Danshen (Salvia miltiorrhiza)
  
Danshen (Salvia miltiorrhiza)
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. Constituents of the danshen root, particularly protocatechualdehyde and 3,4-dihydroxyphenyl-lactic acid, are believed to be responsible for its vascular effects. 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 methodological 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 evidenceGrade*Cardiovascular disease / angina
A small number of poor quality studies in animals and humans report that danshen may provide benefits for treating disorders of the heart and blood vessels, including heart attacks, cardiac chest pain (angina), or myocarditis. Traditionally, danshen is most frequently used for these problems in combination with other herbs. Because most studies have been small and brief with flaws in their designs, and the results of different trials have disagreed with each other, it is not clear whether there is any benefit from danshen for these conditions. No specific dose or standardized preparation is widely accepted for these disorders. 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
Ischemic stroke
In limited research from the 1970s, danshen was administered intravenously (through the veins) for up to four weeks in patients with ischemic stroke. Due to poor quality of this evidence, unclear safety, and the existence of more proven treatments for ischemic stroke, this use of danshen cannot be recommended.
C
Liver disease (cirrhosis / chronic hepatitis B)
Some studies suggest that danshen may provide benefits for treating liver diseases such as cirrhosis and chronic hepatitis B. Traditionally, danshen is most frequently used for these problems in combination with other herbs. Although early research in humans suggests a possible reduction in liver fibrosis in people with cirrhosis, and some improvements in liver function in chronic hepatitis, these studies have been small with flaws in their designs. Therefore, it is unclear whether there are any clinically significant effects of danshen in patients with liver disease.
C
Asthmatic bronchitis
A small amount of research in humans suggests that danshen may improve breathing and lessen cough and wheeze in patients with chronic asthmatic bronchitis. Better studies are needed that compare danshen with more proven treatments for this condition before a clear conclusion can be drawn.
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
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
Increased rate of peritoneal dialysis
One study suggests that danshen may speed peritoneal dialysis and ultrafiltration rates when added to dialysate solution. Although this evidence is promising, it is not known whether danshen is safe for this use.
C
* 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 (it may not work);
F: Strong scientific evidence against this use (it likely does not work).
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, antioxidant, antiphospholipid syndrome, anxiety, bleomycin induced lung fibrosis, blood clotting disorders, bruising, cancer, cataracts, circulation, clogged arteries, diabetic nerve pain, ectopic pregnancy, eczema, gastric ulcers, gentamicin toxicity, hearing loss, heart palpitations, high cholesterol, HIV, hypercoagulability, intrauterine growth retardation, kidney failure, left ventricular hypertrophy, leukemia, liver cancer, lung fibrosis, menstrual problems, preeclampsia, 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.
Standardization:
There is no widely accepted standardization or well-studied dosing of danshen, and many different doses are used traditionally. Danshen is frequently used in combination with other herbs.
Adults (18 years and older):
By mouth: Oral dosing has not been studied in well-conducted trials in humans, and therefore no specific dose can be recommended.
By injection: 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 not recommended at his 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
Although danshen has been well tolerated in most studies, there is limited research using danshen alone for extended periods of time, and safety has not been studied systematically.
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.
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.
References
1. Brunetti G, Serra S, Vacca G, et al. IDN 5082, a standardized extract of Salvia miltiorrhiza, delays acquisition of alcohol drinking behavior in rats. J Ethnopharmacol 2003;85(1):93-97.
2. Cao CM, Xia Q, Zhang X, et al. Salvia miltiorrhiza attenuates the changes in contraction and intracellular calcium induced by anoxia and reoxygenation in rat cardiomyocytes. Life Sci 2003;72 (22) :2451-2463.
3. Chan TY. Interaction between warfarin and danshen (Salvia miltiorrhiza). Ann Pharmacother 2001;35(4):501-504.
4. Chen Y, Ruan Y, Li L, et al. Effects of Salvia miltiorrhiza extracts on rat hypoxic pulmonary hypertension, heme oxygenase-1 and nitric oxide synthase. Chin Med J (Engl) 2003;116(5):757-760.
5. Cheng TO. Warfarin danshen interaction. Ann Thorac Surg 1999;67(3):894.
6. Ji X, Tan BK, Zhu YC, et al. Comparison of cardioprotective effects using ramipril and DanShen for the treatment of acute myocardial infarction in rats. Life Sci 2003;73(11):1413-1426.
7. Kang HS, Chung HY, Byun DS, et al. Further isolation of antioxidative (+)-1-hydroxypinoresinol-1-O-beta-D-glucoside from the rhizome of Salvia miltiorrhiza that acts on peroxynitrite, total ROS and 1,1-diphenyl-2-picrylhydrazyl radical. Arch Pharm Res 2003;26(1):24-27.
8. Lay IS, Chiu JH, Shiao MS, et al. Crude extract of Salvia miltiorrhiza and salvianolic acid B enhance in vitro angiogenesis in murine SVR endothelial cell line. Planta Med 2003;69(1):26-32.
9. Lee TY, Mai LM, Wang GJ, et al. Protective Mechanism of Salvia miltiorrhiza on Carbon Tetrachloride-Induced Acute Hepatotoxicity in Rats. J Pharmacol Sci 2003;91(3):202-210.
10. Liu GY. Analysis of effect of composite danshen droplet pills in treatment of chronic stable angina. Hubei J Trad Chin Med 1997;19(2):33-34.
11. Liu F, Liu Y, Li J. [Effects of danshen on solute transport by peritoneal dialysis]. Hunan Yi Ke Da Xue Xue Bao 1997;22(3):237-239.
12. Lo CJ, Lin JG, Kuo JS, et al. Effect of salvia miltiorrhiza bunge on cerebral infarct in ischemia-reperfusion injured rats. Am J Chin Med 2003;31(2):191-200.
13. Mashour NH, Lin GI, Frishman WH. Herbal medicine for the treatment of cardiovascular disease: clinical considerations. Arch Intern Med 1998;158(20):2225-2234.
14. Sha Q, Cheng HZ, Xie XY. Salviae miltiorrhizae composita pill for treating 47 cases of active liver cirrhosis. Chin J Integrat Trad West Med Liver Dis 1999;9(6):50.
15. Vacca G, Colombo G, Brunetti G, et al. Reducing effect of Salvia miltiorrhiza extracts on alcohol intake: influence of vehicle. Phytother Res 2003;17(5):537-541.
16. Wu CT, Mulabagal V, Nalawade SM, et al. Isolation and quantitative analysis of cryptotanshinone, an active quinoid diterpene formed in callus of Salvia miltiorrhiza BUNGE. Biol Pharm Bull 2003;26(6):845-848.
17. Yagi A, Takeo S. [Anti-inflammatory constituents, aloesin and aloemannan in Aloe species and effects of tanshinon VI in Salvia miltiorrhiza on heart]. Yakugaku Zasshi 2003;123(7):517-532.
January 01, 2004 
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