we evaluated the efficacy of oral finasteride and 5% topical minoxidil treatment for 12 months in 65 male patients with mild to severe AGA. Methods: We randomly assigned 40 (61.53%) patients to receive 1 mg/day oral finasteride for 12 months, and 25 (38.47%) patients applied 5% topical minoxidil solution twice daily for 12 months. Results: There were no significant differences between the 2 groups considering age, age of onset of hair loss, family history and type of hair loss (p > 0.05). In the clinical evaluation at the endpoint of treatment, the clinical cure rates (i.e. increased intensity of hair) were 80% (32/40) for the oral finasteride group and 52% (13/25) for the 5% topical minoxidil group. Encountered side effects were all mild, and there was no need to stop the treatment. In the group given oral finasteride, side effects were noted in 7 patients: 6 patients suffered from loss of libido, and 1 patient had an increase in other body hairs; irritation of the scalp was seen in 1 patient in the group administered 5% minoxidil. These adverse events disappeared as soon as the treatment was stopped. The laboratory data on both drug groups did not show any statistically or clinically significant intragroup changes from baseline values to the endpoint (p > 0.05), except the level of serum total testosterone which was increased, and free testosterone and serum prostate-specific antigen in the finasteride group which were statistically decreased from baseline values to the endpoint (p < 0.05). Conclusion: In this comparative study of systemic finasteride and topical minoxidil, it was concluded that both drugs were effective and safe in the treatment of mild to severe AGA, although oral finasteride treatment was more effective (p < 0.05). Adverse events were not considered important either, and these side effects disappeared as soon as the treatment was stopped.
Article
Androgenetic alopecia is the most common type of hair loss in men and women. The disorder represents a quantitative phenotype with an underlying genetic disposition. So far none of the causative genes have been identified. Under the influence of androgens there is a shortening of the anagen phase as well as a reduction of the cellular hair matrix volume in the involved scalp area. This results in the transformation of thick terminal hair follicles into thin vellus-like hair follicles. Clinically, patients present with an alopecia that follows a defined pattern (pattern baldness) and progresses continuously but in varying degrees. In advanced cases, men may develop baldness with remaining hair exclusively in the temporal and occipital regions. Women are prone to exhibit a more diffuse type of hair loss with pronounced thinning in the parietal region. Whereas the diagnosis of androgenetic alopecia is easy, its treatment is often difficult. The physician is commonly confronted with high patients' expectations regarding hair regrowth. Today, with minoxidil and finasteride, effective therapies are available which can lead to cessation of hair loss. The identification of underlying genes will make a more specific therapy easier to achieve.
Article
The need for a widely accepted, accurate, and reproducible standard of classification for male pattern baldness has increased with the advent and increasing popularity of hair transplant surgery. This report establishes such a classification, and reports its use in determining the incidence of male pattern baldness at various ages in 1,000 white adult male subjects. The action of testosterone as an incitant in male pattern baldness is well known, but this study points out the continued effect of time, even in later years. Since most hair transplant surgery is peformed on subjects with male pattern baldness, and because the success of hair transplant surgery is largely dependent on proper patient selection, a complete understanding of male pattern baldness is essential for consistently good results with hair transplantation.
Article
We studied the effect of the water fraction of Panax ginseng, one of traditional oriental medicine herbs on apoptosis and the formation of medullary cell in the hair follicles of irradiated mice. The hair follicle or its differentiated product, the hair, which represents a linear historical record of follicular proliferative activity, could provide a biological indicator of the effect of radioprotective drugs. Adult N:GP(s) mice with hair follicles synchronously in the middle of the hair growth cycle received whole-body doses of gamma-radiation. The hair follicles were analysed either 12 hours after irradiation with 2 Gy in the experiment on the apoptosis, or 3 days after irradiation with 3 Gy in the experiment on the forming medulla. The number of medullary cells per unit length (100 microns) were measured by H and E staining. Apoptosis was detected by a nonisotopic in situ DNA end-labeling (ISEL) technique and H and E stain applied to the serial histologic sections. Ginseng administration before irradiation resulted in a suppression of apoptosis, as shown by a reduced number of cells stained with ISEL for fragmented DNA, both i.p. (0.3 mg/head, p < 0.05) and p.o. (2 mg/ml of drinking water, p < 0.05) treatment. In addition, ginseng treatment was associated with an increase in the number of medullary cell per unit length as compared with the vehicle treated mice (p < 0.001, i.p.; p < 0.05, p.o.). These results indicate that the water fraction of ginseng can exert a potent effect on the recovery of the hair follicles by its combined effects on proliferation and apoptosis of the cells in the hair follicle.
Article
Programmed cell death (apoptosis), a form of cell death, described by Kerr and Wyllie some 20 years ago, has generated considerable interest in recent years. The mechanisms by which this mode of cell death (seen both in animal and plant cells), takes place have been examined in detail. Extracellular signals and intracellular events have been elaborated. Of interest to the clinician, is the concentrated effort to study pharmacological modulation of programmed cell death. The attempt to influence the natural phenomenon of programmed cell death stems from the fact that it is reduced (like in cancer) or increased (like in neurodegenerative diseases) in several clinical situations. Thus, chemicals that can modify programmed cell death are likely to be potentially useful drugs. From foxglove, which gave digitalis to the Pacific Yew from which came taxol, plants have been a source of research material for useful drugs. Recently, a variety of plant extracts have been investigated for their ability to influence the apoptotic process. This article discusses some of the interesting data. The ability of plants to influence programmed cell death in cancerous cells in an attempt to arrest their proliferation has been the topic of much research. Various cell-lines like HL60, human hepatocellular carcinoma cell line (KIM-1), a cholangiocarcinoma cell-line (KMC-1), B-cell hybridomas, U937 a monocytic cell-line, HeLa cells, human lymphoid leukemia (MOLT-4B) cells and K562 cells have been studied. The agents found to induce programmed cell death (measured either morphologically or flow cytometrically) included extracts of plants like mistletoe and Semicarpus anacardium. Isolated compounds like bryonolic acid (from Trichosanthes kirilowii var. Japonica, crocin (from saffron) and allicin (from Allium sativum) have also been found to induce programmed cell death and therefore arrest proliferation. Even Chinese herbal medicine "Sho-saiko-to" induces programmed cell death in selected cancerous cell lines. Of considerable interest is the finding that Panax ginseng prevents irradiation-induced programmed cell death in hair follicles, suggesting important therapeutic implications. Nutraceuticals (dietary plants) like soya bean, garlic, ginger, green tea, etc. which have been suggested, in epidemiological studies, to reduce the incidence of cancer may do so by inducing programmed cell death. Soy bean extracts have been shown to prevent development of diseases like polycystic kidneys, while Artemisia asiatica attenuates cerulein-induced pancreatitis in rats. Interestingly enough, a number of food items as well as herbal medicines have been reported to produce toxic effects by inducing programmed cell death. For example, programmed cell death in isolated rat hepatocytes has been implicated in the hepatitis induced by a herbal medicine containing diterpinoids from germander. Other studies suggest that rapid progression of the betel- and tobacco-related oral squamous cell carcinomas may be associated with a simultaneous involvement of p53 and c-myc leading to inhibition of programmed cell death. Several mechanisms have been identified to underlie the modulation of programmed cell death by plants including endonuclease activation, induction of p53, activation of caspase 3 protease via a Bcl-2-insensitive pathway, potentiate free-radical formation and accumulation of sphinganine. Programmed cell death is a highly conserved mechanism of self-defense, also found to occur in plants. Hence, it is natural to assume that chemicals must exist in them to regulate programmed cell death in them. Thus, plants are likely to prove to be important sources of agents that will modulate programmed cell death.
Article
There are racial differences in the prevalence and types of androgenetic alopecia (AGA). There have been several reports on the prevalence and types of AGA in the general population of caucasians, but few studies on Koreans with samples of sufficient numbers have been reported. To obtain a more precise estimate of the prevalence and types of AGA in Korean men and women and to compare the results with those in caucasians. The prevalence and types of AGA were analysed in 10,132 Koreans (5531 men and 4601 women) who had visited the Health Examination Centre at Kyung Hee University Hospital for regular health examinations between December 1997 and July 1999. To classify the degree of hair loss for each subject, the Norwood classification was used in men and the Ludwig classification in women. For AGA in men, 'female pattern' was added to the Norwood classification. In Korean men, the prevalence of AGA (Norwood III or above) at all ages was 14.1%. It increased steadily with advancing age, but was lower than that of caucasians: 2.3% in the third decade, 4.0% in the fourth decade, 10.8% in the fifth decade, 24.5% in the sixth decade, 34.3% in the seventh decade and 46.9% over 70 years. Type III vertex involvement was the most common type in the third decade to the seventh decade; over 70 years, type VI was most common. A 'female pattern' was observed in 11.1% of cases. In Korean women, the prevalence of AGA (Ludwig I or above) at all ages was 5.6%. It also increased steadily with advancing age: 0.2% in the third decade, 2.3% in the fourth decade, 3.8% in the fifth decade, 7.4% in the sixth decade, 11.7% in the seventh decade and 24.7% over 70 years. Grade I was the most common type up to the sixth decade; over 60 years, grade I and II were similar in prevalence. Grade III (total baldness) was not observed. A family history of baldness was present in 48.5% of men and 45.2% of women with AGA. The prevalence of AGA in Korean men and women was lower than that in caucasians, as recorded in the literature. Korean men tend to have more frontal hairline preservation and show a more 'female pattern' of hair thinning than caucasians. Therefore, 'female pattern' should be added to the classification of AGA.
Article
A 70% methanol extract from red ginseng (steamed and dried roots of Panax ginseng C. A. Meyer, a kind of Ginseng Radix) had superior activity to that of white ginseng (peeled and dried root of P. ginseng, another kind of Ginseng Radix) in a hair growth promoting assay using mouse vibrissal follicles in organ culture. Of the major constituents of P. ginseng, ginsenoside-Rb(1) (G-Rb(1)) exhibited activity, but ginsenoside-Rg(1) (G-Rg(1)) and -Ro (G-Ro) were ineffective. Additionally, 20(S)-ginsenoside-Rg(3) (20(S)-G-Rg(3)) formed by the processing of red ginseng from the crude root of P. ginseng also showed hair growth promoting activity. These results indicate that Ginseng Radix possesses hair growth promoting activity, and its bioactive components are partially attributable to the ginseng saponin components mentioned above.
Article
Androgenetic alopecia is the most common type of hair loss in men and women. The disorder represents a quantitative phenotype with an underlying genetic disposition. So far none of the causative genes have been identified. Under the influence of androgens there is a shortening of the anagen phase as well as a reduction of the cellular hair matrix volume in the involved scalp area. This results in the transformation of thick terminal hair follicles into thin vellus-like hair follicles. Clinically, patients present with an alopecia that follows a defined pattern (pattern baldness) and progresses continuously but in varying degrees. In advanced cases, men may develop baldness with remaining hair exclusively in the temporal and occipital regions. Women are prone to exhibit a more diffuse type of hair loss with pronounced thinning in the parietal region. Whereas the diagnosis of androgenetic alopecia is easy, its treatment is often difficult. The physician is commonly confronted with high patients' expectations regarding hair regrowth. Today, with minoxidil and finasteride, effective therapies are available which can lead to cessation of hair loss. The identification of underlying genes will make a more specific therapy easier to achieve.
Article
It has not been conclusively established that female pattern hair loss (FPHL) is either due to androgens or responsive to oral antiandrogen therapy. To evaluate the efficacy of oral antiandrogen therapy in the management of women with FPHL using standardized photographic techniques (Canfield Scientific), and to identify clinical and histological parameters predictive of clinical response. For this single-centre, before-after, open intervention study, 80 women aged between 12 and 79 years, with FPHL and biopsy-confirmed hair follicle miniaturization [terminal/vellus (T/V) hair ratio < or = 4 : 1] were photographed at baseline and again after receiving a minimum of 12 months of oral antiandrogen therapy. Forty women received spironolactone 200 mg daily and 40 women received cyproterone acetate, either 50 mg daily or 100 mg for 10 days per month if premenopausal. Women using topical minoxidil were excluded. Standardized photographs of the midfrontal and vertex scalp were taken with the head positioned in a stereotactic device. Images were evaluated by a panel of three clinicians experienced in the assessment of FPHL, blinded to patient details and treatment and using a three-point scale. As there was no significant difference in the results or the trend between spironolactone and cyproterone acetate the results were combined. Thirty-five (44%) women had hair regrowth, 35 (44%) had no clear change in hair density before and after treatment, and 10 (12%) experienced continuing hair loss during the treatment period. Ordinal logistic regression analysis to identify predictors of response revealed no influence of patient age, menopause status, serum ferritin, serum hormone levels, clinical stage (Ludwig) or histological parameters such as T/V ratio or fibrosis. The only significant predictor was midscalp clinical grade, with higher-scale values associated with a greater response (P = 0.013). Eighty-eight percent of women receiving oral antiandrogens could expect to see no progression of their FPHL or improvement. High midscalp clinical grade was the only predictor of response identified. A placebo-controlled study is required to compare this outcome to the natural history of FPHL.
Article
The inhibitory effects of the Korean red ginseng (steamed root of Panax ginseng C.A. MEYER, family Araliaceae) saponin fraction (KRGS) and its constituents ginsenosides Rg3, Rf, and Rh2 in mouse passive cutaneous anaphylaxis (PCA) and contact dermatitis models were measured. Orally administered KRGS and its genuine ginsenosides potently inhibited the PCA reaction induced by IgE. However, when these ginsenosides were intraperitoneally administered, ginsenoside Rh2 showed the most potent inhibition. The ginsenoside Rh2 also the most potently inhibited the beta-hexosaminidase release from RBL-2H3 cells induced by IgE with antigen. KRGS administered topically at a dose of 0.1% suppressed ear swelling in an oxazolone-induced mouse contact dermatitis model by 38.8%. Its constituents ginsenosides Rg3, Rf, and Rh2 at a concentration of 0.05% also potently suppressed mouse ear swelling by 47.5%, 34.8%, and 49.9% at 16 d, respectively. These ginsenosides also significantly reduced mRNA expression levels of cyclooxygenase (COX)-2, interleukin (IL)-1beta, tumor necrosis factor-alpha and interferon-gamma induced by oxazolone applied to mouse ears. However, the ginsenosides, except for ginsenoside Rh2, almost did not notably reduce IL-4 levels. The ginsenoside Rh2 also potently inhibited COX-2 and inducible NO synthetase protein expression in liphopolysaccharide-stimulated RAW264.7 cells. Based on these findings, KRGS and its ginsenosides are suggested to improve atopic and contact dermatitis by regulating expression of cytokines.
Article
Male pattern hair loss (MPHL) is a potentially reversible condition in which dihydrotestosterone is an important etiologic factor. Our aim was to evaluate the efficacy of the type 1 and 2 5alpha-reductase inhibitor dutasteride in men with MPHL. Four hundred sixteen men, 21 to 45 years old, were randomized to receive dutasteride 0.05, 0.1, 0.5 or 2.5 mg, finasteride 5 mg, or placebo daily for 24 weeks. Dutasteride increased target area hair count versus placebo in a dose-dependent fashion and dutasteride 2.5 mg was superior to finasteride at 12 and 24 weeks. Expert panel photographic review and investigator assessment of hair growth confirmed these results. Scalp and serum dihydrotestosterone levels decreased, and testosterone levels increased, in a dose-dependent fashion with dutasteride. The study was limited to 24 weeks. Dutasteride increases scalp hair growth in men with MPHL. Type 1 and type 2 5alpha-reductase may be important in the pathogenesis and treatment of MPHL.
Article
Studies generally, it is believed that the ancient 'Chinese ginseng' did exist due to the fact that it is clearly recorded in the Chinese historical and medicine-related sources. Although it is hard to deny that such 'ginseng' did exist in ancient China, the re-examination of its true nature is also necessary. In other words, certain refutation can be made against the claim that ancient 'Chinese jinseng' was in fact 'Panax jinseng' (C. A. Mey.), since the Chinese jinseng accounts do not tell that it is such. For example, when looking into its shape based on descriptions, the 'Chinese Jinseng' has black seed, hairy stem, and violet flower. ' Panax jinseng' on the other hand, has opal seed, no-hair stem, and light-green flower. In terms of cultivation centre, most of mainland China is unsuitable for Jinseng production with the exception of the Shangdang area of Shanxi province, which solely had the reputation of being the production centre of ancient 'Chinese jinseng'. However, when looking into the Chinese sources for jinseng-producing areas, they show that Hepei and Liaoning province and Jiangnan (south of the Yangtze river) areas also have had some jinseng-related history. Regardless of such instance, these regions did not cultivate Panax jinseng. As shown above, ancient 'Chinese jinseng' was far from being identical, in respect to its shape or production areas, to Panax jinseng. Hence, this study came to the conclusion that there is indeed very high skepticism about whether the true nature of 'jinseng' in ancient China was in fact Panax jinseng. On the contrary, there is higher possibility that the ancient 'Chinese jinseng' is totally different plant from Panax jinseng which is actually Codonopsis pilosula. When examining the shape and production areas of Codonopsis pilosula, it is closely matched with many parts of ancient 'Chinese jinseng' texts. In short, it is presumed that the 'Chinese jinseng' did indeed exist in ancient China but it was Codonopsis pilosula instead of Panax jinseng.
An open, randomized, comparative study of oral finasteride and 5% topicalminoxidil in male androgenetic alopecia
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  • G Acikgoz
  • Hb Ta Tan
  • O Kose
  • Z Kurumlu
A study on the true nature of
  • J P Yang
  • I S Yeo
Yang JP, Yeo IS. A study on the true nature of "Chinese jinseng". Uisahak 12: 144-166 (2003)