Salvia miltiorrhiza is highly prized in Traditional Chinese Medicine (TCM) for promoting blood flow and heart health. Read on to learn about the current state of research and when Danshen may be dangerous.
What is Salvia miltiorrhiza?
Salvia miltiorrhiza, also known as red sage, is a flowering plant native to China and Japan. It is part of the mint family. The plant’s roots are called Danshen and have been used in Traditional Chinese Medicine for over 2000 years [1, 2].
Traditionally, Danshen is given to people with problems related to the heart and circulatory systems, such as high blood pressure or stroke [3, 1].
Traditional Meets Modern
It is often included as part of other traditional medicine. For example, Salvia miltiorrhiza, notoginseng, and borneol can be combined to make Danshen dripping pills. These pills are the first Traditional Chinese Medicine (TCM) that has successfully completed a Phase 2 clinical trial under the U.S. Food and Drug Administration (FDA). This means that it may become the first TCM remedy approved by the FDA in the future [4, 5, 6].
This FDA-monitored study involved 15 centers across the US and 125 patients with angina pectoris, a type of chest pain from heart disease. Due to poor heart function, people with angina have lower exercise tolerance and quality of life. In this study, they discontinued most other heart medications. And after 8 weeks, the pills effectively improved their heart symptoms and exercise capacity .
Danshen dripping pills are currently undergoing trials in the US. They are a great example of a TCM remedy undergoing proper scientific testing – and while the results have been encouraging so far, the quality of many of the available studies has been low.
However, clinical studies have yet to determine whether their use is safe, and these pills are not regulated outside of China. They fall in the grey area of regulation; we recommend caution when evaluating any products that claim to be Danshen dripping pills.
The evidence to back up other benefits of Danshen is weaker but still holds a lot of promise. In most instances, the use of high-quality, regulated supplements from this herb is safe. We carefully break down the research so you know what to expect and what dangers to watch out for.
- Early studies indicate potential use in heart disease
- Long history of traditional use
- Generally considered safe
- May cause side effects including nausea and dizziness
- May interact with medications
- Many available studies are poor in quality and show signs of bias
- Currently unregulated; potentially contaminated or dangerous formulations
This plant contains over 200 active compounds .
Salvia miltiorrhiza produces tanshinones, special kinds of molecules first found in this herb. Over 40 tanshinones have been identified in Danshen, and they are thought to be responsible for many of the herb’s properties, such as its effects on the heart [7, 8, 9, 10].
The roots of the plant contain a number of antioxidants, such as salvianolic acid and other organic acids [11, 1].
The herb also contains vitamins and minerals, like vitamin E and potassium .
There are some small differences in the content of these components among plants from different places. However, the amounts of important molecules like tanshinones are comparable among plants from different areas [12, 13].
Mechanism of Action
Researchers have conducted a number of cell and animal studies on Salvia miltiorrhiza with the goal of determining how it works on the cellular and tissue level.
According to cell studies, Salvia miltiorrhiza may help the heart and decrease blood pressure by:
- Activating ion channels that help widen blood vessels .
- Decreasing the levels of stress-related proteins in blood vessel cells [15, 11].
- Helping blood vessel cells survive when they are injured .
Some researchers believe that the herb’s benefits for people with diabetes are likely related to its ability to boost blood flow, lower inflammation, and quench cellular stress. Its protective effects on the kidney also probably contribute to preventing diabetes-associated kidney disease [17, 18, 19].
What’s more, it may aid in wound healing by promoting the formation of blood vessels and decreasing inflammation and cell death .
According to cell studies, this herb might help the brain and nervous system by:
- Helping brain cells survive when there isn’t enough oxygen, which happens during a stroke .
- Preserving myelin sheaths – coatings around brain cells that help them send electric signals more efficiently .
- Decreasing the formation of Alzheimer’s disease-related plaques .
Many of the compounds in Salvia miltiorrhiza increased the activities of neurotransmitters, like acetylcholine, in the brain, which may be related to the herb’s usefulness for insomnia, anxiety, and depression .
It might kill cancer cells by:
- Generating reactive oxygen species selectively in cancer cells, which can damage their DNA .
- Activating molecular signals in cancer cells that lead the cells to die, stop growing, or even turn into non-cancerous cells [26, 27, 28].
- Cutting of the tumor’s blood supply, effectively causing the tumor cells to starve .
Danshen also appears to have antibacterial and anti-inflammatory effects. Components of the plant might also block male sex hormones, which can otherwise trigger or worsen acne .
It likely affects kidney and liver health by modulating the activity of the immune system and the body’s energy usage [31, 32, 33].
Potential Health Benefits
Salvia miltiorrhiza supplements have not been approved by the FDA for medical use and generally lack solid clinical research. Regulations set manufacturing standards for them but don’t guarantee that they’re safe or effective. Furthermore, unregulated products imported from abroad may be adulterated or otherwise dangerous. Speak with your doctor before supplementing.
Insufficient Evidence For
The following purported benefits are only supported by limited, low-quality clinical studies. There is insufficient evidence to support the use of Salvia miltiorrhiza for any of the below-listed uses. Remember to speak with a doctor before taking Salvia miltiorrhiza or anything labeled “Danshen dripping pills”, and never use them in place of something your doctor recommends or prescribes.
1) Heart Health
One analysis examined 39 clinical trials including 2431 people treated for heart disease with Salvia miltiorrhiza alone or combined with other herbs. Herbal treatment was beneficial in 63.4% to 99.2% of people studied, though the quality of the studies was low .
Another analysis examined the well-known Danshen dripping pill, which contains Salvia miltiorrhiza for heart disease and chest pain. A total of about 34,000 people were included, and it was generally effective, though again, study quality was low .
One analysis compared Danshen dripping pill to a drug called isosorbide dinitrate for treating heart disease-related chest pain. Sixty studies including almost 7k people were analyzed. The herbal treatment was more effective than the drug, but study quality was again poor .
In an analysis of 56 studies including over 5.5k people, Salvia miltiorrhiza was generally effective for reducing chest pain – however, study quality was poor .
In one study, 123 people with heart disease were given either Salvia miltiorrhiza or a placebo. The herbal treatment lowered levels of disease-related blood markers, like cholesterol .
A Danshen injection prevented heart failure in rats, and a similar injection prevented heart scarring in mice [37, 38].
Whether Salvia miltiorrhiza affects blood pressure in a meaningful way isn’t entirely clear, as studies have obtained conflicting results.
In one study, of 90 people with disease-related high blood pressure, herbal combination remedies including Salvia miltiorrhiza didn’t affect blood pressure after 12 months. It did have other circulation-related benefits, like widening and relaxing blood vessels .
Contrastingly, in a study of 55 people with high blood pressure, Danshen reduced blood pressure in about half of those who received it. However, people given the placebo also had a fairly high response rate .
In another study, an injection containing Salvia miltiorrhiza decreased blood pressure-related markers in 30 pregnant women, although this study did not include a control group .
A study of 72 healthy smokers also found that Danshen reduced blood pressure and artery hardening relative to placebo .
Studies in mice and rats were conflicting. On the one hand, compounds in the plant decreased blood pressure. On the other hand, the herbal treatment alone didn’t prevent high blood pressure in rats [15, 43, 14].
In rats, an extract from Salvia miltiorrhiza prevented aneurysms – bulges in blood vessels that can cause problems or even lead the vessel to burst .
Studies in both rodents and cells also suggest that extracts from the herb prevent hardening of the arteries, which may lower the risk of health problems like high blood pressure and heart disease [45, 46, 11, 47].
An herbal combination including Danshen lowered cholesterol in a trial of 165 menopausal women with high cholesterol .
The herb also lowered cholesterol in animals, like rats and dogs, that were fed high-fat diets [49, 50, 51].
Additionally, the antioxidants in the herb lowered levels of oxidized LDL – a type of cholesterol that is highly associated with heart problems – in rabbits .
An analysis of 6 clinical trials including 494 people found that, although the trials all reported vague improvements in people treated with the herb, the quality of the studies was so poor that, “There was no evidence that [Danshen] did more good than harm” .
A larger analysis of clinical trials found a similar lack of high-quality evidence when Traditional Chinese Medicines, including Danshen, were given to people with stroke [53+].
On the other hand, in a more recent trial that included 106 people, those taking Danshen dripping pill were less likely to have another stroke. People taking the pill also had lower levels of C-reactive protein, a marker of inflammation .
Salvia miltiorrhiza also decreased the likelihood of strokes in rats, and it protected rat brain cells from stroke-caused damage [55, 56, 21].
Overall, there is some evidence that this herb could be useful for preventing strokes or enhancing recovery, but because of the lack of high-quality studies, the jury is still out.
3) Cancer and Chemotherapy Side Effects
One study reviewed the data of people who had been treated for prostate cancer in the Taiwanese health system, and they found that those who were taking Danshen during their treatment tended to live longer. This was also true in lung cancer patients [57, 58].
The use of Chinese medicines, including Danshen, was also linked to a lower likelihood of developing cervical cancer after a Pap smear diagnosis of cervical dysplasia – cancer-like cells that aren’t quite cancer yet .
A study of 313 people with multiple myeloma found that herbal remedies could reduce the risk of blood clots that can be a serious problem with certain cancer treatments (thalidomide) .
In mice and rats, this herb could shrink tumors. The plant can also synergize with chemotherapy and reduce chemotherapy side effects, like pain [61, 62, 63, 64, 27, 65].
Many studies of cells in dishes have shown that components of the herb can kill cancer cells, often without doing too much damage to normal cells [61, 62, 66, 67, 68, 26, 69, 70, 71, 64, 72, 73, 74].
Extracts from the plant also reduced inflammation of the mouth, a side effect of chemotherapy, in hamsters .
Because of this, some researchers have proposed that it might be effectively combined with chemotherapy and other treatments, but rigorous studies in humans have yet to be done [57, 66, 76].
Danshen is often used to reduce acne, although proper clinical studies are scarce. In one study of 93 people, a pill containing a Danshen extract reduced the lesions by around half after 4 weeks [77, 78].
Danshen reduced skin irritation in rabbits, and molecular studies support the idea that it could help with acne [30, 79].
5) Wound Healing
In a trial of 90 people recovering from breast cancer surgery, an injection with Salvia miltiorrhiza led to better wound healing and less tissue death around the wound. People who received this injection also had fewer side effects than those who received a different experimental drug .
Studies in rats and mice have also demonstrated that this herb can aid in the wound healing process [81, 82, 20].
6) Pain from Shingles
Postherpetic neuralgia is a painful condition that can occur as a result of shingles. A study of 80 people with this condition found that a combination of pain medication and an acupuncture technique that included Salvia miltiorrhiza reduced pain more than either technique alone .
7) Insomnia and Anxiety
In a trial of 100 people with insomnia, an herbal treatment including Salvia miltiorrhiza was effective for 80% of people after two months. However, the control group also had a high efficacy rate (50%), suggesting a powerful placebo effect .
Components of the plant can reduce anxiety- and depression-like behaviors in mice and rats [85, 86, 87, 24, 88].
8) Kidney Health
In an analysis of 200 people treated for kidney stones, those who took Danshen were less likely to have additional stones in the five years following treatment. The herbal treatment also didn’t seem to increase the likelihood of problematic bleeding during surgery .
In a study of 80 people with kidney failure, an herbal treatment including Salvia miltiorrhiza improved kidney function when combined with standard treatment .
A study of 70 children with kidney inflammation also showed that adding this herb to standard treatments improved kidney health .
In rats, this herb had protective effects during kidney failure and could even protect the kidneys from damage related to aging. Danshen also prevents kidney stones in fruit flies [31, 92, 93, 33, 94].
9) Liver Function
An analysis of 8 studies including 800 patients found that Danshen might be helpful for treating nonalcoholic fatty liver disease. However, the included studies weren’t great – for example, none were blinded, making it almost impossible to rule out the placebo effect .
In mice and rats, Salvia miltiorrhiza decreased liver inflammation and prevented liver scarring after injury [96, 97, 32].
10) Diabetes Complications
In an analysis of 13 trials including 874 people, Danshen dripping pill helped to prevent diabetic retinopathy, a complication of diabetes that affects the eyes. However, the quality of the analyzed studies was low .
In trials including over 400 people in total, medicines containing the herb improved kidney function in cases of kidney inflammation caused by diabetes [99, 100, 101].
In a study of 102 people with diabetes, an injection containing components of the plant led to smaller foot ulcers when combined with standard treatment .
Studies in rodents have also suggested that Salvia miltiorrhiza is effective at improving diabetes and its complications, particularly diabetes-related kidney disease [18, 103, 104, 105, 106].
11) Menstruation and Fertility
Although Salvia miltiorrhiza is commonly taken for menstrual problems like irregular bleeding, there isn’t actually much hard evidence that it has an effect. It just hasn’t really been studied, so most of the evidence relies on clinical use in traditional medicine and not on rigorous trials [107, 108].
One study of 400 patients found that an herbal injection containing Danshen might improve outcomes for surgeries to unblock the fallopian tubes; blocked tubes can cause female infertility .
Danshen also has estrogen-like effects in rats, which may help alleviate menopause symptoms .
Animal Research (Lacking Evidence)
No clinical evidence supports the use of Salvia miltiorrhiza for any of the conditions listed in this section. Below is a summary of the existing animal and cell-based research, which should guide further investigational efforts. However, the studies listed below should not be interpreted as supportive of any health benefit.
12) Brain and Spinal Cord Function
In a mouse model of Alzheimer’s disease, extracts from Salvia miltiorrhiza prevented a loss of brain function .
In rats, Salvia miltiorrhiza improves movement after spinal cord injuries. Extracts from the herb also protected brain cells and enhanced the growth of new neurons [22, 112, 113, 114].
Because of these results, compounds in the plant may be useful for Alzheimer’s disease and spinal cord injury; however, trials in people have yet to be conducted [115, 116, 117, 118].
13) Bone Health
Studies in rodents suggest that compounds in Danshen might allow bones to heal from fractures more quickly. The herb also prevents bone loss in menopausal rats [119, 120, 121].
14) Antibacterial and Insecticidal Activity
Salvia miltiorrhiza kills certain species of bacteria, including bacteria that are resistant to antibiotics, in dishes. Additionally, it was used to make a silver-based compound that can kill both bacteria and the mosquitoes that spread the Zika virus [79, 122, 123].
Side Effects & Precautions
Because of its long history of traditional use, Salvia miltiorrhiza is generally considered safe. It has also been used safely in both pregnant people and children. However, we recommend consulting your doctor if you are pregnant and plan to supplement with this herb to avoid any potential risks [91, 124, 125].
Otherwise, commonly reported side effects of Danshen include upset stomach, diarrhea, low blood cell count, dizziness, shortness of breath, and rash. However, it should be noted that many studies did not report what, if any, side effects occurred [126, 2, 98, 125, 5].
The use of approved, quality-tested Danshen extracts and formulations probably don’t pose serious risks. However, some restrictions apply to Danshen Dripping Pills, especially if you are in the US or in Canada. These pills are mostly produced in China and their use in Western countries is still a grey zone.
In 2013, Health Canada reported that Compound Danshen Dripping Pills were brought into the country without authorization. Their use was associated with a case of methemoglobinemia, a rare but serious condition that may result in coma or death. The product was manufactured in China.
Additionally, one study of 24 middle-aged people found that a combination of herbs including salvia miltiorrhiza prevented muscle gain during exercise. It might be wise for anyone looking to increase muscle mass to avoid this herb – although this one study with a small sample size is hardly conclusive .
Salvia miltiorrhiza may interfere with warfarin, a drug used to prevent blood clotting. This interference can cause dangerous bleeding, so people taking warfarin are advised to avoid the herb [128, 129].
Components in the plant can also decrease the activity of enzymes made by the liver. Since many of these enzymes break down drugs, salvia miltiorrhiza might make it harder for the body to remove drugs, including sedatives and antihistamines [130, 131, 132, 133].
To avoid adverse effects and unexpected interactions, talk to your doctor before using Salvia miltiorrhiza.
Limitations and Caveats
First, many of the available studies in humans were poorly designed. This includes lacking control groups, not reporting side effects, not reporting exact dosages/compositions of treatments, etc. It’s therefore difficult to give too much credence to most of them [2, 98, 125].
Many studies used combinations of herbs including Salvia miltiorrhiza. It’s hard to tease out what the exact role of this specific plant might be in these studies. The highest-quality evidence does give credibility to Danshen dripping pills, which have begun the process of rigorous study [2, 98, 5].
Lastly, some studies reported very high success rates in placebo groups. Even though these studies show that Danshen treatment was generally more effective than nothing, they also suggest that a lot of the herb’s effectiveness might just be a placebo effect [84, 40].
Danshen is sold in a variety of forms, including the dried root itself, as a cream, and as a tea or tincture. Extracts of the plant can also be found, and Danshen is the main ingredient in various multi-herbal supplements [134, 1].
Some studies have also used components of the herb in injections, which is limited to clinical research environments or specialized medical clinics [41, 80, 109].
Additionally, supplements are not standardized, and different products may have different amounts of the herb or its active components.
Danshen dripping pills are still being investigated in rigorous trails. Their dosage in previous trials was 10 pills, three times a day, applied directly under the tongue .
However, Danshen dripping pills are not available in the US. In Canada, they have not been authorized for sale. Beware of any products labeled as Danshen dripping pills.
There is no safe and effective dose of Salvia miltiorrhiza because no sufficiently powered study has been conducted to find one. That said, clinical studies have observed benefits at certain doses.
Dosages of Salvia miltiorrhiza also vary depending on the study and how it’s being taken: by pill, injection, etc. [135, 2, 125].
Additionally, many studies didn’t report details about the dosages they used. For example, some used Danshen dripping pills, which contain Salvia miltiorrhiza, notoginseng, and borneol, but did not detail the exact composition of the pills used [135, 2, 125].
In general, the recommended dosage of orally consumed Danshen (the dried root) ranges around 10-30 grams per day .
Users of this herb generally report high satisfaction, including decreased symptoms from diseases like diabetes, heart disease, and asthma, as well as a general feeling of calm upon taking the herb.
Other users report that the supplement didn’t work at all for them. Some also had unpleasant side effects like headaches.
Salvia miltiorrhiza has been used in traditional medicine for thousands of years. Modern research is tapping into its potential to combat chronic diseases and improve health. Available evidence suggests that compounds in the plant could one day be helpful for heart disease, diabetes, cancer, kidney and liver problems, and more.
However, currently available studies are of low quality. Additional high-quality clinical trials are needed. Although Salvia miltiorrhiza is generally considered safe and side effects, it can interact with some medications. Consult your doctor before supplementing, especially if you take blood thinners or any prescription drugs.
Danshen dripping pills are still under trials in the US and their use outside of China is restricted and potentially dangerous.