Dan Shen
StarSalvia miltiorrhiza Bge.
☯ TCM Properties
Invigorates Blood and Dispels Stasis; Promotes menstruation and alleviates pain; Clears Heart Fire and Eliminates Irritability; Cools the Blood and reduces swelling; Nourishes Blood and Calms the Spirit
Traditional Chinese Uses
Dan Shen (salvia root, red sage root) is a cool Blood-moving herb considered one of the most important cardiovascular herbs in Chinese medicine. Its primary action of activating Blood circulation and eliminating stasis makes it valuable for angina, coronary artery disease, menstrual irregularities, and pain from Blood stagnation. It also calms the Spirit to address palpitations and insomnia stemming from Blood stasis affecting the Heart. Modern Chinese medicine uses it extensively in cardiovascular formulas.
Western Herbalism Properties
Used In Formulas (2)
Botanical Description
Salvia miltiorrhiza (Dan Shen, red sage, Chinese sage) is a perennial herb in the Lamiaceae family, growing 30 to 80 centimeters tall from a striking dark brick-red to purplish-red, woody, branched root system that is the medicinal material and gives the herb its Chinese name (Dan Shen, literally cinnabar root). The erect, quadrangular, glandular-hairy stems bear opposite, odd-pinnately compound leaves with three to seven ovate to broadly ovate leaflets 1.5 to 8 centimeters long, with crenate margins and a softly pubescent undersurface. From late spring through summer, terminal and axillary verticillate racemes bear whorls of two-lipped, tubular violet-blue to bluish-purple flowers about 2 to 2.7 centimeters long, with a strongly arched upper lip and a three-lobed lower lip. The nutlets are small and brown. Native to China, growing on grassy hillsides and forest margins; widely cultivated in Sichuan, Shandong, and other provinces. Roots are harvested in spring or autumn, washed, and sun-dried for medicinal use.
Active Constituents
Tanshinone IIA
Lipophilic diterpenoid ortho-quinoneConcentration: Chinese Pharmacopoeia marker, required >=0.20% of the root
The principal lipophilic active. Anti-ischemic, anti-inflammatory, antioxidant and vasodilatory; protects myocardium and vascular endothelium and inhibits vascular smooth-muscle proliferation. Its water-soluble derivative, sodium tanshinone IIA sulfonate, is used clinically by injection for angina.
Salvianolic acid B
Hydrophilic polyphenolic acid (caffeic acid tetramer)Concentration: Chinese Pharmacopoeia marker, required >=3.0% of the root
The most abundant water-soluble constituent. A powerful antioxidant with antifibrotic, antithrombotic and endothelial-protective activity; central to Dan Shen's blood-invigorating and stasis-dispelling action.
Cryptotanshinone
Lipophilic diterpenoid quinoneConcentration: Moderate lipophilic constituent
Anti-inflammatory, antibacterial and antitumor; inhibits STAT3 signaling and aromatase in preclinical studies and contributes to the heat-clearing, swelling-reducing uses of the herb.
Tanshinone I
Lipophilic diterpenoid quinoneConcentration: Minor to moderate
Anti-inflammatory and anti-platelet activity; contributes to the cardiovascular and anti-aggregatory profile of the tanshinone fraction.
Danshensu (3,4-dihydroxyphenyllactic acid)
Phenolic acidConcentration: Minor water-soluble constituent
Antioxidant and antiplatelet; improves microcirculation and protects the endothelium, supporting the blood-moving action.
Rosmarinic acid
Phenolic acid (caffeic acid dimer)Concentration: Minor
Antioxidant and anti-inflammatory phenolic acid that contributes to the hydrophilic activity of the root.
Protocatechuic aldehyde
Phenolic aldehydeConcentration: Minor
Shows antiplatelet, antioxidant and cardioprotective activity in preclinical models.
⚠ Drug Interactions
Warfarin
Danshen inhibits platelet aggregation and can alter warfarin pharmacokinetics/pharmacodynamics; case reports document markedly raised prothrombin time/INR and bleeding, including over-anticoagulation and bleeding events when co-administered.
Clinical note: Avoid concurrent use where possible; if unavoidable, monitor INR closely and watch for bleeding.
Antiplatelet drugs (aspirin, clopidogrel)
Danshensu and salvianolic acids inhibit platelet aggregation, which can add to the antiplatelet effect of aspirin/clopidogrel and increase bleeding tendency.
Clinical note: Monitor for bruising/bleeding, especially perioperatively; consider discontinuing before surgery.
Digoxin
Danshen constituents cross-react with some digoxin immunoassays, producing falsely altered digoxin readings, and may additionally influence cardiac contractility.
Clinical note: Interpret digoxin levels cautiously (use a monoclonal/LC-MS assay) and monitor clinically.
Antihypertensive agents
Danshen's vasodilatory activity may add to the effect of antihypertensive drugs.
Clinical note: Monitor blood pressure when combined.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 6-15g | Daily | — | — | — |
Preparation Methods
Raw Dan Shen decoction
Parts: dried root and rhizome
Typical dose 9-15 g decocted in water. The raw root is used to invigorate the Blood, dispel stasis, cool the Blood and calm the Spirit. Note the classical caution that Dan Shen is incompatible with Li Lu (Veratrum), one of the 'eighteen incompatibilities.'
Wine-fried Dan Shen (jiu dan shen)
Parts: root stir-fried with rice wine
Stir-frying with wine enhances the warming, blood-moving quality and strengthens the actions of promoting menstruation and relieving stasis-type pain; preferred for menstrual disorders and blood-stasis pain.
Injectable / concentrated extracts (modern)
Parts: standardized root extract (tanshinones / salvianolic acids)
Modern hospital preparations include Danshen injection, salvianolate injection and sodium tanshinone IIA sulfonate injection, given intravenously for angina and ischemic conditions; these differ pharmacologically from oral decoctions and are used only under medical supervision.
Clinical Studies
Salvia Miltiorrhiza Root Water-Extract (Danshen) Has No Beneficial Effect on Cardiovascular Risk Factors: A Randomized Double-Blind Cross-Over Trial
Healthy volunteers took a standardized Danshen water-extract or placebo for 4 weeks each. The extract did not significantly improve blood pressure, lipids, glucose or other cardiovascular risk markers, highlighting that oral water-extract efficacy differs from that of the intravenous Danshen preparations used in Chinese hospital practice.
Efficacy and safety of danshen class injections in the treatment of coronary heart disease: a network meta-analysis
Pooling numerous randomized trials of Danshen-based injectable preparations (e.g., Danhong, salvianolate, sodium tanshinone IIA sulfonate) added to conventional therapy for coronary heart disease, the analysis reported improvements in anginal symptoms and ECG efficacy versus conventional treatment alone, while noting generally low methodological quality of the primary trials.
Historical Texts
Shennong Bencao Jing (Divine Farmer's Materia Medica)
Eastern Han dynasty, c. 200 CEBen Cao Gang Mu (Compendium of Materia Medica), by Li Shizhen
Ming dynasty, 1596 CEFu Ren Ming Li Lun / later herbal commentaries
Qing dynastyReferences
- van Poppel PCM, Breedveld P, Abbink EJ, et al.. Salvia Miltiorrhiza Root Water-Extract (Danshen) Has No Beneficial Effect on Cardiovascular Risk Factors: A Randomized Double-Blind Cross-Over Trial . PLoS ONE (2015) [DOI]
- Su CY, Ming QL, Rahman K, Han T, Qin LP. Salvia miltiorrhiza: Traditional medicinal uses, chemistry, and pharmacology . Chinese Journal of Natural Medicines (2015) [DOI]
- Chinese Pharmacopoeia Commission. Pharmacopoeia of the People's Republic of China (Radix et Rhizoma Salviae Miltiorrhizae, Dan Shen) . China Medical Science Press (2020) [DOI]
This information is for educational purposes only and is not intended to replace professional medical advice. Always consult a qualified healthcare provider before using any herbal remedy, especially if you are pregnant, nursing, or taking medications.
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