​Salvia Miltiorrhiza (Red Sage)

Salvia Miltiorrhiza (Red Sage)

Product Name: Шалфей краснокорневой, Salvia miltiorrhiza, Roter Salbei, Salvia roja, Sauge rouge, المريمية الحمراء, เสจแดง, Qizil shalfey, Кызыл шалфей, Qırmızı adaçayı, Шалфей сурхи, Raudonasis šalavijas, Sarkanais salvija, Шавлія червона, מרווה אדומה

Synonyms: Даньшень, Краснокорневой шалфей, Danshen, Chinese red sage, Rotwurz-Salbei, Salvia roja china, Sauge rouge chinoise, المريمية الصينية الحمراء, เสจแดงจีน

Parts Used: root, rhizome, stem, leaves, seeds, root.

Main Indications for Salvia miltiorrhiza Use: Atherosclerosis, coronary heart disease, chronic heart failure, post-infarction cardiosclerosis, angina pectoris, coronary artery thrombosis, hypertension, chronic cerebral ischemia, acute cerebrovascular accident, diabetic microangiopathy, nephrosclerosis, liver cirrhosis, chronic viral hepatitis, systemic scleroderma, Raynaud’s syndrome.

Use of Salvia miltiorrhiza in mixtures and complexes: Chronic gastritis, gastric and duodenal ulcer, chronic pancreatitis, varicose veins of the lower extremities, chronic venous insufficiency, thrombophlebitis, diabetic polyneuropathy, osteoarthritis, rheumatoid arthritis, chronic obstructive pulmonary disease, bronchial asthma.

Pharmacological Properties of Salvia miltiorrhiza: Cardioprotective, vasodilatory, antiplatelet, anticoagulant, anti-ischemic, antioxidant, anti-inflammatory, hepatoprotective, nephroprotective, antifibrotic, neuroprotective, antiatherosclerotic, hypotensive, spasmolytic, immunomodulatory, antimicrobial, oncoprotective, capillaroprotective, regenerative.

Dosage of Pharmaceutical Forms — Salvia miltiorrhiza

Powder — Salvia miltiorrhiza

Indications (Powder): atherosclerosis, coronary heart disease, chronic heart failure, post-infarction cardiosclerosis, angina pectoris, coronary artery thrombosis, chronic cerebral ischemia, acute cerebrovascular accident, diabetic microangiopathy, nephrosclerosis, liver cirrhosis, chronic viral hepatitis, systemic scleroderma, Raynaud’s syndrome.

Standard Dosage (Powder): 2–3 grams of powder 2 times a day, with 200 milliliters of warm water, 30 minutes before meals.

Enhanced Dosage (Powder): 3 grams of powder 3 times a day for acute coronary artery thrombosis, pronounced chronic cerebral ischemia, Raynaud’s syndrome.

Maximum Dosage (Powder): 12 grams of powder per day for severe chronic heart failure and pronounced nephrosclerosis.

Preventive Dosage (Powder): 1 gram of powder 1 time a day in courses of 30 days with a 3-month break for chronic cerebral ischemia, hypertension, diabetic microangiopathy, in patients over 50 years of age.

Pediatric Dosage (Powder): for children from 12 years of age and body weight from 40 kilograms — 0.5 grams 1 time a day. No scientific data registered on use in children under 12 years of age.

Contraindications (Powder): individual intolerance, active bleeding, severe hypotension. No contraindication data scientifically registered for pregnancy, lactation, and children under 12 years of age.

Side Effects (Powder): in case of overdose, lowering of blood pressure, dizziness, nausea possible.

Adjustment for Patient Body Weight: body weight below 60 kg — dosage reduction by 25%, body weight above 90 kg — dosage increase by 25%.

Preparation method (Powder): grind dry roots to a fine powder using a laboratory mill. For 100 grams of product, use 100 grams of dried raw material. Temperature regime during drying — not exceeding 45 degrees Celsius. Sift the ground powder through a sieve with a mesh size of 0.3 millimeters.

Storage Conditions and Shelf Life: store in an airtight glass container, in a dark place at a temperature of 5 to 20 degrees Celsius, protecting from direct sunlight and sources of electromagnetic radiation. Shelf life — 24 months. After opening the package, use within 6 months.

Dry Extract — Salvia miltiorrhiza

Indications (Dry Extract): atherosclerosis, coronary heart disease, chronic heart failure, post-infarction cardiosclerosis, angina pectoris, coronary artery thrombosis, chronic cerebral ischemia, acute cerebrovascular accident, diabetic microangiopathy, nephrosclerosis, liver cirrhosis, chronic viral hepatitis, systemic scleroderma, Raynaud’s syndrome.

Standard Dosage (Dry Extract): 0.5–1 gram of dry extract 2 times a day, dissolved in 150 milliliters of warm water, 30 minutes before meals.

Enhanced Dosage (Dry Extract): 1 gram of dry extract 3 times a day for acute coronary artery thrombosis, pronounced chronic cerebral ischemia, Raynaud’s syndrome.

Maximum Dosage (Dry Extract): 4 grams of dry extract per day for severe chronic heart failure and pronounced nephrosclerosis.

Preventive Dosage (Dry Extract): 0.5 grams of dry extract 1 time a day in courses of 30 days with a 3-month break for chronic cerebral ischemia, hypertension, diabetic microangiopathy, in patients over 50 years of age.

Pediatric Dosage (Dry Extract): for children from 12 years of age and body weight from 40 kilograms — 0.25 grams 1 time a day. No scientific data registered on use in children under 12 years of age.

Contraindications (Dry Extract): individual intolerance, active bleeding, severe hypotension. No contraindication data scientifically registered for pregnancy, lactation, and children under 12 years of age.

Side Effects (Dry Extract): in case of overdose, lowering of blood pressure, dizziness, nausea possible.

Adjustment for Patient Body Weight: body weight below 60 kg — dosage reduction by 25%, body weight above 90 kg — dosage increase by 25%.

Preparation method (Dry Extract): pour 2 liters of 40% ethyl alcohol over 500 grams of ground dry roots, infuse for 7 days at a temperature of 20 degrees Celsius in a dark place, shaking daily. After filtration, evaporate at a temperature not exceeding 45 degrees Celsius to a dry state. To obtain 100 grams of dry extract, evaporate to a residual moisture content of 5%.

Storage Conditions and Shelf Life: store in an airtight container, in a dark place at a temperature of 5 to 20 degrees Celsius, protecting from direct sunlight and sources of electromagnetic radiation. Shelf life — 24 months. After opening the package, use within 12 months.

Tincture — Salvia miltiorrhiza

Indications (Tincture): atherosclerosis, coronary heart disease, chronic heart failure, post-infarction cardiosclerosis, angina pectoris, coronary artery thrombosis, chronic cerebral ischemia, acute cerebrovascular accident, diabetic microangiopathy, nephrosclerosis, liver cirrhosis, chronic viral hepatitis, systemic scleroderma, Raynaud’s syndrome.

Standard Dosage (Tincture): 20 drops of Tincture 3 times a day, diluted in 50 milliliters of warm water, 30 minutes before meals.

Enhanced Dosage (Tincture): 30 drops 3 times a day for acute coronary artery thrombosis, pronounced chronic cerebral ischemia, Raynaud’s syndrome.

Maximum Dosage (Tincture): 40 drops 3 times a day for severe chronic heart failure, pronounced nephrosclerosis.

Preventive Dosage (Tincture): 10 drops 1 time a day in courses of 30 days with a 3-month break for chronic cerebral ischemia, hypertension, diabetic microangiopathy, in patients over 50 years of age.

Pediatric Dosage (Tincture): for children from 14 years of age and body weight from 50 kilograms — 5 drops 1 time a day. No scientific data registered on use in children under 14 years of age.

Contraindications (Tincture): individual intolerance, active bleeding, severe hypotension, alcoholism. No contraindication data scientifically registered for pregnancy, lactation, and children under 14 years of age.

Side Effects (Tincture): in case of overdose, pronounced lowering of blood pressure, tachycardia, nausea, dizziness possible.

Adjustment for Patient Body Weight: body weight below 60 kg — dosage reduction by 20%, body weight above 90 kg — dosage increase by 20%.

Preparation method (Tincture): grind 200 grams of dry roots, pour 1 liter of 40% ethyl alcohol, infuse for 14 days at a temperature of 20–22 degrees Celsius in a dark place, stirring daily. After infusion, filter through a paper filter. For medical use, the tincture should be clear, without sediment.

Storage Conditions and Shelf Life: store in a tightly closed dark glass bottle, at a temperature of 5 to 20 degrees Celsius, protect from direct light and sources of electromagnetic radiation. Shelf life — 3 years. After opening, use within 6 months.

Ointment — Salvia miltiorrhiza

Indications (Ointment): trophic ulcer of the leg, diabetic foot syndrome, varicose eczema, localized scleroderma, post-traumatic scar, contact dermatitis, plaque psoriasis, acne vulgaris, perioral dermatitis, seborrheic dermatitis.

Standard Dosage (Ointment): apply a thin layer of ointment to the affected skin area 2 times a day.

Enhanced Dosage (Ointment): apply the ointment 3–4 times a day for trophic ulcers, diabetic foot syndrome, localized scleroderma.

Maximum Dosage (Ointment): up to 5 applications per day for severe forms of varicose eczema and pronounced scleroderma.

Preventive Dosage (Ointment): apply 1 time a day in courses of 14 days every 3 months for chronic dermatitis, varicose veins, scar changes of the skin.

Pediatric Dosage (Ointment): for children from 6 years of age, apply 1 time a day to limited skin areas. No scientific data registered on use in children under 6 years of age.

Contraindications (Ointment): individual intolerance to components, open bleeding wounds. No contraindication data scientifically registered for pregnancy, lactation, and children under 6 years of age.

Side Effects (Ointment): in case of overdose, local skin irritation, hyperemia, itching possible.

Adjustment for Patient Body Weight: adjustment not required, as this form is for external use.

Preparation method (Ointment): prepare an oil extract: pour 100 milliliters of coconut oil over 30 grams of ground dry roots, heat in a water bath at a temperature of 50 degrees Celsius for 3 hours, then filter. Mix the resulting extract with 65 grams of beeswax and 5 grams of lanolin, heat in a water bath until completely melted, stir until homogeneous, pour into sterile jars of 100 grams.

Storage Conditions and Shelf Life: store in a tightly closed container, in a dark place at a temperature of 5 to 15 degrees Celsius, protecting from sunlight. Shelf life — 12 months. After opening, use within 60 days.

Cream — Salvia miltiorrhiza

Indications (Cream): atopic dermatitis, seborrheic dermatitis, acne vulgaris, erythematotelangiectatic rosacea, rosacea, post-inflammatory hyperpigmentation, skin photoaging, perioral dermatitis, plaque psoriasis on the face.

Standard Dosage (Cream): apply a thin layer to the affected or problem skin area 2 times a day, morning and evening, after skin cleansing.

Enhanced Dosage (Cream): apply 3 times a day for pronounced rosacea, active rosacea, post-inflammatory hyperpigmentation.

Maximum Dosage (Cream): up to 4 applications per day for severe forms of rosacea, pronounced hyperpigmentation, post-inflammatory dermatitis.

Preventive Dosage (Cream): apply 1 time a day in courses of 21 days every 3 months for chronic tendency to rosacea, skin photoaging, post-inflammatory hyperpigmentation.

Pediatric Dosage (Cream): for children from 6 years of age, apply 1 time a day to limited skin areas. No scientific data registered on use in children under 6 years of age.

Contraindications (Cream): individual intolerance to components, open skin injuries with active bleeding. No contraindication data scientifically registered for pregnancy, lactation, and children under 6 years of age.

Side Effects (Cream): with excessive application, local irritation, hyperemia, burning sensation possible.

Adjustment for Patient Body Weight: adjustment not required, as this form is for external use.

Preparation method (Cream): prepare an oil extract: pour 100 milliliters of coconut oil over 25 grams of dry ground roots, keep in a water bath at a temperature of 50 degrees Celsius for 3 hours, filter. In the aqueous phase, dissolve 3 grams of glycerin and 0.5 grams of xanthan gum in 60 milliliters of distilled water. Add 10 grams of shea butter and 5 grams of beeswax to the oil phase (extract with coconut oil), heat to 65 degrees Celsius. Combine both phases at a temperature of 65 degrees Celsius using an emulsifier (5 grams of lecithin), stir until cooled and thickened. Pour into sterile jars of 100 grams.

Storage Conditions and Shelf Life: store in a dark, tightly closed container, at a temperature of 5 to 10 degrees Celsius, protecting from direct light. Shelf life — 6 months. After opening, use within 45 days.

Cosmetic Serum — Salvia miltiorrhiza

Indications (Cosmetic Serum): skin photoaging, rosacea, erythematotelangiectatic rosacea, post-inflammatory hyperpigmentation, acne vulgaris, post-acne, seborrheic dermatitis, dry skin, impaired skin barrier function.

Standard Dosage (Cosmetic Serum): apply 3–4 drops of serum to the face and neck 1–2 times a day on cleansed skin.

Enhanced Dosage (Cosmetic Serum): apply 5–6 drops 2 times a day for pronounced rosacea, active rosacea, persistent hyperpigmentation.

Maximum Dosage (Cosmetic Serum): up to 8 drops 2 times a day for severe forms of skin photoaging, pronounced post-acne and hyperpigmentation.

Preventive Dosage (Cosmetic Serum): apply 2–3 drops 1 time a day in courses of 14 days every 3 months for chronic tendency to dry skin, rosacea, photoaging.

Pediatric Dosage (Cosmetic Serum): no scientific data registered on use in persons under 18 years of age in cosmetic serum.

Contraindications (Cosmetic Serum): individual intolerance to components. No contraindication data scientifically registered for pregnancy, lactation, and children under 18 years of age.

Side Effects (Cosmetic Serum): with excessive application, skin irritation, temporary redness, burning sensation possible.

Adjustment for Patient Body Weight: adjustment not required, as this form is for external use.

Preparation method (Cosmetic Serum): prepare a concentrated water-glycerin extract: pour 50 milliliters of distilled water and 30 milliliters of glycerin over 20 grams of ground dry roots, keep in a water bath at a temperature of 50 degrees Celsius for 2 hours, filter. Add 5 milliliters of coconut oil, 1 gram of hyaluronic acid, 0.5 grams of green tea extract to the extract, mix thoroughly until homogeneous. Pour into sterile dropper bottles of 30 milliliters.

Storage Conditions and Shelf Life: store in a refrigerator at a temperature of 4 to 8 degrees Celsius, protect from light. Shelf life — 3 months. After opening, use within 30 days.

Oil Infusion — Salvia miltiorrhiza

Indications (Oil Infusion): trophic ulcer of the leg, diabetic foot syndrome, varicose eczema, localized scleroderma, post-traumatic scar, contact dermatitis, seborrheic dermatitis, plaque psoriasis, acne vulgaris, perioral dermatitis, erythematotelangiectatic rosacea, dry skin, impaired skin barrier function.

Standard Dosage (Oil Infusion): apply 3–5 milliliters of infusion to the affected skin area or use as part of cosmetic products 1–2 times a day.

Enhanced Dosage (Oil Infusion): apply 5–7 milliliters 2 times a day for trophic ulcers, diabetic foot syndrome, localized scleroderma.

Maximum Dosage (Oil Infusion): up to 10 milliliters 2 times a day for severe chronic dermatoses and pronounced scleroderma.

Preventive Dosage (Oil Infusion): apply 2–3 milliliters 1 time a day in courses of 14 days every 3 months for chronic dry skin, varicose veins, post-traumatic scars.

Pediatric Dosage (Oil Infusion): for children from 6 years of age, apply 1–2 milliliters 1 time a day to limited skin areas. No scientific data registered on use in children under 6 years of age.

Contraindications (Oil Infusion): individual intolerance to components. No contraindication data scientifically registered for pregnancy, lactation, and children under 6 years of age.

Side Effects (Oil Infusion): with excessive application, local irritation, skin hyperemia, burning possible.

Adjustment for Patient Body Weight: adjustment not required, as this form is for external use.

Preparation method (Oil Infusion): pour 100 milliliters of coconut oil over 30 grams of ground dry roots, place in a glass jar with a tightly closed lid. Infuse in a water bath at a temperature of 45–50 degrees Celsius for 4 hours or keep in a dark place at a temperature of 25–28 degrees Celsius for 21 days, shaking daily. After infusion, strain through cheesecloth or a filter, pour into dark glass bottles of 100 milliliters.

Storage Conditions and Shelf Life: store in a tightly closed dark glass container at a temperature of 5 to 15 degrees Celsius, protect from sunlight and heat sources. Shelf life — 12 months. After opening, use within 60 days.

Toxicity and Biosafety of Salvia miltiorrhiza

Acute toxicity studies have shown that the LD50 for Salvia miltiorrhiza extracts upon intravenous administration in mice is approximately 1500–2000 mg/kg body weight, indicating low toxicity of the preparation. Upon oral administration, the LD50 is significantly higher and is estimated to exceed 5000 mg/kg, which confirms the safety of use at therapeutic doses. Chronic toxicity studies have shown the absence of mutagenic and carcinogenic effects with long-term use. The biosafety of the preparation has been confirmed in numerous preclinical and clinical studies with a minimal risk of adverse reactions when adhering to recommended dosages.

Reference: https://pubmed.ncbi.nlm.nih.go...

Pharmacodynamics — Salvia miltiorrhiza

The active components of Salvia miltiorrhiza include groups of phenolic acids and lipophilic tanshinones, which possess a wide range of pharmacological effects due to their interaction with numerous biological targets at the systemic and local levels. The main target biological systems are the cardiovascular, nervous, immune, endocrine, as well as skin and gastrointestinal systems.

Phenolic acids exhibit pronounced antioxidant activity, inducing inhibition of lipid peroxidation, reduction of free radical production, and enhancement of the activity of endogenous detoxification enzymes. They influence the regulation of cellular redox balance, contributing to tissue protection against oxidative stress. Tanshinones have the ability to modulate platelet aggregation, reduce leukocyte adhesion to the endothelium, which helps improve microcirculation and reduce inflammatory processes at the vascular level.

The effect on the nervous system is expressed in a neuroprotective effect by reducing oxidative damage to neurons, regulating neurotransmitter activity, and reducing neuroinflammation, which positively affects cognitive functions and reduces damage in ischemic conditions. In the immune system, modulation of the inflammatory response is observed through suppression of pro-inflammatory cytokines and activation of anti-inflammatory pathways, which contributes to the restoration of homeostasis and reduction of pathological inflammation.

Active substances affect vascular endothelial cells, improving the synthesis of vasodilators (e.g., nitric oxide) and reducing the expression of adhesion molecules, which improves the elasticity of the vascular wall and reduces the risk of thrombosis. In the gastrointestinal tract, components help protect the mucosa, stimulate epithelial regeneration, have antispasmodic and anti-inflammatory effects, which improves barrier functions and promotes tissue restoration.

In the skin system, active components modulate inflammation, reduce the activity of allergy and irritation mediators, stimulate collagen synthesis and increase regenerative potential, which improves skin quality and promotes healing of damage.

Pharmacodynamic effects are due to interaction with enzymes (cyclooxygenase, lipoxygenase, nitric oxide synthase), modulation of signaling pathways (NF-kB, MAPK), effects on receptors (adrenergic, cholinergic, opioid), and regulation of genes responsible for inflammation, apoptosis, and oxidative stress. This provides a complex action with systemic and local effects aimed at restoring homeostasis and reducing pathophysiological processes.

References: https://pubmed.ncbi.nlm.nih.go...  https://www.sciencedirect.com/science/article/abs/pii/S0378874117312566

Pharmacokinetics — Salvia miltiorrhiza

The active substances of Salvia miltiorrhiza have features of absorption, distribution, metabolism, and excretion that determine their bioavailability and efficacy with different routes of administration. Upon oral administration, phenolic acids and tanshinones undergo partial hydrolysis and metabolism in the gastrointestinal tract and liver, including phase I and II biotransformation involving cytochrome P450 enzymes and conjugation with glucuronic and sulfate acids.

Some polyphenolic compounds undergo biotransformation by the intestinal microflora, which affects their activity and absorption. Tanshinones are characterized by low water solubility, therefore their absorption is limited, which can be partially compensated by the use of extracts and tinctures with various carriers.

The distribution of active components occurs mainly in tissues with high blood flow, such as the liver, kidneys, heart, and brain, where they exert local pharmacological action. Metabolites are actively excreted in bile and urine, partially through the intestines, providing cycles of enterohepatic recirculation.

With transdermal application and administration through mucous membranes, components enter the systemic circulation, bypassing the first pass through the liver, which increases bioavailability. Metabolism occurs mainly in the liver with the participation of enzyme systems, and excretion — through the kidneys, which requires consideration of the function of these organs with long-term use.

The inhalation route of administration for this taxon has been studied to a limited extent, however, it is assumed that the systemic effect will depend on the physicochemical properties of the active substances and their solubility in the respiratory tract.

Interaction with the intestinal microflora plays a role in modulating the metabolism and pharmacological activity of phenolic acids, affecting the degree of absorption and systemic action. Accumulation of active substances in tissues is minimal, which reduces the risk of cumulative toxicity at recommended doses.

Excretion in urine and bile ensures effective removal of metabolites, which is important for maintaining balance and preventing undesirable effects. Given the involvement of the liver and kidneys in metabolism and excretion, monitoring the function of these organs is necessary with long-term use.

References: https://pubmed.ncbi.nlm.nih.go...   https://www.frontiersin.org/ar...

Mechanisms of Action and Scientific Rationale — Salvia miltiorrhiza

The pharmacological activity of Salvia miltiorrhiza is due to the complex action of the main groups of biologically active substances: lipophilic tanshinones and hydrophilic phenolic acids. Tanshinones exhibit a significant effect on the vascular system by inhibiting platelet aggregation and suppressing the activation of endothelial cells, which is associated with the regulation of intracellular signaling pathways, including MAPK and NF-κB. They reduce the production of pro-inflammatory cytokines (e.g., TNF-α, IL-6), which leads to a reduction in the inflammatory response at the level of the vascular wall. In addition, tanshinones possess antioxidant activity mediated by stimulating the activity of superoxide dismutase and glutathione peroxidase enzymes, helping to reduce oxidative stress in tissues.

Hydrophilic phenolic acids, including salvianolic acids and danshensu, act primarily as potent antioxidants, inhibiting lipid peroxidation, and also regulate the expression of enzymes responsible for restoring cellular redox balance. They interact with the enzymes cyclooxygenase and lipoxygenase, reducing the production of prostaglandins and leukotrienes, thereby reducing inflammation and improving microcirculation. Active substances affect neurotransmitter receptors and transporters (adrenergic, dopaminergic), which manifests as neuroprotective and vasodilatory effects.

At the cellular level, Salvia miltiorrhiza modulates the functions of macrophages and neutrophils, regulates apoptosis and proliferation of endothelial cells, which promotes tissue repair and normalization of hemodynamics. Through influence on JAK/STAT signaling cascades, the immune response is regulated, with suppression of excessive activation of inflammatory cells and cytokines. This complex action forms an anti-inflammatory, antioxidant, antifibrotic, and cardioprotective profile of action.

Interaction with glucocorticoid and opioid receptor systems helps modulate inflammation and pain response. Active components reduce the expression of adhesion molecules on the endothelium, improving microcirculation and preventing the development of ischemic damage. These effects are achieved at the systemic level and locally in tissues where receptors and enzyme systems vulnerable to the phytochemicals of Salvia miltiorrhiza are present.

References: https://pubmed.ncbi.nlm.nih.go...   https://www.sciencedirect.com/science/article/pii/S0378874116304380

Synergy — Salvia miltiorrhiza

Research data confirm the pharmacological synergy of Salvia miltiorrhiza with other plant and synthetic substances, especially in the context of enhancing antioxidant and anti-inflammatory activity. In combination with plants rich in flavonoids and polyphenols, such as green tea (Camellia sinensis) and ginkgo biloba (Ginkgo biloba), an additive or potentiating effect is observed, enhancing cell protection against oxidative stress and improving microcirculation.

When combined with natural immunomodulators, for example echinacea (Echinacea purpurea), modulation of the immune response is enhanced due to the combined suppression of pro-inflammatory cytokines and increased macrophage activity, which helps normalize inflammatory processes. Interaction with anti-inflammatory drugs (e.g., cyclooxygenase inhibitors) is noted as modulating, allowing the reduction of dosages of the latter by enhancing overall efficacy and reducing side effects.

At the cellular level, the combined effect of Salvia miltiorrhiza with antioxidants such as vitamin E and selenium demonstrates protection of mitochondria and reduction of cell apoptosis during oxidative damage. Potentiation of vasodilatory and antiplatelet effects is observed in combination with ginkgo biloba and resveratrol, which helps improve microcirculation and reduce the risks of thrombosis.

Studies show that these interactions are realized through influence on common signaling cascades (NF-κB, MAPK), as well as through the combined inhibition of enzyme systems (COX, LOX), which leads to a comprehensive reduction of inflammation and oxidative stress at the systemic and tissue levels. Synergistic effects make it possible to form a multi-target approach to the modulation of pathophysiological processes while minimizing the risk of drug interactions.

References: https://pubmed.ncbi.nlm.nih.go...  https://www.frontiersin.org/ar...

Geography of Use and Traditional Medicine — Salvia miltiorrhiza

Red sage is traditionally used in the regions of East Asia, mainly in China, Korea, Japan, and Vietnam, where it occupies an important place in traditional medicine systems such as Chinese (TCM) and Korean folk medicine. In Chinese medicine, Salvia miltiorrhiza is known as "Danshen" and has been used for more than two thousand years. Written references to the use of this taxon date back to the classical herbalists of the Han and Tang dynasties, where the plant was described as a remedy for strengthening blood circulation and recovering from injuries.

In the folk medicine of these regions, sage root was used in the form of decoctions, aqueous or alcoholic infusions, as well as in the form of powders for internal use and external applications. Wraps with root infusions were also used, and the juice from fresh roots was used externally to treat skin diseases. In traditional practice, oil extract of the root was also used for massage and compresses.

In Korean and Japanese traditions, the plant is used in a similar way, and in Korea, unique recipes for combined herbal remedies with Salvia miltiorrhiza integrating local herbs have been noted. Vietnamese folk medicine also includes this taxon in complex herbal mixtures.

In the ethnocultural context of East Asia, red sage was considered a plant of power, symbolizing the restoration of energy and life balance. Its roots were often used in rituals aimed at harmonizing body and spirit, and in some regions were considered a means of cleansing from negative energies. In Tibetan medicine, Salvia miltiorrhiza is mentioned as a component of complex medicinal collections used to maintain blood and nervous system health.

Apart from medicine, in the ritual practices and ceremonies of some East Asian peoples, sage root was used as a smoking substance for cleansing space and protecting against evil spirits. In folklore, the plant was associated with strength and longevity, its roots served as amulets or protective objects.

In other regions, including Southeast Asia and regions with strong Chinese medical influence, cases of using Salvia miltiorrhiza are also known, but documented ethnobotanical information is limited.

Currently, ethnobotanical information on the use of the taxon "Salvia miltiorrhiza" in folk, medical, or ritual traditions outside East Asia has not been recorded in available sources.