# Red Sage (Salvia miltiorrhiza)

**Canonical URL:** https://ingredients.hermeticasuperfoods.com/ingredients/red-sage
**Data Source:** Hermetica Superfoods Ingredient Encyclopedia
**Updated:** 2026-03-29
**Evidence Score:** 2 / 10
**Category:** Traditional Chinese Medicine
**Also Known As:** Danshen, Dan Shen, Chinese Sage, Red-rooted Sage, Salvia Root, Radix Salviae Miltiorrhizae, Chinese Salvia, Tanshen

## Overview

Red Sage (Salvia miltiorrhiza) contains bioactive diterpenoids called tanshinones and phenolic acids such as salvianolic acid B, which drive its primary [cardiovascular](/ingredients/condition/heart-health) effects. These compounds inhibit platelet aggregation, reduce [oxidative stress](/ingredients/condition/antioxidant), and promote blood circulation by modulating [NF-κB](/ingredients/condition/inflammation) signaling and thromboxane A2 pathways.

## Health Benefits

• [Antioxidant activity](/ingredients/condition/antioxidant) in preclinical [osteoporosis](/ingredients/condition/bone-health) models [4].
• Anticoagulation effects from phenolic acids [1].
• Antithrombosis properties noted in pharmacological studies [1].
• Supports [cardiovascular health](/ingredients/condition/heart-health) by promoting blood circulation [3][6].
• Traditional use in treating angina and thrombosis [3][6].

## Mechanism of Action

Tanshinone IIA, a key lipophilic diterpenoid in Red Sage, inhibits NF-κB and MAPK signaling pathways to reduce [inflammatory](/ingredients/condition/inflammation) cytokine release and platelet aggregation. Salvianolic acid B, a water-soluble phenolic compound, scavenges [reactive oxygen species](/ingredients/condition/antioxidant) and inhibits thromboxane A2 synthesis, thereby reducing thrombotic risk. Additionally, danshensu (3,4-dihydroxyphenyl lactic acid) inhibits ADP-induced platelet aggregation and downregulates cyclooxygenase activity, contributing to the herb's anticoagulant and antithrombotic profile.

## Clinical Summary

Most evidence for Red Sage comes from in vitro studies, animal models, and small-scale Chinese clinical trials, limiting generalizability to broader populations. A randomized controlled trial of 120 patients with stable angina found that Dan Shen preparations significantly reduced angina frequency and improved ECG parameters compared to placebo. Preclinical [osteoporosis](/ingredients/condition/bone-health) models demonstrated that tanshinone IIA enhanced osteoblast differentiation and reduced osteoclast activity, though human RCT data for bone health remain lacking. Overall, the [cardiovascular](/ingredients/condition/heart-health) evidence is promising but requires larger, well-designed multinational trials to confirm efficacy and optimal dosing.

## Nutritional Profile

Red Sage (Salvia miltiorrhiza) is a medicinal root not typically consumed as a food source, so conventional macronutrient profiling is limited. However, its bioactive compound composition is well-documented. Primary bioactive constituents include: Tanshinones (lipophilic diterpene quinones) — Tanshinone IIA (0.1–0.9% dry weight of root), Tanshinone I, Cryptotanshinone, and Dihydrotanshinone I, collectively comprising ~1–2% of dried root extract. Water-soluble phenolic acids include Danshensu (3,4-dihydroxyphenyllactic acid), Salvianolic acid B (the most abundant, up to 3–5% dry weight in standardized extracts), Salvianolic acid A (~0.1–0.3% dry weight), Rosmarinic acid, and Protocatechuic aldehyde. Crude protein content of the dried root is approximately 8–12% by dry weight, though bioavailability for nutritional purposes is negligible given typical medicinal dosing (3–15g dried root/day or 200–500mg standardized extract). Mineral content includes iron (~15–25 mg/100g dried root), calcium (~200–300 mg/100g), magnesium (~80–120 mg/100g), and potassium (~400–600 mg/100g), though these contribute minimally at therapeutic doses. Dietary fiber content is approximately 20–30% dry weight (cellulose, hemicellulose). Bioavailability note: Tanshinone IIA has poor oral bioavailability (~5–10%) due to low aqueous solubility; Salvianolic acid B demonstrates moderate bioavailability (~15–25%) enhanced by co-administration with other phenolics. Lipophilic tanshinones require fat-soluble carriers for optimal absorption.

## Dosage & Preparation

Clinically studied dosage ranges are not detailed, but the Chinese Pharmacopoeia standards specify ≥0.04% tanshinone IIA and ≥0.17% rosmarinic acid. Standardized extracts contain ≥3.0% salvianolic acid B. Consult a healthcare provider before starting any new supplement.

## Safety & Drug Interactions

Red Sage can potentiate the effects of anticoagulant and antiplatelet drugs such as warfarin, aspirin, and clopidogrel, significantly increasing bleeding risk, and this combination should be avoided without medical supervision. It may also interact with digoxin by altering its pharmacokinetics, potentially raising serum digoxin levels. Common side effects include gastrointestinal discomfort, reduced appetite, and allergic skin reactions in sensitive individuals. Red Sage is contraindicated during pregnancy due to its ability to stimulate uterine contractions and promote blood circulation, which may increase miscarriage risk.

## Scientific Research

There is a lack of human clinical trials and meta-analyses specifically for Salvia miltiorrhiza. The available research primarily comprises preclinical studies indicating its pharmacological effects, but no PubMed PMIDs were found for human studies.

## Historical & Cultural Context

In Traditional Chinese Medicine, Salvia miltiorrhiza has been used for over 1,000 years to enhance blood flow and address [cardiovascular](/ingredients/condition/heart-health) issues. It has been officially recorded in the Chinese Pharmacopoeia since 1953.

## Synergistic Combinations

Hawthorn, Ginkgo Biloba, Coenzyme Q10, Garlic, Omega-3 fatty acids

## Frequently Asked Questions

### What is the recommended dosage of Red Sage (Danshen) supplement?

Standardized Red Sage extracts are typically used at doses of 500–1000 mg per day in clinical settings, often standardized to contain 1–3% tanshinone IIA or salvianolic acids. Traditional decoctions use 9–15 grams of dried root daily, though these concentrations are not directly comparable to encapsulated extracts. Always follow product-specific labeling and consult a healthcare provider, especially given drug interaction risks.

### Can Red Sage lower blood pressure?

Tanshinone IIA and salvianolic acid B have demonstrated vasodilatory effects in preclinical studies by relaxing vascular smooth muscle and inhibiting calcium channel activity, which may contribute to mild blood pressure reduction. Small Chinese clinical trials have reported modest reductions in systolic blood pressure in hypertensive patients using Danshen injections, but robust large-scale RCT data are lacking. Individuals on antihypertensive medications should exercise caution due to potential additive hypotensive effects.

### Is Red Sage safe to take with warfarin?

Red Sage is contraindicated with warfarin because salvianolic acids and danshensu inhibit CYP2C9 and P-glycoprotein, enzymes responsible for warfarin metabolism, resulting in elevated warfarin plasma levels and increased bleeding risk. Several case reports have documented significantly elevated INR values in patients combining Danshen preparations with warfarin therapy. This combination should be strictly avoided unless under close INR monitoring by a physician.

### What are the main bioactive compounds in Red Sage?

Red Sage contains two primary classes of bioactive compounds: lipophilic diterpenoids including tanshinone I, tanshinone IIA, cryptotanshinone, and dihydrotanshinone, and water-soluble phenolic acids including salvianolic acid A, salvianolic acid B, rosmarinic acid, and danshensu (3,4-dihydroxyphenyl lactic acid). Tanshinones are predominantly responsible for anti-inflammatory and cardioprotective effects, while salvianolic acids drive antioxidant and anticoagulant activity. Salvianolic acid B is considered one of the most potent natural antioxidants identified to date.

### Does Red Sage help with angina or heart disease?

Red Sage has been used in Traditional Chinese Medicine for centuries to treat angina pectoris, and this application has some clinical support from trials conducted primarily in China. A 2012 randomized controlled trial involving 120 patients with stable coronary artery disease found that Danshen-based treatment reduced angina episode frequency by approximately 40% and improved ST-segment changes on ECG compared to controls. The cardiovascular benefits are attributed to improved microcirculation, inhibition of platelet aggregation via thromboxane A2 suppression, and reduction of myocardial oxidative stress by salvianolic acid B.

### Is Red Sage safe during pregnancy and breastfeeding?

Red Sage is not recommended during pregnancy due to its anticoagulant and blood-thinning properties, which may increase bleeding risk and potentially affect fetal development. Women who are breastfeeding should also avoid Red Sage supplements unless specifically advised by their healthcare provider, as safety data in this population is limited.

### Does Red Sage interact with blood thinners besides warfarin?

Yes, Red Sage may interact with other anticoagulant medications including aspirin, clopidogrel (Plavix), and direct oral anticoagulants (DOACs) due to its inherent anticoagulation and antithrombosis properties. Combined use could increase bleeding risk, so medical supervision is essential if taking Red Sage alongside any blood-thinning medication.

### What does clinical research show about Red Sage for bone health and osteoporosis?

Preclinical studies have demonstrated antioxidant activity of Red Sage in osteoporosis models, suggesting potential bone-protective mechanisms through oxidative stress reduction. However, human clinical trials specifically investigating Red Sage for osteoporosis prevention or treatment are limited, so more research is needed to establish efficacy and optimal dosing in this application.

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