In the trials that counted side effects, notoginseng matched placebo. The largest, 2,966 people on a saponin capsule for 3 months, put serious adverse events at 1.0 percent on the capsule and 1.1 percent on placebo. The cautions that remain come from how the root works: it calms platelets, so it adds to any medicine that thins the blood. Here is what the trials reported, then the cautions that follow from the mechanism.
Serious Side Effects Matched Placebo in the Largest Trial
A 2023 trial at 67 Chinese hospitals gave 2,966 people Xuesaitong soft capsules at 120 mg twice a day, or placebo, for 3 months after an ischemic stroke (Wu 2023). Serious adverse events occurred in 15 of 1,488 people on the capsule, 1.0 percent, and 16 of 1,482 on placebo, 1.1 percent. A 2011 trial of 140 people in four hospitals paired a notoginseng extract capsule with low dose aspirin, and its side effects were light to moderate, equal in both groups, and cleared without treatment (He 2011).
It Made Aspirin Easier on the Stomach
A 2021 trial gave 42 people with stable coronary disease and chronic gastritis either aspirin alone or aspirin plus notoginseng saponins for 2 months (Wang 2021). The combination held platelets back further than aspirin alone, and the people on it reported less indigestion. The trial was small and assessor blinded rather than double blind.
Bleeding Did Not Rise When It Joined Antiplatelet Drugs
A 2017 review of 36 trials found notoginseng preparations lowered platelet clumping on top of antiplatelet drugs without adding bleeding events (Li 2017). The review is Chinese language, and its authors noted wide differences between trials and poor methods. A 2022 review of 20 trials in 2,216 people with coronary disease or stroke compared notoginseng plus aspirin with aspirin alone (Dai 2022). Platelet aggregation fell about 6 points further with the saponins, and blood in the stool, stomach bleeding, skin bleeding, eye bleeding, blood in the urine, stomach side effects and hives were no more common.
A 2026 network meta-analysis of 50 trials in 18,424 stroke patients compared saponin products with seven antiplatelet drugs and found no significant difference in adverse events between the treatments (Zhang 2026).
Blood Thinners and Surgery Need a Conversation First
Notoginseng calms platelets, and that is the point of taking it for circulation. Warfarin, aspirin, clopidogrel and every other blood thinner work on the same system, so notoginseng stacks with them rather than replacing them. The trials above measured bleeding under hospital follow up; at home nobody is counting. Talk with your doctor before taking notoginseng if you take any blood thinner, and stop it before surgery, since a change in platelet function is the last thing a surgeon wants to discover on the table. Chinese hospital trials have given sanqi powder after hip fracture surgery to steady blood counts, and a 2024 review of 31 trials in 2,076 people ranked it among the top three herbal options for holding haemoglobin up (Wu 2024); that is a surgical team's decision made with the patient's chart in front of it.
Pregnancy, Breastfeeding and Periods
No trial has given notoginseng during pregnancy. The one childbirth trial, 60 women on Xuesaitong soft capsules for 7 days, started after delivery in hospital (Liu 2002). Practitioner references list pregnancy as a caution (American Dragon; TCM Wiki). No trial covers breastfeeding. Avoid notoginseng in both. Tradition uses raw sanqi for bleeding of many kinds, and no trial has tested it during menstruation; a change in your cycle after starting it is a reason to stop and ask your doctor.
Children
Every trial on this site was in adults; the 2023 stroke trial enrolled people aged 18 to 75 (Wu 2023). There is no trial in children, and no dose for them.
Diabetes Medicines
A 2012 trial of 52 men without diabetes found 3 grams of notoginseng a day for 3 days lowered blood sugar 30 minutes after a glucose drink by 26 mg/dL against placebo (Liang 2012). If you take insulin or tablets that lower blood sugar, tell your doctor before adding notoginseng and watch your readings in the first week. That single trial is the whole record on blood sugar, and the people in it took no diabetes medicines.
Injection Reactions Belong to Hospital Products
Chinese reviews of Xuesaitong injection count adverse events for a product given into a vein in hospital. A 2015 review of 23 trials in 2,196 people recorded 37 adverse events, 17 of them in the injection groups (Zhang 2015). A 2021 review of 12 trials in 1,769 people found adverse reactions no different from standard treatment alone (Feng 2021). Those numbers describe the injection. The powder and capsules sold as supplements have the capsule record above, led by the 2023 trial.
What Users Report
Most people who take notoginseng report nothing they can feel. Some report a dry mouth, a warm feeling or mild stomach upset in the first days, and some report easier bruising when they take it with aspirin. These are reports, not study findings.
Safety Notes
Talk with your doctor before taking notoginseng if you take warfarin, aspirin, clopidogrel or any blood thinner. Stop it before surgery. Avoid it in pregnancy and breastfeeding, where there are no trials. Tell your doctor if you take diabetes medicines. In the 2023 stroke trial, serious adverse events were 1.0 percent on the capsule and 1.1 percent on placebo (Wu 2023).
The doses behind each trial above are in notoginseng dosage.
References
- Wu L et al. 2023. Efficacy and Safety of Panax notoginseng Saponins in the Treatment of Adults With Ischemic Stroke in China: A Randomized Clinical Trial. JAMA Netw Open.
- He L et al. 2011. Radix/rhizoma notoginseng extract (sanchitongtshu) for ischemic stroke: a randomized controlled study. Phytomedicine.
- Wang W et al. 2021. Combination of Panax notoginseng saponins and aspirin potentiates platelet inhibition with alleviated gastric injury via modulating arachidonic acid metabolism. Biomed Pharmacother.
- Li Y et al. 2017. Effect of Panax notoginseng preparations on platelet function. Zhongguo Zhong Yao Za Zhi.
- Dai L et al. 2022. Panax notoginseng preparation plus aspirin versus aspirin alone on platelet aggregation and coagulation in patients with coronary heart disease or ischemic stroke: A meta-analysis of randomized controlled trials. Front Pharmacol.
- Zhang H et al. 2026. Comparative effectiveness of Panax notoginseng saponins-related agents and antiplatelet agents in ischemic stroke: A systematic review and network meta-analysis. J Ethnopharmacol.
- Wu X et al. 2024. Identifying an effective Chinese herbal medicine for reducing postoperative hidden bleeding and stabilizing blood volume following intertrochanteric femur fracture: a Bayesian network meta-analysis of randomized controlled trials. J Orthop Surg Res.
- Liu DY et al. 2002. Clinical observation on treatment of postpartum hemorrhage by xuesaitong soft capsule. Zhongguo Zhong Xi Yi Jie He Za Zhi.
- Liang MTC et al. 2012. Effects of Panax notoginseng (Chinese ginseng) and acute exercise on postprandial glycemia in non-diabetic adults. J Complement Integr Med.
- Zhang X et al. 2015. Xuesaitong injection as one adjuvant treatment of acute cerebral infarction: a systematic review and meta-analysis. BMC Complement Altern Med.
- Feng L et al. 2021. The efficacy and safety of Xuesaitong injection combined with western medicines in the treatment of ischemic stroke: an updated systematic review and meta-analysis. Ann Palliat Med.
Nothing here is medical advice. If you take prescription medication, talk with your doctor before adding notoginseng.
