Danshen (Salvia miltiorrhiza)

 
Contents of this page:
 

 

Danshen
Danshen

Background

Danshen ( Salvia miltiorrhiza ) is widely used in traditional Chinese medicine (TCM), often in combination with other herbs. Remedies containing danshen are used traditionally to treat a diversity of ailments, particularly cardiac (heart) and vascular (blood vessel) disorders such as atherosclerosis ("hardening" of the arteries with cholesterol plaques) or blood clotting abnormalities.

 

The ability of danshen to "thin" the blood and reduce blood clotting is well documented, although the herb's purported ability to "invigorate" the blood or improve circulation has not been demonstrated in high-quality human trials. Because danshen can inhibit platelet aggregation and has been reported to potentiate (increase) the blood-thinning effects of warfarin, it should be avoided in patients with bleeding disorders, prior to some surgical procedures, or when taking anticoagulant (blood-thinning) drugs, herbs, or supplements.

 

In the mid-1980s, scientific interest was raised in danshen's possible cardiovascular benefits, particularly in patients with ischemic stroke or coronary artery disease/angina. More recent studies have focused on possible roles in liver disease (hepatitis and cirrhosis), and as an antioxidant. However, the available research in these areas largely consists of animal studies and small human trials of poor quality. Therefore, firm evidence-based conclusions are not possible at this time about the effects of danshen for any medical condition.

 

Synonyms

Ch'ih Shen (scarlet sage), Dan-Shen, Dan Shen, danshen root, Huang Ken, Hung Ken (red roots), Pin-Ma Ts'ao (horse-racing grass),  Radix  salvia miltiorrhiza , red-rooted sage, red sage root, red saye root,  Salvia bowelyana ,  Salvia miltiozzhiza bunze ,  Salviae miltiorrhizae ,  Salvia przewalskii ,  Salvia przewalskii mandarinorum ,  Salvia yunnanensis , salvia root, Sh'ih Shen, Shu-Wei Ts'ao (rat-tail grass), Tan Seng, Tan-Shen, Tzu Tan-Ken (roots of purple sage).

 

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidence Grade*
Asthmatic bronchitis

Better studies are needed that compare danshen with more proven treatments for this condition before a clear conclusion can be drawn.

C
Burn healing

Although animal studies suggest that danshen may speed healing of burns and wounds, there are no reliable studies in humans evaluating this claim.

C
Cardiovascular disease / angina

A small number of poor quality studies report that danshen may provide benefits for treating disorders of the heart and blood vessels, including heart attacks, cardiac chest pain (angina), or myocarditis. Danshen may have effects on blood clotting, and therefore may be unsafe when combined with other drugs used in patients with cardiovascular disease. Patients should check with a physician and pharmacist before combining danshen with prescription drugs.

C
Chronic prostatitis

One study found that danshen in combination with routine western medicine was not as effective as warming needle moxibustion. More studies are warranted in this area to draw any firm recommendations.

C
Glaucoma

Danshen has been proposed as a possible glaucoma therapy, but further studies are needed in humans before a clear conclusion can be drawn. Danshen should not be used in place of more proven therapies, and patients with glaucoma should be evaluated by a qualified eye care specialist.

C
Kidney disease

Although early evidence is promising, it is not known whether danshen is safe for this use. Danshen injection may be helpful for recovery of kidney function after kidney transplant. Further research is needed to confirm these results.

C
Liver disease (cirrhosis / chronic hepatitis B, fibrosis)

Some studies suggest that danshen may provide benefits for treating liver diseases such as cirrhosis, fibrosis, chronic hepatitis B. However, it is unclear whether there are any clinically significant effects of danshen in patients with liver disease.

C
Ischemic stroke

Due to poor quality of evidence, unclear safety, and the existence of more proven treatments for ischemic stroke, this use of danshen cannot be recommended.

D

 

*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.

 

Grading rationale

Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Acne, anoxic brain injury, anti-inflammatory, antioxidant, antiphospholipid syndrome, anti-thrombosis, antitumor, antiviral, anxiety, bleomycin induced lung fibrosis, blood clotting disorders, bruising, cancer, chemotherapy drug resistance, circulation, clogged arteries, diabetes, diabetic foot, diabetic nerve pain, ectopic pregnancy, eczema, external humeral epicondylitis, gastric ulcers, gentamicin toxicity, hearing loss, heart palpitations, high blood pressure, high cholesterol, HIV, hypercoagulability, immunomodulatory effects, intrauterine growth retardation, kidney disease or failure, left ventricular hypertrophy, leukemia, liver cancer, lung fibrosis, menstrual problems, mycardial reperfusion injury, organ preservation, pre-eclampsia, pregnancy-induced hypertension (high blood pressure), psoriasis, pulmonary hypertension, radiation-induced lung damage, restlessness, sleep difficulties, stimulation of GABA (gamma-aminobutyric acid) release, stomach ulcers, wound healing.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older):
Oral dosing has not been studied in well-conducted trials in humans, and therefore no specific dose can be recommended.

 

In research from the 1970s, an 8 milliliter injection of danshen (16 grams of the herb) was given intravenously (diluted in 500 milliliters of a 10% glucose solution) for up to four weeks for ischemic stroke. Safety and effectiveness have not been established for this route of administration and it cannot be recommended at this time.

 

Children (younger than 18 years):
There is not enough scientific evidence to recommend the safe use of danshen in children, and it should be avoided due to potentially serious side effects.

 

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies
People with known allergy to danshen or its constituents (such as protocatechualdehyde, 3,4-dihydroxyphenyl-lactic acid, tanshinone I, dihydrotanshinone, cryptotanshione, miltirone, or salvianolic acid B) should avoid this herb. Danshen is often found in combination with other herbs in various formulations, and patients should read product labels carefully.

 

Side Effects and Warnings
Danshen may increase the risk of bleeding. This herb is reported to inhibit platelet aggregation and to increase the blood-thinning effects of warfarin in humans. Caution is advised in patients with bleeding disorders, taking drugs that may increase the risk of bleeding, or prior to some surgical procedures. Dosing adjustments may be necessary.

 

Some people may experience stomach discomfort, reduced appetite, or itching.

 

In theory, danshen may lower blood pressure and should be used cautiously by patients with blood pressure abnormalities or taking drugs that alter blood pressure.

 

In theory, a chemical found in danshen called miltirone may increase drowsiness. Caution is advised while driving or operating machinery.

 

Convulsions, mental changes, and dystonia syndrome may occur.

 

Pregnancy and Breastfeeding
Danshen should be avoided during pregnancy and breast-feeding. In theory, the blood-thinning properties of danshen may increase the risk of miscarriage or bleeding, and effects on the fetus or nursing infants are not known.

 

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs
Danshen may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. This herb is reported to inhibit platelet aggregation and to cause over-anticoagulation (excessive "blood-thinning" effects) in patients taking the blood thinner warfarin (Coumadin®). Examples of drugs that increase the risk of bleeding include aspirin, anticoagulants such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

 

In theory, the risk of side effects or toxicity from digoxin (Lanoxin®) may be increased if taken with danshen. In addition, danshen may cause laboratory measurements of digoxin blood levels to be inaccurate (too high or too low).

 

Danshen may result in hypotension (dangerously low blood pressure) if taken with drugs that also lower blood pressure, such as ACE-inhibitors like captopril (Capoten®) or lisinopril (Prinivil®), and beta-blockers like atenolol (Tenormin®) or propranolol (Inderal®). In addition, the use of danshen with beta-blockers may cause bradycardia (dangerously slow heart rate).

 

In theory, a chemical found in danshen called miltirone may increase sleepiness or other side effects associated with some drugs taken for anxiety or insomnia, such as lorazepam (Ativan®), alprazolam (Xanax®), and diazepam (Valium®), or alcohol. In addition, based on animal studies, danshen may affect the absorption of alcohol into the blood.

 

Interactions with Herbs and Dietary Supplements
Danshen may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of  Ginkgo biloba , and fewer cases with garlic and saw palmetto.

 

In theory, danshen may add to the effects of other herbs with potential cardiac glycoside properties, potentially resulting in slow heart rate or toxicity such as hawthorn.

 

Danshen should be used cautiously with herbs/supplements that may also lower blood pressure lower blood pressure.

 

In theory, a chemical found in danshen called miltirone can increase the amount of drowsiness that may be caused by other herbs or supplements.