---
topic: "Panax Notoginseng"
title: "Cardiovascular, Hemostasis, and Anti-Inflammatory Benefits"
order: 1
description: "How Panax notoginseng's unique saponins simultaneously stop bleeding, improve circulation, protect against stroke, and modulate inflammation through multiple validated pathways"
question: "Does Panax notoginseng actually work for stroke, heart health and inflammation?"
answer: "Panax notoginseng probably helps recovery after ischemic stroke (one 3,072-patient trial), but most heart, inflammation and anti-aging claims are animal or cell data."
actions:
  - "If you have had a stroke, ask your neurologist about standardized saponin extracts; the trial used a licensed capsule added to standard care [1]."
  - "Choose standardized PNS extract capsules over raw powder; trials used 150–600 mg of PNS daily in two or three doses."
  - "Take it with food; most cardiovascular trials ran 12 weeks to 6 months."
cautions:
  - "Blood thinners (aspirin, warfarin, clopidogrel): significant interaction potential, so use it only under physician supervision."
  - "Avoid in pregnancy (uterine effects seen in animals) and with active bleeding disorders unless a doctor supervises."
  - "The stroke trial used a Chinese licensed capsule not widely sold elsewhere, so other products and populations may differ [1]."
confidence: 4
confidenceNote: "One 3,072-patient double-blind RCT (89% vs 82% functionally independent at 90 days) plus a 43-trial meta-analysis; all from China, with varied preparations."
evidenceSummary:
  rctCount: 1
  observationalCount: 0
  metaAnalysisCount: 1
  totalParticipants: "7,000+"
  replicated: true
  newestStudyYear: 2023
references:
  - id: "1"
    pmid: "37338907"
    title: "Efficacy and Safety of Panax notoginseng Saponins in the Treatment of Adults With Ischemic Stroke in China: A Randomized Clinical Trial"
    authors: "Wu L, Song H, Zhang C, Wang A, Ji X"
    year: 2023
    journal: "JAMA Network Open"
  - id: "2"
    pmid: "25152758"
    title: "Protective Effects of Panax Notoginseng Saponins on Cardiovascular Diseases: A Comprehensive Overview of Experimental Studies"
    authors: "Yang X, Xiong X, Wang H, Wang J"
    year: 2014
    journal: "Evidence-Based Complementary and Alternative Medicine"
  - id: "3"
    pmid: "34335808"
    title: "Systematic Review and Meta-Analysis on Randomized Controlled Trials on Efficacy and Safety of Panax Notoginseng Saponins in Treatment of Acute Ischemic Stroke"
    authors: "Wang LD, Xu ZM, Liang X, Qiu WR, Liu SJ, Dai LL, et al."
    year: 2021
    journal: "Evidence-Based Complementary and Alternative Medicine"
  - id: "4"
    pmid: "29344413"
    title: "Therapeutic Potential and Cellular Mechanisms of Panax Notoginseng on Prevention of Aging and Cell Senescence-Associated Diseases"
    authors: "Zhao H, Han Z, Li G, Zhang S, Luo Y"
    year: 2017
    journal: "Aging and Disease"
  - id: "5"
    pmid: "33829964"
    title: "Panax notoginseng Saponins Modulate the Inflammatory Response and Improve IBD-Like Symptoms via TLR/NF-κB and MAPK Signaling Pathways"
    authors: "Luo H, Vong CT, Tan D, Zhang J, Yu H, Yang L, et al."
    year: 2021
    journal: "American Journal of Chinese Medicine"
---

Panax notoginseng — known in China as "Tian Qi" or "San Qi" — is a root herb with one of the most unusual and well-documented dual actions in natural medicine: it can simultaneously stop bleeding and improve blood flow. Used in traditional Chinese medicine for over 400 years, it contains a family of compounds called saponins that protect the heart and blood vessels, inhibit the dangerous clumping of platelets, and modulate inflammation. [2] A 2023 randomized clinical trial of more than 3,000 stroke patients published in JAMA Network Open found that patients taking Panax notoginseng saponins achieved functional independence at 3 months at a significantly higher rate than placebo (89% vs 82%). [1] Unlike conventional blood thinners, it works through multiple complementary pathways — making it one of the most clinically researched traditional herbs for cardiovascular and inflammatory conditions.

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## How Panax Notoginseng Works

The root contains over twenty active saponins. Three dominate the research:

- **Notoginsenoside R1** — unique to Panax notoginseng (not found in other ginsengs); has particularly strong effects on platelet aggregation inhibition and protection of the blood-brain barrier
- **Ginsenoside Rb1** — anti-inflammatory, neuroprotective, and cardioprotective; inhibits myocardial cell death during ischemia
- **Ginsenoside Rg1** — improves microcirculation, stimulates nitric oxide production in blood vessels, and reduces oxidative stress after ischemia-reperfusion injury

Together these are usually abbreviated as PNS (Panax notoginseng saponins), and most research uses standardized PNS extracts rather than raw root.

### Cardiovascular Protection

PNS addresses cardiovascular disease through multiple simultaneous mechanisms: [2]

- **Antiplatelet aggregation** — reduces the stickiness of platelets without completely blocking clotting, a critical distinction from pharmaceutical anticoagulants. A meta-analysis of 20 RCTs found PNS plus aspirin increased the platelet inhibition rate without increasing bleeding risk compared with aspirin alone.
- **Antiatherosclerosis** — lowers LDL cholesterol and triglycerides, raises HDL, and inhibits the inflammatory signaling in arterial walls that drives plaque formation
- **Microcirculation** — improves blood flow in small vessels, which is central to heart muscle and brain tissue oxygen delivery
- **Cardioprotection** — protects cardiac cells from ischemia-reperfusion injury (the cell death that occurs when blood flow is restored after blockage) via antioxidant and anti-apoptotic mechanisms

### Stroke Recovery: The PANDA Trial

The most rigorous clinical evidence comes from the PANDA trial, published in JAMA Network Open in 2023. [1] This was a multicenter, double-blind, placebo-controlled RCT conducted at 67 hospitals in China:

- **n = 3,072** patients with ischemic stroke (NIH Stroke Scale score 4–15)
- **Intervention:** Xuesaitong soft capsules (standardized PNS), standard care
- **Control:** Placebo plus standard care
- **Primary endpoint:** Functional independence (modified Rankin Scale 0–2) at 90 days

The PNS group achieved functional independence in 89% of patients versus 82% in placebo (p < 0.001). This absolute risk difference of 7 percentage points — in a condition where stroke disability is common and difficult to reverse — represents a clinically meaningful benefit. Adverse event rates were similar between groups, confirming the safety profile.

### Anti-Inflammatory Mechanisms

PNS broadly suppresses pro-inflammatory signaling through two master regulatory pathways: [5]

- **NF-κB pathway** — the central "switch" that turns on inflammatory gene expression, including the cytokines TNF-α, IL-6, and MCP-1. In a mouse colitis model PNS reduced the DSS-induced activation of the NF-κB pathway components IKKα/β, IκBα and p65, and in macrophages it reduced the release of TNF-α, IL-6 and MCP-1
- **MAPK pathway** — a parallel inflammatory signal transduction system; PNS inhibits ERK, JNK, and p38 kinases, reducing the production of inflammatory mediators

The authors tied the protection seen in colitis mice to downregulation of both of these pathways. In a DSS-induced colitis model, PNS significantly reduced colon inflammation and improved gut barrier function — suggesting potential in IBD beyond its cardiovascular applications. [5]

### Anti-Aging and Cellular Protection

A 2017 review in *Aging and Disease* examined PNS's effects on multiple aging-related mechanisms: [4]

- **Vascular aging** — PNS inhibits the proliferation and migration of smooth muscle cells that drives arterial stiffening; reduces oxidative damage in endothelial cells
- **Brain aging** — saponins cross the blood-brain barrier; notoginsenoside R1 specifically reduces neuroinflammation and supports neurogenesis in animal models of age-related cognitive decline
- **Lifespan extension** — in invertebrate models (C. elegans), PNS supplementation extended lifespan and delayed markers of cellular senescence
- **Cell senescence** — PNS inhibits the p16/p21 senescence pathway in multiple cell types, reducing the accumulation of non-dividing "zombie" cells that drive chronic inflammation

### The Hemostasis Paradox

Traditional Chinese physicians described Panax notoginseng's dual action as "san yu zhi xue" — stopping bleeding while resolving blood stasis (poor circulation). Modern research has explained this apparent contradiction: the hemostatic effect primarily operates through enhanced platelet function and coagulation factor activity in the context of injury and bleeding, while the antiplatelet/circulation-improving effects dominate in the context of cardiovascular disease where platelets are excessively activated. The specific saponin composition and dose determine which effect predominates in a given physiological context.

### Practical Use

**Forms:** Standardized PNS extract capsules are the best-researched form. Raw notoginseng powder (0.5–1g/day) is the traditional preparation. Yunnan Baiyao — a famous Chinese topical and internal hemostatic product — contains Panax notoginseng as a primary ingredient.

**Dosage:** Clinical trials have typically used standardized extracts equivalent to 150–600 mg of PNS daily, divided in two or three doses. The PANDA trial used Xuesaitong soft capsules at the standard licensed dose.

**Timing:** Take with food; no strong evidence for specific timing.

**Duration:** Cardiovascular benefits in most trials ran 12 weeks to 6 months. The herb appears well-tolerated for extended periods.

**Drug interactions:** Significant interaction potential with pharmaceutical anticoagulants and antiplatelet drugs (aspirin, warfarin, clopidogrel). If taking blood thinners, use only with physician supervision. Panax notoginseng is not the same as Panax ginseng or Siberian ginseng — different herb, different chemistry, different applications.

**Who should avoid:** Pregnancy (uterine effects have been observed in animal models). Active bleeding disorders without medical supervision.

See our [Danshen page](/danshen/cardiovascular-and-liver-protection) for a related TCM herb with complementary cardiovascular effects, and our [Nattokinase page](/nattokinase/cardiovascular-fibrinolysis) for another natural approach to blood viscosity and clot prevention.

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## Evidence Review

### PANDA Randomized Controlled Trial (2023)

Wu et al.'s trial published in JAMA Network Open [1] is the largest and most rigorously designed clinical trial of PNS to date. Study design highlights:

- Conducted at 67 tertiary hospitals across China, July 2018–June 2020
- 3,072 patients aged 18–75 with confirmed ischemic stroke, NIHSS 4–15 (moderate stroke)
- Intervention: Xuesaitong soft capsules (a licensed PNS formulation approved in China since 1999), added to standard stroke care
- Double-blind, randomized, placebo-controlled, multicenter design

**Primary outcome:** Modified Rankin Scale score 0–2 (functional independence) at 90 days — 89.0% PNS vs 82.1% placebo (adjusted odds ratio 1.79, 95% CI 1.30–2.47; p < 0.001).

**Secondary outcomes:** Significant improvements in the PNS group for NIHSS neurological deficit scores at 14 days and 90 days; reduced rates of major disability (mRS 3–5).

**Safety:** No significant difference in adverse events or serious adverse events between groups. Notably, no increased bleeding risk was observed — an important safety signal for an agent used in stroke patients who may also receive antithrombotics.

**Limitation:** The study population was Chinese, and the preparation (Xuesaitong) is not widely available outside China. The absolute baseline rates of functional independence reflect a specific trial population; generalizability to Western stroke populations requires caution.

### Cardiovascular Overview: Experimental Evidence (2014)

Yang et al.'s comprehensive review [2] catalogued the cardiovascular pharmacology of PNS monomers across experimental systems. Key findings:

- **Rb1:** Reduces myocardial infarct size in animal models; inhibits cardiomyocyte apoptosis via upregulation of Bcl-2 and downregulation of Bax; reduces arrhythmia incidence after ischemia-reperfusion
- **Rg1:** Dilates blood vessels through endothelial nitric oxide synthase (eNOS) activation — a mechanism similar to that of pharmaceutical vasodilators; reduces platelet aggregation; inhibits smooth muscle cell proliferation
- **R1:** Uniquely potent in platelet aggregation inhibition; protective against blood-brain barrier disruption after stroke

The review identified more than 20 published studies demonstrating significant cardioprotective effects in rodent and cell models, with consistent effects across independent research groups. The authors noted the relative scarcity of large human RCTs at the time of publication — a gap that the PANDA trial has since substantially addressed.

### Stroke Meta-Analysis (2021)

Wang et al.'s systematic review [3] synthesized evidence from 43 RCTs involving 4,170 participants with acute ischemic stroke. The analysis compared PNS formulations (injections and oral preparations) added to conventional treatment versus conventional treatment alone. Key findings:

- Improved functional independence at 3 months (limited to one small sample study at time of publication, but consistent direction)
- Significant improvement in neurological function scores (NIHSS reduction) across multiple studies
- Improved activities of daily living (Barthel Index)
- No significant increase in adverse events

**Heterogeneity and limitations:** The pooled analysis included heterogeneous PNS preparations, dosing regimens, and study quality levels. Injection-based studies dominated the sample. Most trials were conducted in China at single centers. Publication bias cannot be excluded in a literature this geographically concentrated.

### Anti-Aging Mechanisms (2017)

Zhao et al.'s review in *Aging and Disease* [4] synthesized evidence for PNS across aging hallmarks:

- In C. elegans lifespan models, PNS significantly extended median lifespan, associated with activation of the DAF-16/FOXO transcription factor pathway (a conserved longevity mechanism shared across species including mammals)
- In vascular smooth muscle cell studies, PNS inhibited the p16-cyclin D/CDK-Rb senescence pathway — preventing cells from entering the growth-arrested, pro-inflammatory state characteristic of aging vasculature
- Neuroinflammation studies showed that notoginsenoside R1 specifically suppressed microglial activation (the brain's resident immune cell) — reducing IL-6, TNF-α, and nitric oxide production in lipopolysaccharide-stimulated models; this effect may underlie the cognitive benefits seen in some animal models
- The review identified the capacity to reduce both telomere damage and mitochondrial dysfunction as two age-related mechanisms through which PNS may slow cellular aging, though human data for these specific endpoints remain limited

### Inflammation and IBD (2021)

Luo et al. [5] used both in vitro (RAW 264.7 macrophages) and in vivo (DSS-induced colitis mouse model) systems to characterize PNS's anti-inflammatory mechanism. In these experiments, PNS:

- Reduced the release of nitric oxide, TNF-α, IL-6, and MCP-1 in Pam3CSK4-induced RAW 264.7 macrophages
- Reduced the expression of the pro-inflammatory cytokines TNF-α, IL-6, and MCP-1 in the colon tissue of mice with DSS-induced colitis
- Reduced the DSS-induced activation of IKKα/β, IκBα, and p65 (components of the NF-κB pathway)
- Inhibited the phosphorylation of JNK, p38, and ERK1/2 (the MAPK pathway nodes)

The authors concluded that PNS protected colitis mice through downregulation of the MAPK and NF-κB signaling pathways, which were associated with reducing inflammatory responses, alleviating tissue damage, and maintaining intestinal integrity and functionality. This is cell and animal evidence: it points to a mechanism but does not show a benefit in people with IBD or other inflammatory conditions.

### Evidence Strength Summary

Panax notoginseng has an unusually strong evidence base among traditional herbs, anchored by a large, multicenter, placebo-controlled RCT published in a top-tier journal (JAMA Network Open). Cardiovascular protection mechanisms are well characterized in experimental systems, and a consistent pattern of benefit has been replicated across independent Chinese research groups for decades. The main limitations are: most trial evidence comes from China, the specific licensed preparations used in trials may differ from commercially available supplements in the West, and the herb's complex pharmacology means that different preparations (injection vs. oral, different PNS concentrations) may not be interchangeable. Overall confidence: **high for acute ischemic stroke (based on PANDA); moderate for general cardiovascular protection; moderate for anti-inflammatory effects; low-moderate for anti-aging applications in humans.**