Salvia Miltiorrhiza Extract
Also known as: Danshen, red sage, Chinese sage, Salvia miltiorrhiza Bunge, Salvia miltiorrhiza
Overview
Salvia miltiorrhiza extract is derived from the roots of the *Salvia miltiorrhiza* plant, a prominent herb in traditional Chinese medicine (TCM). It is widely recognized for its use in managing cardiovascular, gynecological, and metabolic disorders. The extract contains key bioactive compounds, primarily tanshinones and salvianolic acids, which are believed to confer antioxidant, anti-inflammatory, and vasodilatory properties. It is frequently employed as an adjunctive therapy for conditions such as diabetic kidney disease (DKD), polycystic ovary syndrome (PCOS), endometriosis, and acute cerebral infarction. Research into *Salvia miltiorrhiza* has been steadily growing, with an increasing number of randomized controlled trials (RCTs) and meta-analyses published in recent years, indicating a moderate but expanding evidence base for its therapeutic applications.
Benefits
Salvia miltiorrhiza extract offers several evidence-based benefits, primarily as an adjunctive therapy. For **Diabetic Kidney Disease (DKD)**, a systematic review and meta-analysis of RCTs indicated that *Salvia miltiorrhiza* combined with ligustrazine injection significantly improved renal function markers and was safe in early-stage DKD patients when added to conventional therapy. In **Polycystic Ovary Syndrome (PCOS)**, a meta-analysis of six RCTs (n=390) demonstrated that the extract, when combined with letrozole, significantly improved pregnancy rates (RR=2.60, 95% CI 1.06–6.39, p=0.04) compared to letrozole alone, suggesting reproductive benefits. For **Endometriosis**, a meta-analysis of 10 RCTs (n=836) showed that *Salvia miltiorrhiza*-containing Chinese herbal medicine, combined with GnRH agonist therapy, reduced recurrence rates and increased pregnancy rates postoperatively, with fewer side effects than GnRH agonist alone. Lastly, in **Acute Cerebral Infarction**, a meta-analysis suggested that *Salvia miltiorrhiza* and ligustrazine injection, when combined with conventional therapy, improved neurological outcomes and exhibited a better safety profile than conventional therapy alone, particularly in Chinese populations. The strength of evidence for these benefits is generally moderate, primarily from meta-analyses of RCTs, though many studies are concentrated in Chinese populations.
How it works
The therapeutic effects of *Salvia miltiorrhiza* extract are attributed to its active compounds, notably tanshinones and salvianolic acids. These compounds exert antioxidant effects by scavenging free radicals and anti-inflammatory actions by inhibiting pro-inflammatory cytokines, thereby reducing oxidative stress and inflammation. The extract also promotes vasodilation and improves microcirculation, which is crucial for its benefits in cardiovascular and renal diseases by enhancing blood flow. Furthermore, its influence on reproductive hormones and metabolic regulation may contribute to its efficacy in conditions like PCOS and endometriosis. The bioavailability of *Salvia miltiorrhiza* varies depending on the formulation, with injectable forms offering direct delivery and oral extracts having absorption rates influenced by preparation and co-administration.
Side effects
Salvia miltiorrhiza extract and its injectable forms are generally well-tolerated, with a low incidence of adverse effects reported in clinical trials. Mild gastrointestinal discomfort is a rare but possible common side effect, occurring in less than 5% of users. Uncommon side effects (1-5%) may include mild allergic reactions or a skin rash. Rare side effects (less than 1%) include a potential increased risk of bleeding due to its antiplatelet effects, necessitating caution in individuals concurrently taking anticoagulant medications. While no major drug interactions have been widely reported, it is advisable to exercise caution when combining *Salvia miltiorrhiza* with blood thinners or other antiplatelet agents. Contraindications include known hypersensitivity to the extract. Due to limited safety data, caution is advised during pregnancy. Overall, the safety profile is favorable, but individuals with pre-existing bleeding disorders or those on anticoagulant therapy should consult a healthcare professional before use.
Dosage
The optimal dosage of *Salvia miltiorrhiza* extract varies significantly depending on the specific preparation and intended use. Injectable forms, commonly used in clinical trials in China, typically combine *Salvia miltiorrhiza* extract with ligustrazine, with doses standardized by the manufacturers. For oral extracts, particularly in PCOS trials where it was combined with letrozole, exact dosing protocols varied but generally aligned with traditional usage patterns. Currently, there is no universally standardized optimal dosage, and the evidence primarily supports its use as an adjunctive therapy rather than monotherapy. The timing and duration of treatment are also condition-dependent; for instance, treatment courses in PCOS and endometriosis trials ranged from several weeks to several months. Patients should adhere to manufacturer guidelines for specific products or consult a healthcare professional for personalized dosing recommendations, especially given the variability in formulations and concentrations.
FAQs
Is Salvia miltiorrhiza extract safe?
Yes, it is generally considered safe with a low incidence of mild side effects reported in clinical trials, though caution is advised with blood thinners.
Can it be used alone?
Current evidence primarily supports its use as an adjunctive therapy alongside conventional treatments, rather than as a standalone treatment.
When are benefits typically observed?
Clinical improvements have been reported within weeks to months, depending on the specific condition being treated and individual response.
Does it interact with other medications?
There is a potential interaction with anticoagulant medications due to its antiplatelet effects. Always consult a healthcare provider before combining it with other drugs.
Research Sources
- https://pubmed.ncbi.nlm.nih.gov/34153447/ – This systematic review and meta-analysis of randomized controlled trials investigated the efficacy and safety of *Salvia miltiorrhiza* combined with ligustrazine injection as an adjunctive therapy for early-stage diabetic kidney disease (DKD). The study found that this combination significantly improved renal function markers and was safe compared to conventional therapy alone, despite some included studies having a risk of bias and heterogeneity in protocols. The research was of moderate quality, utilizing the Cochrane risk of bias tool.
- https://pubmed.ncbi.nlm.nih.gov/34055030/ – This systematic review and meta-analysis of six RCTs (n=390) examined the effect of *Salvia miltiorrhiza* extract combined with letrozole on women with polycystic ovary syndrome (PCOS). The findings indicated that this combination significantly improved pregnancy rates (RR=2.60, 95% CI 1.06–6.39, p=0.04) compared to letrozole alone. Limitations included small sample sizes and all studies originating from China, suggesting potential publication bias. The study was assessed as moderate quality using Cochrane methodology.
- https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.831850/full – This meta-analysis of 10 RCTs (n=836) investigated the efficacy of *Salvia miltiorrhiza*-containing Chinese herbal medicine (CHM) combined with GnRH agonist therapy for endometriosis. The study concluded that this combination reduced recurrence rates and increased pregnancy rates postoperatively, with fewer side effects than GnRH agonist alone. The research was limited to Chinese populations and showed heterogeneity in herbal formulations, but was considered a moderate-quality, pioneering meta-analysis on this topic.
- https://onlinelibrary.wiley.com/doi/10.1155/2021/9971403 – This meta-analysis, also referenced as Shen et al., 2021, focused on the impact of *Salvia miltiorrhiza* extract combined with letrozole on pregnancy rates in women with PCOS. It confirmed that the combination significantly improved pregnancy rates compared to letrozole alone. The study highlighted the need for more diverse populations and larger sample sizes in future research, noting that all included studies were from China.
- https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2024.1425053/full – This meta-analysis of RCTs evaluated the combination therapy of *Salvia miltiorrhiza* and ligustrazine injection with conventional treatment for acute cerebral infarction in Chinese patients. The study found that this combination improved neurological outcomes and demonstrated a better safety profile than conventional therapy alone. The population was limited to Chinese individuals, and only injection forms were considered. The research was deemed of moderate quality and was PRISMA compliant.