Recently, we encountered another case of liver failure caused by taking Panax ginseng, which was misdiagnosed as cirrhosis of the liver because of jaundice and ascites after taking homegrown Panax ginseng for more than 20 days. The increase of similar cases in recent years is related to the misunderstanding of Panax pseudoginseng as Panax ginseng. So, why is Panax pseudoginseng so toxic? How to distinguish Panax pseudoginseng from earth panax pseudoginseng? Although there is a word difference between Panax pseudoginseng and Panax notoginseng, the difference is great. Panax pseudoginseng, also known as Tian Qi, is a valuable Chinese herb belonging to the family of Wujia, which is non-toxic and has the function of activating blood circulation, relieving swelling and pain, and is often used in the treatment of bruises and injuries. It is also known as Panax pseudoginseng, which is widely planted in some mountainous and rural areas in China. It is often used by folk as a recipe to invigorate blood, reduce swelling, bruises and injuries, stop bleeding and strengthen the body, and is prone to cause liver damage. The toxicity of panax pseudoginseng comes from the arsenic bilane alkaloids it contains, which, when absorbed by the human body, can cause endothelial damage to the small veins in the liver, followed by occlusion of the small veins, which is known as hepatic sinusoidal obstruction syndrome, with clinical manifestations such as liver enlargement, ascites and jaundice. If you make wine with Panax ginseng, the toxic components of arsenic double alkaloids are more easily dissolved, and the toxicity is many times higher than boiling, so it is very easy to be poisoned after drinking. In fact, it is easy to distinguish between “panax pseudoginseng” and “earth panax pseudoginseng” from the leaf shape and flower shape, the leaf shape of panax pseudoginseng is fat and looks like an open palm, six or seven leaves stretch in different directions, and the flower is red; while the leaf shape of earth panax pseudoginseng is smaller, the leaves grow symmetrically along the stem, and the flower is yellow. The flowers are yellow. Panax pseudoginseng roots are cone-like or cylindrical, with different surfaces depending on the color of the soil where they are planted, commonly earth-red and gray-brown (after being cleaned with a brush, their original color is green), with the main body branching root marks and stem marks at the top, surrounded by verrucous protrusions, solid in quality, gray-green and yellow-brown in cross section, with a slightly radial arrangement in cross section, commonly known as chrysanthemum heart, and the skin part is easily separated from the xylem part; while the roots of earth panax pseudoginseng are cylindrical or slightly cone-shaped, not easy to dry. The root of Panax ginseng is cylindrical or slightly conical, not easy to dry, and the texture is looser and dark brown after drying, and the surface is not flat and flaking. In terms of taste, panax pseudoginseng is very bitter in the mouth, but immediately sweetens without pungency or sourness; earth panax pseudoginseng has a sweet, slightly bitter, sour taste. Since earth panax pseudoginseng and panax pseudoginseng have similar efficacy, and earth panax pseudoginseng is cheap and easy to grow, many people can plant it themselves, so they use earth panax pseudoginseng instead of panax pseudoginseng and either boil and take earth panax pseudoginseng water in large doses to treat bruises and injuries, or take earth panax pseudoginseng wine for a long time as health care, thus leading to poisoning. Given that panax pseudoginseng is toxic and difficult to treat after poisoning, experts advise people not to take it on their own.