부산대학교 도서관

Objective: Ginseng (Panax spp.) has been used for centuries as a natural remedy for numerous varied ailments. We report a life-threatening vaginal hemorrhage that resulted from the use of therapeutic Chinese ginseng douche. Case Report: A 38-year-old nulliparous, virginal, Asian woman presented to the emergency department after vaginal bleeding for 30 minutes. Her past medical history was significant only for a vaginal yeast infection 6 months earlier for which her gynecologist prescribed a douche of Chinese ginseng extract. She used this douche every three days for the previous six months, despite the fact that her yeast infection had resolved. She denied any sexual activity ever, and denied vaginal instrumentation other than use of the douche, which was inserted with a standard soft, flexible tapered plastic tip on a bottle. She reported her last menstrual period 5 weeks earlier. Her vital signs were: heart rate 100/minute, blood pressure 150/100 mmHg, respirations 16/minute, and she was afebrile. Her physical examination was normal excepting for skin pallor and an actively hemorrhaging erosion of the vaginal mucosa. The cervical os was closed and was not bleeding. Initial laboratory investigations were: white blood count 7.8 x [10.sup.9]/L, hemoglobin (Hb) 13.3 g/dL, hematocrit (Hct) 39.6%, platelet count 288 x [10.sup.9]/L, prothrombin time (PT) 12 seconds, partial thromboplastin time (PTT) 30.1 seconds, INR 1.07, and a negative serum pregnancy test. Her blood pressure decreased to 80/40 mmHg and a repeat Hb was 7.5 g/dL. The patient received 2 liters of crystalloid and 500 mL of packed red blood cells. After the blood transfusion, her Hb increased to Hb 11 g/dL. The vaginal hemorrhage ceased after conservative treatment with intravaginal packing, and the patient was discharged the following day with instructions to avoid further use of ginseng douche. The patient suffered no further gynecologic problem after discontinuation of the douche. Conclusions: For centuries, Eastern and Asian cultures have used herbal remedies such as ginseng for numerous ailments. Traditional Western medicine is increasingly accepting and engaging in the use of ginseng and other natural therapies. Ginseng douche has been advocated as a treatment for vaginal yeast infections and cervical dysplasia. Unfortunately, the safety, efficacy, and side-effects of ginseng and many other potentially effective herbal therapies has not been well-studied. This patient suffered a life-threatening vaginal hemorrhage as a consequence of using therapeutic Chinese ginseng extract douche to treat and prevent vaginal yeast infection.
Hoffman RJ, Burke JM, Hahn IH, Hoffman RS. New York City Poison Control Center, New York, New York, [...]