Drugs A - Z
Danshen (Salvia miltiorrhiza)
Generic Name: dan-shen
CategoryHerbs & Supplements
3,4-dihydroxyphenyl-lactic acid, caffeic acid, Ch'ih Shen (scarlet sage), Chinese Salvia, cryptotanshisone, dangshem, Dan-Shen, Dan Shen, danshen root, danshensu, dihydrotanshinone, ethyl acetate, fufangdenshen, horse-racing grass, Huang Ken, Hung Ken (red roots), Labiatae (family), Lamiaceae (family), lithospermic acid B, miltirone, neo-tanshinlactone, phenolic acids, Pin-Ma Ts'ao (horse-racing grass), protocatechualdehyde, protocatechuic acid, protocatechuic aldehyde, Radix salvia miltiorrhiza, rat-tail grass, red-rooted sage, red roots, red sage, red sage root, red saye root, roots of purple sage, Salvia bowelyana, Salvia miltiozzhiza, Salvia miltiozzhiza bunge, Salvia przewalskii, Salvia przewalskii mandarinorum, salvia root, Salvia yunnanensis, salvianolic acid B, scarlet sage, Sh'ih Shen, Shu-Wei Ts'ao (rat-tail grass), Tan Seng, Tan-Shen, tanshisone I, tanshisone IIA, tanshisone IIB, Tzu Tan-Ken (roots of purple sage), yunzhi danshen.
Note: Danshen should not be confused with sage. Danshen is often used in combination with other products; combination products are not specifically discussed in this monograph.
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.
EvidenceDISCLAIMER: 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.
Better studies are needed in which danshen is compared with more proven treatments before a clear conclusion can be drawn.
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.
Early studies have 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 a firm conclusion.
Diabetic complications (diabetic foot):
Early clinical trials suggest danshen may help treat diabetic foot. Well-designed clinical trials are needed before a strong recommendation can be made.
Early studies suggest that danshen may speed peritoneal dialysis and ultrafiltration rates when added to dialysate solution. Although this evidence seems promising, it is not known whether danshen is safe for this use. Further research is necessary.
Danshen may be beneficial in 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.
Early studies suggest that danshen may improve blood levels of cholesterol (lowers LDL or "bad" cholesterol and triglycerides and raises HDL or "good" cholesterol). Large high-quality studies are needed before a strong recommendation may be made.
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.
Liver disease (cirrhosis, chronic hepatitis B, fibrosis):
Some studies suggest that danshen may provide benefits for treating liver diseases such as cirrhosis, fibrosis, and chronic hepatitis B. However, it is unclear whether there are any clinically significant effects of danshen in patients with liver disease.
For many years, danshen has been used as a traditional Chinese medicine (TCM) remedy to treat acute pancreatitis. However, little research is currently available regarding the use of danshen in humans.
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.
There is not enough evidence to recommend either for or against the use of danshen for vasovagal syncope.
Tinnitus (ringing in the ears):
Limited evidence suggests that danshen in combination with other herbs and supplements may be a less effective treatment for tinnitus than acupuncture. Additional research is needed to fully understand danshen's effects on tinnitus.
One study using a combination product that included danshen found that there was no effect on food intake or weight loss. More high-quality studies are needed to confirm these results.
TraditionWARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. 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. There may be other proposed uses that are not listed below.
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.
SafetyDISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.
People with known allergy to danshen (Salvia miltiorrhiza) 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. Signs of allergy may include rash, itching, or shortness of breath.
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, in patients taking drugs that may increase the risk of bleeding, and 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 breastfeeding. 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 with Drugs
Danshen may increase the risk of bleeding when taken with drugs that also 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, such as hawthorn, with potential cardiac glycoside properties, potentially resulting in slow heart rate or toxicity.
Danshen should be used cautiously with herbs/supplements that may also 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.
Antibacterials, anti-inflammatory herbs, antilipemics, antineoplastics, antioxidants, antivirals, steroids, astragalus, chronotropic herbs, herbs and supplements broken down by the liver, immunosuppressants, Gexia zhuyu decoction, licorice, Ligusticum chuanxiong, Ligustrum lucidum, Polyporus, Serissa, Sophora subprostrata, and Yun zhi (Coriolus mushroom) may interact with danshen.
This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Ethan Basch, MD (Memorial Sloan-Kettering Cancer Center); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Nicole Giese, MS (Natural Standard Research Collaboration); Jenna Hollenstein, MS, RD (Natural Standard Research Collaboration); Brooke Sweeney, PharmD (Massachusetts College of Pharmacy); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Mamta Vora, PharmD (Northeastern University); Wendy Weissner, BA (Natural Standard Research Collaboration).
BibliographyDISCLAIMER: Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
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.
Chan K, Chui SH, Wong DY, et al. Protective effects of Danshensu from the aqueous extract of Salvia miltiorrhiza (Danshen) against homocysteine-induced endothelial dysfunction. Life Sci 11-12-2004;75(26):3157-3171.
Chan TY. Interaction between warfarin and danshen (Salvia miltiorrhiza). Ann Pharmacother 2001;35(4):501-504.
Cheng TO. Warfarin danshen interaction. Ann Thorac Surg 1999;67(3):894.
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.
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.
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.
Liu Z, Gao Sy, Deng J, et al. Analysis of effect of composite danshen droplet pills in treatment of chronic stable angina. Chin Trad Pat Med 1997;19(7):20-21.
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.
Mashour NH, Lin GI, Frishman WH. Herbal medicine for the treatment of cardiovascular disease: clinical considerations. Arch Intern Med 1998;158(20):2225-2234.
Natural Standard Research Collaboration, Chief Editors: Ulbricht C, Basch E, Natural Standard Herb and Supplement Reference - Evidence-Based Clinical Reviews, USA: Elsevier/Mosby, 2005.
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.
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.
Wu B, Liu M, Zhang S. Dan Shen agents for acute ischaemic stroke. Cochrane Database Syst Rev 2007;(2):CD004295.
Xue YP, Zhang SB, Gao T. [Observation on therapeutic effect of chronic prostatitis treated mainly by warming needle moxibustion] Zhongguo Zhen Jiu 2006 May;26(5):335-6.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.