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Quick guide to Red Sage

Scientific Name: Danshen

Other Names: Chinese Sage, Huang Ken, Radix Salvia, Red Sage, Salvia Root, Salvia miltiorrhiza, Ten Shen

Who is this for?

In traditional Chinese medicine, danshen has been used to treat heart conditions and strokes. Results from animal and human studies support these uses of danshen to some extent. Danshen is known to decrease the blood's ability to clot in at least two ways. First, it limits the stickiness of blood components known as platelets. Secondly, it also decreases the production of fibrin — threads of protein that trap blood cells to form clots. Both these effects help to improve blood circulation. In addition, chemicals in danshen may relax and widen blood vessels, especially those around the heart. Some research also suggests that danshen potentially may increase the force of heartbeats and slow the heart rate slightly. All these effects need more study before they can be recommended.

In animal studies, danshen has appeared to interfere with the development of liver fibrosis - the formation of scar-like fibers in the liver. Because the non-functioning fibers crowd out active liver tissue, liver function decreases gradually as the amount of fibrous tissue increases. Chronic hepatitis and drinking large amounts of alcoholic beverages are the major causes of liver fibrosis. Damage from exposure to chemicals or certain drugs may also result in liver fibrosis. Because danshen may also increase blood flow into the liver, the length of time that potentially damaging substances stay in the liver may be reduced, also reducing the possible damage they may cause. Both of these possible liver-protective actions need further study.

Recently, some results from laboratory studies show that danshen may have some activity against human cancer cells and HIV (the virus that causes AIDS). Danshen may stop the spread of several different cancer cells types by interrupting the cell division process and also by causing cancer cells to disintegrate. For HIV, chemicals in danshen may block the effectiveness of an enzyme, HIV-1 integrase, that the virus needs to replicate. Neither of these potential uses of danshen has been tested in humans.

When should I be careful taking it?

Individuals who have hemophilia or other disorders of blood clotting should avoid taking danshen because chemicals in danshen are known to interfere with blood clotting.

Because very little is known about the possible effects of danshen for developing babies, infants, and very young children; women who are pregnant or breast-feeding and children less than 2 years of age should avoid taking it.

What side effects should I watch for?

Only minor side effects such as itching and stomach upset have been associated with taking danshen.

What interactions should I watch for?

Prescription Drugs

In studies and case reports, danshen has been shown to increase the time blood needs to clot. When it is taken with antiplatelet or anticoagulant drugs, the effect of the drug may be increased, resulting in uncontrolled bleeding.

  • Antiplatelets include Plavix and Ticlid.
  • Anticoagulants include heparin and warfarin.

Danshen has an effect on the heart that is similar to, but less definite than, the effect of digoxin, a drug used to increase the force and decrease the rate of heartbeats. If danshen and digoxin are taken together, heartbeats may become too forceful or too slow, possibly causing dangerous changes in heart rhythm.

Non-prescription Drugs

Danshen can decrease the ability of blood to clot after an injury. Aspirin can also delay clotting, so danshen should not be taken at the same time as aspirin. Additionally, results from laboratory studies show that danshen may cause increased blood levels of aspirin. As a result, the risk of aspirin's side effects, such as stomach pain or vomiting, may be higher. Although serious side effects from aspirin are rare, they may include bloody or very dark stools, dizziness, rash, or ringing in the ears.

Herbal Products

Theoretically, if danshen is used with other herbs that affect blood clotting, bleeding may occur. Some of the most common herbal products that might inhibit blood clotting are:

  • Devil's Claw
  • Eleuthero
  • Garlic
  • Ginger (in high amounts)
  • Ginkgo
  • Horse Chestnut
  • Panax Ginseng
  • Papain
  • Red Clover
  • Saw Palmetto

If danshen is taken at the same time as other herbs that may also affect the heart, potentially dangerous changes in heart function may result. Herbal products with heart effects include:

  • European Mistletoe
  • Ginger (in large doses)
  • Hawthorn
  • Motherwort
  • Panax Ginseng
  • Pleurisy Root
  • Squill

Some interactions between herbal products and medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals.

Should I take it?

A small perennial that grows mostly in sunny areas, danshen is believed to have originated in the area of the Mediterranean Sea. It produces small, fuzzy, grayish leaves in the spring; blue, red, or purple flowers in summer; and brownish nut-like fruits in the fall. Because danshen belongs to the sage family of plants, its aromatic leaves are often dried and used to season meats and stuffing. In some parts of the world, a tea is brewed from danshen leaves and twigs.

The medical use of danshen is concentrated mainly in Asia, where it grows abundantly in the wild. It is also grown on farms in China and Japan. Its distinctive, bright red roots are dug up in the fall or early winter, and then dried in the sun for use in medicine.

Dosage and Administration

Note: Much of the research done with danshen has been with injected forms of the drug, which are not available in the United States.

For oral use, danshen may be available alone, but it is more commonly included with other herbals, such as Panax ginseng or hawthorn, that may have effects on heart function that are similar to the potential effects of danshen. The most common oral dosage forms of danshen when it is used alone are capsules (usually containing powdered danshen root) and extracts (concentrated liquid preparations typically made by soaking chopped or mashed plant parts in a liquid such as alcohol, and then straining out the solid parts). Oral doses of danshen vary widely, with amounts of up to 15,000 mg (15 grams) per day suggested by some sources. However, in one clinical study of healthy individuals, danshen was given at a dose of 20 mg per kilogram of body weight. Since a kilogram is about 2 pounds, in this study a dose of danshen for a person weighing about 165 pounds would have been 1500 mg (1.5 grams) per day.

Summary

Danshen contains chemicals that may decrease blood clotting, cause blood vessels to relax, increase the force of heartbeats, and slow the heart rate. All these effects may help to treat heart conditions and strokes. In addition, danshen may help to prevent liver damage caused by alcohol, drugs, or diseases. It shows some antiviral and anticancer activity in laboratory studies, but all its potential uses need to be studied further.

Risks

Due to the likelihood that it may increase bleeding, danshen should not be taken by individuals who have impaired blood clotting. Small children, pregnant women, and women who are breast-feeding should avoid danshen due to uncertainty about its possible effects for developing babies and young children.

Side Effects

While no major side effects have been reported from taking danshen, some individuals who used it have experienced itching or upset stomach.

Interactions

Taking danshen may increase the risk of uncontrolled bleeding while an anticoagulant or antiplatelet drug or herbal is also being taken. In addition, danshen may interfere with the heart drug digoxin or herbal products that have digoxin-like effects.

References

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Chan K, Lo AC, Yeung JH, Woo KS. The effects of Danshen (Salvia miltiorrhiza) on warfarin pharmacodynamics and pharmacokinetics of warfarin enantiomers in rats. Journal of Pharmacy and Pharmacology. 1995;47(5):402-406.

Chan TY. Drug interactions as a cause of overanticoagulation and bleedings in Chinese patients receiving warfarin. International Journal of Clinical Pharmacology and Therapeutics 1998;36:403-405.

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(Note: The above information is not intended to replace the advice of your physician, pharmacist, or other healthcare professional. It is not meant to indicate that the use of the product is safe, appropriate, or effective for you.)

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