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Limited evidenceHeart & metabolic

Panax Notoginseng

Panax notoginseng (san qi, tienchi) is a distinct species from Asian ginseng with a different saponin profile and a genuinely different use: it is given as an injectable stroke drug in China (Xuesaitong) with a large but low-quality trial base. Oral notoginseng supplements sold in the West have essentially none of that evidence and carry a real bleeding-interaction concern.

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What the science says

  • Injectable notoginseng saponins in acute ischemic stroke: many trials, poor quality Limited evidence

    A systematic review and meta-analysis of Panax notoginseng saponins (Xuesaitong) in acute ischemic stroke pooled dozens of randomized trials reporting improved neurological deficit scores and clinical response rates versus control. A separate review of its use after intravenous thrombolysis reports similar signals. Almost all trials are Chinese-language, single-center, inadequately blinded, and use an intravenous formulation — none of this transfers to an oral capsule bought online.

  • Affects platelet aggregation — which cuts both ways Moderate evidence

    A meta-analysis of notoginseng preparations added to aspirin in coronary heart disease and ischemic stroke found greater inhibition of platelet aggregation and changes in coagulation markers versus aspirin alone. This is a documented pharmacodynamic effect, and it is the single most important practical fact about the herb: it means additive bleeding risk with aspirin, clopidogrel, warfarin and DOACs, not a benign "circulation support."

  • Traditional hemostatic use and modern anticoagulant claims are contradictory Limited evidence

    Notoginseng is classically used topically and orally to stop bleeding (it is the main ingredient in Yunnan Baiyao), yet it is marketed in the West for "blood flow" and cardiovascular circulation. Both effects have preclinical support depending on preparation and dose, and no controlled human trial has established which dominates for an oral supplement. That ambiguity is itself a reason for caution around surgery and anticoagulants.

Dosage & safety

Studied doseChinese stroke trials use intravenous Xuesaitong at roughly 200-400 mg/day of notoginseng saponins for 10-14 days — an injectable drug, not a supplement. Traditional oral use is 1-3 g/day of raw powdered root for bleeding, or 3-9 g/day of the cooked root in decoction. Western capsules typically supply 250-500 mg of root or extract, standardized (if at all) to total saponins. There is no validated oral dose for any Western health claim.
SafetyBleeding interaction is the headline concern: combine with aspirin, clopidogrel, warfarin or DOACs only under medical supervision, and stop at least two weeks before surgery or dental procedures. The injectable form has documented anaphylaxis and infusion-reaction risk in Chinese pharmacovigilance data; the oral form's most common complaints are dry mouth, nausea, and sleep disturbance. Do not use in pregnancy — traditional texts consider it contraindicated and there are no human safety data. San qi is expensive and frequently adulterated or substituted with cheaper Panax species and with cornstarch; species and saponin verification matter. Notoginseng preparations are prescription medicines in China, which is context worth having when they arrive as an unregulated capsule elsewhere.

How to take it

TimingTiming does not matter.
With food?With food — nausea and dry mouth are the usual complaints otherwise.
Worth knowingSan qi is frequently adulterated or substituted with cheaper Panax species, so buy only products that name the species and state total saponin content.

Interactions

With medications

  • warfarin, DOACs, aspirin and clopidogrel

    Notoginseng affects platelet function and can add to bleeding risk. combine only under medical supervision and stop at least two weeks before surgery or dental work

With other supplements

  • fish oil, ginkgo, garlic and high-dose vitamin E

    Additive antiplatelet effect. avoid stacking, especially around surgery

Well-established interactions only — this is not a complete list. Always tell your doctor and pharmacist what you take.

Frequently asked questions

Is Panax notoginseng the same as ginseng?

Panax notoginseng (san qi, tienchi) is a distinct species from Asian ginseng, with a different saponin profile and a different traditional use centred on blood and circulation. It is frequently adulterated or substituted with cheaper Panax species, so buy only products that name the species and state total saponin content.

Does notoginseng help after a stroke?

The stroke evidence for notoginseng comes from an intravenous drug used in China (Xuesaitong), backed by many trials that are almost all single-center, poorly blinded and low quality (limited evidence). None of it transfers to an oral notoginseng capsule bought online.

Can I take notoginseng with aspirin or blood thinners?

Only under medical supervision: notoginseng measurably increases platelet inhibition when added to aspirin (moderate evidence), meaning additive bleeding risk with aspirin, clopidogrel, warfarin and DOACs. Stop it at least two weeks before surgery or dental work.

What are the side effects of san qi?

Oral notoginseng most commonly causes dry mouth, nausea and sleep disturbance, and taking it with food helps. Its main risk is bleeding interactions, and it should not be used in pregnancy.

Scientific references

Where to buy

Imperial Elixir, Tienchi Ginseng, 100 Capsules (500 mg per Capsule)

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