The aim of the present study was to investigate the effects of Panax ginseng root extract on the histomorphometric characteristics of the gills of rainbow trout. The experiment was conducted over 60 days using four dietary treatments with three replicates per treatment. In each replicate, 60 fry with an initial mean weight of 15 g were randomly distributed among the experimental units. Fish were fed diets supplemented with 0, 1.0, 1.5, or 2.0 g/kg of aqueous ginseng root extract. Tissue samples were collected from the dorsal and ventral regions of the second gill arches and stained with hematoxylin and eosin and toluidine blue for histological examination. Increasing dietary ginseng supplementation to 1.5 g/kg significantly increased the mean length of the secondary lamellae, as well as the numbers of mucous cells and blood capillaries, in both the dorsal and ventral regions of the gill arches (p < 0.05). In contrast, the mean length of the primary lamellae, interlamellar distance, epithelial thickness, and number of chloride cells did not differ significantly among the ginseng-supplemented groups and the control group in either region of the gill arches (p > 0.05). The numbers of mucous cells and blood capillaries were significantly higher in the ventral region than in the dorsal region across all experimental groups (p < 0.05), whereas the other histomorphometric parameters did not differ significantly between the two regions (p > 0.05). Overall, dietary supplementation with P. ginseng root extract, particularly at 1.5 g/kg diet, was associated with changes in selected gill histomorphometric characteristics of rainbow trout, including secondary lamellar length, mucous cell abundance, and blood capillary number.