HERBAL
MEDICINAL
PLANT
---------------------------------------------------
SAGE
*Salvia officinalis L.
(Labiatae/Lamiaceae)
BY
RETTODWIKART THENU
SAGE
(sayj)
Salvia officinalis L. (Labiatae/Lamiaceae)
SUMMARY AND PHARMACEUTICAL COMMENT
The characterisstic
components of sage (Salvia officinalis) to which its
traditional uses can be attributed are the volatile oil and tannins. The oil of
a related species Salvia lavandulifolia is being
investigated for symptomatic treatment of Alzheimer’s disease. However, at
present, there is a lack of well-designed clinical studies investigating the
reputed effects of sage. Sage oil contains high concentrations of thujone, a
toxic ketone, and should not be ingested. Sage is commonly used as a culinary
herb and presents no hazard when ingested in amounts normally encountered in
foods. However, extracts of the herb should be used with caution and should not
be ingested in large amounts or over prolonged periods. Sage should not be used
during pregnancy and lactation.
The Salvia
genus is one osf the largest groups of the Lamiaceae family with over 700 species
spread throughout the world (Nickavar et al 2005).
Sage has been used since ancient times as an antiseptic, astringent, tonic,
carminative, antispasmodic, anti-inflammatory and to reduce sweating agent in various
traditional medicine systems. The name ‘Salvia’ derives from the Latin salvere
(to be saved) (Blumenthal et al 2000). Sage oil is used as a culinary spice and as a fragrance in
soaps and perfumes. The fragrance is said to suppress the odour of fish.
DESCRIPTION
MEDICINAL PARTS: The medicinal
parts are the fresh leaves and the fresh flowering aerial parts, the dried
leaves, and the oils extracted from the flowers and stems.
FLOWER AND FRUIT: The
medium-sized, pale violet, white or pink labiate flowers are in 6- to 12-
blossomed false whorls, which are arranged above each other in 4 to 8 rows. The
surrounding leaves fall early. The calyx is 10 to 14 mm long, funnel-shaped-campanulate,
downy, glandular punctate and bilabiate. The upper lip has 3 throrny-awned
teeth; the lower lip has 2. The corolla tube has a ring of hair inside. The upper
lip is almost straight and the lower lip has 3 segments. There are 2 stamens
with almost semicircular bent filaments.
LEAVES,.STEM AND ROOT: Sage grows as.a
bush up to 60 cm high. The stem is erect and woody at the base with leafy, quadrangular,
white-gray tomentose branches. The leaves are simple, oblong or oblong-lanceolate
and narrowed at the base. They are petiolate, densely and finely crenate, ribbedwrinkled,
and white-gray tomentose initially, tough, and evergreen.
CHARACTERISTICS: The leaves are
aromatic, tangy, and bitterly astringent.
HABITAT: The plant is
indigenous to the Mediterranean region and has naturalized in all of Europe. It
is cultivated in North America.
PRODUCTION: Sage leaf
consists of the fresh or dried leaf of Salvia officinalis. In the wild, sage is
collected from the former Yugoslavia, the Adriatic coast and those areas that are
farther from the coast but are still under Mediterranean influence. The harvest
lasts from mid-July until December, depending on the area. October is
recommended as the most favorable time to harvest Dalmatian sage. When Sage is cultivated, it is recommended
that the harvest take place beginning in the second vegetation year at the beginning
of the flowering period and in the afternoon. Sage can be dried in direct sunlight,
but up to 25% of the oil can be lost. Drying in shade reduces oil loss to 2 to
10%. Optimum drying conditions for preventing oil loss use a drying chamber
with vertical incoming air currents at 50° C with 0.9% absolute humidity.
NOT TO BE CONFUSED WITH: Confusion can
arise with the leaves of Salvia triloba and also with Salvia or Phlomis
species.
SPECIES (FAMILY)
*Salvia officinalis L.
(Labiatae/Lamiaceae)
S.
lavandulifolia Vahl
SYNONYM(S)
*Dalmatian Sage, Garden Sage, True Sage
ORIGIN
Sage is a perennial found in
Europe, Canada, and the United States.
PHARMACOPODIAL AND OTHER MONOGRAPHS
BHP 1996(G9)
BP 2007(G84)
Complete German Commission E(G3)
ESCOP 2003(G76)
Martindale 35th edition(G85)
Ph Eur 2007(G81)
LEGAL CATEGORY (LICENSED PRODUCTS)
GSL(G37)
CONSTITUENTS
The
following is compiled from several sources, including Reference 1 and General
References G2, G52, G58 and G62.
Acids Phenolic
– caffeic, chlorogenic, ellagic, ferulic, gallic and rosmarinic.(2)
Flavonoids
5-Methoxysalvigenin.
Flavonoids: including, among
others, apigenin- and luteolin-7-glucosides, numerous methoxylated aglycones,
including among others, genkwanin, genkwanin-6-methylether
Terpenes
Monoterpene glycosides. Diterpenes, abietanes including carnosic acid and
derivatives, e.g. carnasol. Triterpenes, oleanolic acid and derivatives.
Diterpenes: chief components
carnosolic acid (picrosalvin, 0.2-0.4%), rosmanol, safficinolide
Tannins
3–8%. Hydrolysable and condensed.(2, 3)
Volatile
oil 1–2.8%. Pharmacopoeial standard not less than 1.0% cut herb.(G81, G84)
Major components are a- and b-thujones (35–50%, mainly a). Others include
1,8-cineole, borneol, camphor, caryophyllene, linalyl acetate and various
terpenes.(4, 5)
CAFFEIC
ACID DERIVATIVES (3-6%): rosmarinic acid, chlorogenic acid.
It
has been noted that commercial sage may be substituted with Salvia triloba.(1)
In contrast to S. officinalis, the principal volatile oil component of S.
triloba is 1,8-cineole, with a-thujone only accounting for 1–5%.(1) Compared
with S. officinalis, the volatile oil yield of various Salvia species is lower,
with lower total ketone content and higher total alcohol content.(6)
The
exact chemical constituents depend on geographic and climatic conditions as
well as harvesting conditions, distillation method and the part of the plant
used (Nickavar et al 2005). The leaves contain up to
2.5% essential oil, which contains thujone, cineol and camphor, as well as
humulene, pinene, camphene, limonene, carnosol and rosmarinic acid. In
addition, the leaves contain catechin-type tannins, diterpene bitter
principles, triterpenes, steroids, flavones, and flavonoid glycosides, together
with polysaccharides. Sage is a rich source of beta-carotene, vitamins C and
B-complex (Fisher & Painter 1996). The flowering parts of S.
hypoleuca contain bicyclogermacrene, (E)-beta-caryophyllene, viridifloral,
spathulenol, beta-pinene and delta-pinene. Pharmacopoeial grade sage leaf must
contain not less than 1.5% thujone-rich volatile oil (Blumenthal
et al 2000).
USES
USES
Sage has been used to treat menstrual disorders,
diarrhea, sore throat, depression, cerebral ischemia, Alzheimer’s disease,
gastrointestinal disorders, and gum disease. Topically, sage is used for herpes
labialis, laryngitis, stomatitis, and infl ammation of the nose or throat
(Jellin et al, 2008). It is also used as a food fl avoring and in cosmetics.
FOOD USE
Sage
is commonly used as a culinary herb. It is listed by the Council of Europe as a
natural source of food flavouring (category N2).(G16) This category indicates
that sage can be added to foodstuffs providing the concentration of thujones (a
and b) present in the final product does not exceed 0.5 mg/kg, with the exceptions
of alcoholic beverages (10 mg/kg), bitters (35 mg/kg), food containing sage (25
mg/kg) and sage stuffing (250 mg/kg).(G16) Previously, sage has been listed as
GRAS (Generally Recognised As Safe).(G65)
HERBAL USE
Sage
is stated to possess carminative, antispasmodic, antiseptic, astringent and
antihidrotic properties. Traditionally, it has been used to treat flatulent
dyspepsia, pharyngitis, uvulitis, stomatitis, gingivitis, glossitis (internally
or as a gargle/mouthwash), hyperhidrosis, and galactorrhoea.(G2, G4, G7,
G32,G43, G52,G54, G64) The herbals of Gerard, Culpeper and Hill credit sage
with the ability to enhance memory.(7) The German Commission E approved
internal use for dyspeptic symptoms and excessive perspiration, and external
use for inflammation of mucous membranes of mouth and throat.(G3)
ACTIONS
ACTIONS
Several studies have focused on the actions of myrrh.
Myrrh has been found to decrease cholesterol levels, decrease infl ammation,
provide analgesia, act as an antiulcer and antitumor agent, and stimulate
triiodothyronine production.
Antilipidemic
Action
When
myrrh was studied along with garlic for reduction of cholesterol,
triglycerides, and phospholipids, garlic was found to be far superior to myrrh
(Dixit et al, 1980). However, when myrrh was studied with Allium sativum and Allium
cepa,
all three agents were found to
prevent a rise in these three indicators (Lata et al, 1991).
Antiinflammatory
and Antipyretic Actions
Three
studies have identifi ed the antiinfl ammatory action of myrrh. One study used
laboratory animals that had been injected with liquid paraffin containing killed
mycobacterial adjuvant. In this study, phenylbutazone, ibuprofen, and a fraction
of myrrh all were shown to provide signifi cant relief of arthritis symptoms
(Sharma et al, 1977). The other studies identifi ed a triterpene with antiinfl
ammatory and analgesic properties (Dolara et al, 2000; Fourie et al, 1989). In
this study, a signifi cant antiinfl ammatory effect occurred when myrrh was
administered to mice. In another study, an antipyretic action was observed (Tariq
et al, 1986).
Anticancer
Action
Myrrh’s
anticancer action has been demonstrated in a study using mice. The study evaluated
results at 25 to 50 days. Anticarcinogenic results were less pronounced after
50 days. The effect was comparable to that of cyclophosphamide (Al-Harbi et al,
1994). Another study showed similar results, leading researchers to conclude that
the use of myrrh for the treatment of cancer is appropriate (Qureshi et al,
1993).
The water-soluble polysaccharide complex from sage has demonstrated
immunomodulatory activity (Capek & Hribalova 2004)
and the terpenoid fractions have shown antimutagenic properties in vivo (Vujosevic
& Blagojevic 2004). In vitro and in vivo studies indicate that sage essential oil
and some individual monoterpenoid constituents demonstrate antioxidant, anti-inflammatory
and oestrogenic effects (Perry et al 2003).
Sage extract has been found to also significantly decrease serum glucose
in diabetic rats without affecting insulin release, suggesting a possible role
in diabetes (Eidi et al 2005). It has been suggested that extracts
of sage containing carnosic acid may act as a new class of lipid absorption
inhibitor. A methanolic extract of sage has also shown significant inhibitory effect
on serum triglyceride elevation in olive oil-loaded mice, and inhibitory
activity against pancreatic lipase, mainly because of the carnosic acid content.
Carnosic acid was also found to reduce the weight gain and accumulation of
epididymal fat in high-fat diet-fed mice after 14 days (Ninomiya
et al 2004).
PHARMACOLOGICAL ACTIONS
IN VITRO AND ANIMAL STUDIES
Hypotensive
activity in anaesthetised cats, CNS-depressant action (prolonged barbiturate
sleep) in anaesthetised mice, and an antispasmodic action in vitro (guinea-pig
ileum) have been reported for a sage extract(8) and for the essential oil.(9)
Antispasmodic activity
Inhibition of contractions induced by acetylcholine, histamine, serotonin and
barium chloride by 60–80% has been noted for a total sage extract, with lesser
activity exhibited by a total flavonoid extract.(8) An initial spasmogenic action
exhibited by low doses of sage oil has been attributed to the pinene
content.(9) Antispasmodic activity in vivo (guinea-pigs) has been reported for
sage oil administered intravenously, which released contraction of Oddi's sphincter
induced by intravenous morphine.(5)
Anticholinesterase activity
Early herbals claim that sage enhances the memory.(7) The anticholinesterase
activity of several Salvia species and their constituents have been investigated
in the search for new drugs for the treatment of Alzheimer's disease. The inhibition
of anticholinesterase in vitro by an ethanolic extract of S. officinalis (2.5
mg/mL) was 68%, and by oils of S. officinalis and S. lavandulifolia (0.1 mg/mL)
was 52% and 63%, respectively.(10) The IC50 value of S. lavandulifolia oil is
reportedly 0.03 mg/mL.(11) The monoterpenes 1,8-cineole and a-pinene from the
oil have been identified as the inhibitors of acetylcholinesterase with IC50 values
of 0.67 and 0.63 mmol/L, respectively.(11) Rats given S. Lavandulifolia oil (20
mL or 50mL for five days) were sacrificed, and acetylcholinesterase activity assessed
for striatum, cortex and hippocampus of brain left hemisphere.(12) At the lower
dose, there was a decrease in acetylcholinesterase activity in the striatum,
but not in the hippocampus or cortex of treated rats. At the higher dose, there
was a decrease in striatal acetylcholinesterase activity. It was concluded that
the oil inhibited acetylcholinesterase in selective areas of the brain.
Hypoglycaemic activity
Hypoglycaemic activity in vivo (rabbits) has been reported for S. lavandulifolia.(13)
and for mixed phytotherapy preparations containing various Salvia species, including
S. officinalis.(14) Activity in normoglycaemic, hypoglycaemic and in
alloxan-diabetic rabbits was observed, although no change in insulin
concentrations was noted.(13)
Antimicrobial and antiviral activity Antimicrobial
activity of the volatile oil has been attributed to the thujone content.(4) Antimicrobial
activity in vitro was noted against Escherichia coli, Shigella sonnei,
Salmonella species, Klebsiella ozanae (Gramnegative), Bacillus subtilis (Gram-positive),
and against various fungi (Candida albicans, C. krusei, C. pseudotropicalis, Torulopsis
glabrata, Cryptococcus neoformans).(15) No activity was observed versus
Pseudomonas aeruginosa.(4) Microencapsulation of sage oil into gelatin-acacia
capsules introduced a lagtime with respect to antibacterial activity and
inhibited antifungal activity.(4) Diterpene constituents of S. officinalis are
reported to be active against vesicular stomatitis virus.(G52)
Other activities
An aqueous ethanolic extract of sage (50%) strongly inhibited collagenolytic
activity of Porphyromonas gingivitis.(G52) In addition to anticholinesterase
activity, other biological activities have relevance in the treatment of Alzheimer's
disease. In this context, S. lavandulifolia and its individual constituents
have been assessed for antioxidant, anti-inflammatory and oestrogenic
activities.(11) An ethanolic extract of dried herb (5 mg/mL) and the
monoterpenes a- and b-pinene and 1,8- cineole (0.1 mol/L) inhibited bovine
brain liposome peroxidate activity. Anti-inflammatory activity was demonstrated
by weak inhibition of thromboxane B2 and leukotriene B4 synthesis, and possible
oestrogenic activity of sage oil (0.01 mg/mL) and geraniol (0.1–2 mmol/L),
demonstrated by induction of b-galactosidase in yeast cells.
CLINICAL STUDIES
Clinical research assessing the effects of sage is limited and rigorous
randomised controlled clinical trials are required. Excessive sweat induced by
pilocarpine was inhibited by a dialysate of an aqueous extract of fresh
sage.(G52) In an open study, 40 patients were given dried aqueous extract of
sage (440 mg, equivalent to 2.6 g herbs) and 40 were given infusion of sage
(4.5 g herb daily). Reduction of sweat (less than 50%) was achieved in both
groups of patients with idiopathic hyperhidriosis.(G52) It should be noted,
however, that this study did not include a control group and, therefore, the
observed effects cannot be attributed to sage with any certainty.
A double-blind, placebo-controlled, crossover study involving 20
healthy volunteers compared the effects of 50 mL, 100 mL and 150 mL of S.
lavandulifolia oil and sunflower oil.(12) Cognitive assessment indicated improvements
in both immediate and delayed word recall scores, coupled with decrements in
accuracy and speed of attention, with sage oil 50 mL. At this dose, selfrelated
alertness at 2.5 hours and calmness at four hours and six hours were reported
to be reduced.
ACTIVITIES
Acne
(f; CAN); Alzheimer’s (1; COX; FNF); Alopecia (f; CRC); Amenorrhea (f; JFM);
Angina (f; MAD); Anorexia (2; PHR; PH2); Aphtha (f; MAD); Arthrosis (1; COX;
FNF); Asthma (1; CRC; PH2; WAM); Bacteria (1; CAN; KOM; PH2; PIP; WAM); Bleeding
(f; MAD); Body Odor (f; WOI); Bronchosis (1; PH2); Bug Bite (f; APA); Cancer
(1; APA; COX; FNF); Cancer, gum (f; CRC; JLH); Cancer, mouth (f; CRC; JLH); Candida
(1; CAN; FNF; WOI); Canker Sore (f; APA); Catarrh (f; BGB; MAD); Cold (1; DEM;
WAM); Colic (f; MAD); Constipation (f; DEM); Cough (1; APA; BGB; MAD; WAM);
Cramp (1; APA; CAN; PH2); Cystosis (f; MAD); Debility (f; DEM); Depression (f;
APA); Dermatosis (f; PHR; PH2); Diabetes (1; PH2); Diarrhea (f; APA; DEM; PHR;
PH2); Dysentery (f; JFM); Dysmenorrhea (f; APA); Dyspepsia (2; APA; CAN; KOM;
PH2); Dysphagia (f; APA); Dyspnea
(f; MAD); Dysuria (f; MAD); Enterosis (1; APA;
INDICATIONS
Acne
(f; CAN); Alzheimer’s (1; COX; FNF); Alopecia (f; CRC); Amenorrhea (f; JFM);
Angina (f; MAD); Anorexia (2; PHR; PH2); Aphtha (f; MAD); Arthrosis (1; COX;
FNF); Asthma (1; CRC; PH2; WAM); Bacteria (1; CAN; KOM; PH2; PIP; WAM);
Bleeding (f; MAD); Body Odor (f; WOI); Bronchosis (1; PH2); Bug Bite (f; APA);
Cancer (1; APA; COX; FNF); Cancer, gum (f; CRC; JLH); Cancer, mouth (f; CRC;
JLH); Candida (1; CAN; FNF; WOI); Canker Sore (f; APA); Catarrh (f; BGB; MAD);
Cold (1; DEM; WAM); Colic (f; MAD); Constipation (f; DEM); Cough (1; APA; BGB;
MAD; WAM); Cramp (1; APA; CAN; PH2); Cystosis (f; MAD); Debility (f; DEM);
Depression (f; APA); Dermatosis (f; PHR; PH2); Diabetes (1; PH2); Diarrhea (f;
APA; DEM; PHR; PH2); Dysentery (f; JFM); Dysmenorrhea (f; APA); Dyspepsia (2;
APA; CAN; KOM; PH2); Dysphagia (f; APA); Dyspnea (f; MAD); Dysuria (f; MAD);
Enterosis (1; APA; PHR; PH2); Escherichia (1; CAN; HH2); Fatigue (f; PH2);
Fever (1; APA; DEM; JFM; MAD; PHR; PH2; WOI); Flu (f; JFM); Fungus (1; HH2;
KOM; PH2); Gas (1; APA; PED; PH2; WOI); Gastrosis (1; APA; FEL; PH2); Gingirrhagia
(1; PHR); Gingivosis (1; APA; CAN; PH2; PNC); Glossosis (1; CAN; PNC);
Halitosis (f; PH2); Headache (f; MAD); Hepatosis (f; CRC); High Blood Pressure
(1; APA; CAN; PH2); Hoarseness (1; BGB); Hot Flash (f; BGB); Hyperhydrosis (1;
BGB; CAN; CRC); Hyperlactation (f; AHP); Hysteria (f; CRC); Immunodepression
(f; PED); Infection (1; HH2; KOM; PH2); Infertility (f; BGB); Inflammation (1;
COX; FNF; PH2; PNC); Insomnia (1; CAN; DEM); Laryngosis (f; PHR; PH2); Lethargy
(f; CRC); Leukorrhea (f; MAD); Malaria (f; JFM); Measles (f; CRC); Mucososis
(2; PH2; PIP); Mycosis (1; HH2; KOM; PH2); Nephrosis (f; CRC; MAD); Nervousness
(1; CAN; DEM); Neurosis (f; CRC; PH2); Night Sweats (f; BGB; MAD); Odontosis
(f; MAD); Ophthalmia (f; JFM); Pain (f; CRC); Perspiration (2; KOM; PH2; PIP);
Pharyngosis (2; APA; CAN; KOM; PH2); Phthisis (f; CRC; MAD); Pulmonosis (1;
CRC; MAD); Rheumatism (f; APA; CRC; FEL); Rhinosis (2; KOM; PH2); Salmonella
(1; CAN; HH2); Shigella (1; CAN; HH2); Sore (1; BGB; MAD); Sore Throat (2; APA;
PH2; PIP; PNC); Spermatorrhea (f; FEL); Splenosis (f; MAD); Sprain (f; APA);
Stomatosis (2; APA; CAN; MAD; PHR; PH2); Tonsilosis (1; CRC; PNC); Toothache
(f; CRC); Tuberculosis (f; APA); Tumor (f; CRC); Uterosis (f; MAD); Uvulosis
(f; BGB; CAN; FEL); Virus (1; KOM; PH2; PIP); Water Retention (f; MAD); Wormc
(f; DEM; FEL; JFM); Wound (f; PHR; PH2).
INDICATIONS AND USAGE
Approved by Commission E:
• Loss of
appetite
• Inflammation
of the mouth and pharynx
• Excessive
perspiration
Sage is used
externally for inflammation of the mucous membranes of the nose and throat and
internally for dyspeptic symptoms and as a diaphoretic.
Unproven Uses: In folk
medicine, the drug is used internally for gastric disorders such as loss of
appetite, bloating, flatulence, diarrhea, enteritis, and excessive
perspiration. Externally, Sage is used as a rinse and gargle for light injuries
and skin inflammation, bleeding gums, stomatitis, laryngitis, pharyngitis, and
for firming the gums.
Homeopathic Uses: The most common
application in homeopathy is for excessive perspiration.
PRODUCT AVAILABILITY
Extract
PLANT PARTS USED: Whole plant
DOSAGES
DOSAGES
Menstrual
Irregularities
•
Adult PO extract: 1-4 mL (1:1 dilution in 45% alcohol) tid
Sore Throat
•
Adult PO extract: 1-4 g as a gargle prn
DOSAGES
Dosages
for oral administration (adults) for traditional uses recommended in standard
herbal reference texts are given below.
·
Leaf 1–4 g as an infusion three times daily;(G7)
4–6 g daily. (G3)
·
Liquid extract 1–4mL (1:1 in 45% alcohol) three times
daily.(G7)
·
Gargles, rinses 2.5 g/100mL water.(G3)
DOSAGES
·
4–6 g/day (AHP); 4–6 g herb
(KOM; PH2); 2 tsp (3 g) cut herb/cup water (APA);
·
1–4 mL liquid herb extract
(PNC); 1–4 g leaf, or in tea, 3 ×/day (CAN); 2–3 tsp (3.4–5.1 g) leaf in hot tea
(MAD); boil 100 g leaf/liter wine 2 minutes (f; PH2); 2–4 tbsp fresh leaf
(PED);
·
3–6 g dry leaf (PED); 4.5 g dry
leaf/2 mL alcohol/23 mL water (PED); 1–4 mL liquid leaf extract (1:1 in 45%
ethanol) 3 ×/day (CAN); 0.1–0.3 g EO (KOM;
PH2).
DOSAGES
Internal use
·
Infusion
of dried herb: 1–4 g three times daily.
·
Tincture
(1:1): 1–4 mL three times daily.
·
Essential
oil: 2–3 drops in 100 mL water several times daily.
·
Gargle
or rinse (use warm infusion): 2.5 g cut leaf in 100 mL water; or 2–3 drops
essential oil in 100 mL water; or use 5 mL fluid extract diluted in a glass of
water, several times daily.
DOSAGE
Mode of Administration: Cut herb for
infusions, alcoholic extracts, and distillates for gargles, rinses, and other
topical applications such as compresses or poultices. The pressed juice of
fresh plants is also used. In folk medicine, Sage is used internally as an
antihidrotic infusion and "medicinal cigarettes" are used for asthma.
How Supplied: Sage is
available as an alcohol-free 1:1 liquid.
Preparation: ' v
Tincture —
prepared 1:10 with 70% ethanol.
Liquid extract —
1:1 with 45% euianol.
The formulas for
several "generic" folk medicine decoctions and infusions follows.
Decoction No. 1
— One spoonful of powdered drug scalded with 1 cup of water, quickly strained,
and sweetened.
Decoction No. 2
— 15 g of the fresh leaves with 200 ml of water heated for 3 minutes.
Infusion No.l —
Scald 20 g dried leaves with 1 liter water, steep for 15 minutes, strain,
press, and sweeten if required.
Infusion No. 2 —
Pour 1 liter boiling water over 50 g drug, strain after 15 minutes and sweeten
with honey.
Antihidrotic
infusion — Scald 20 g of the dried leaves wiuh 1 liter water, steep 15 minutes,
strain, compress and sweeten if required.
Cardiac
insufficiency — A tonic infusion is prepared by pouring 1 liter boiling water
over 50 g of the drug, strain after 15 minutes, sweeten with sugar or honey.
Diabetes —
Prepare a fortified wine made by boiling 100 g of the leaves with one liter
wine for 2 minutes.
Inflammation of the
bronchial mucous membranes — An expectorant honey is made by mixing 50 g of the
powdered drug with 80 g of honey.
Nervous
exhaustion — A fortified wine is manufactured using an 8-day maceration of 100
g of the leaves with one liter of wine.
Tumors — The
drug is worked into an ointment base or pounded into a paste together with salt
and vinegar to make an adhesive paste.
Wounds — The
drug is prepared as a cleanser or rinse to heal wounds using a wine made by
heating 100 g of the leaves with 0.5 liter white wine for 1 minute.
Daily Dosage: The average daily
internal dose is 4 to 6 g of the drug; 0.1 to 0.3 g of the essentia] oil; 2.5
to 7.5 g of the tincture; 1.5 to 3 g of the liquid extract.
Antihidrotic —
0.25 g of the powdered drug (spoonful or capsules) taken before meals for
excessive perspiration and nervous complaints.
Cardiac
insufficiency — 1 glass of the tonic infusion can be taken 4 times daily. The decoction
dosage (using No. 1 or No. 2) is 1 glass at hourly intervals.
Diabetes — 1
glass of the wine preparation after meals.
'Halitosis — The
leaves may be chewed occasionally.
Inflammation of
the bronchial mucous membranes — 1 spoonful of the expectorant in the morning
and at bedtime.
Nervous
complaints — 0.25 g of the powdered drug (spoonful or capsules) before meals.
Externally, the
following dosages/applications are often
used:
Antihidrotic
infusion — 200 ml of infusion 1 to three times daily.
Gargles and
rinses — 2.5 g of the drug or 2 to 3 drops of essential oil in 100 ml of water
as infusion or 5 g of the alcoholic extract in 1 glass of water.
Inflamed mucous
membranes — Undiluted alcohol extract is applied repeatedly.
Homeopathic Dosage: 5 drops, 1
tablet or 10 globules every 30 to 60 minutes (acute) or 1 to 3 times daily
(chronic); parenterally: 1 to 2 ml sc acute: 3 times daily; chronic: once a day
(HAB1), Special doses must be prepared for children.
Storage: Sage leaves are
to be protected from light and humidity in sealed containers. Storage duration
of coarsely cut drug is 18 months; powder, maximum 24 hours. The tincture is
stored in tightly sealed containers away from light.
The liquid
extract may
be kept for up to 2 years.
CONTRAINDICATIONS, INTERACTIONS, AND SIDE
EFFECTS
CLASS
2B, 2D. Not For Long-Term Use.
Do
not exceed recommended dose. Alcoholic extracts contraindicated in pregnancy
(AHP). “Hazards and/or side effects not known for proper therapeutic dosages”
(PH2). Commission E reports for oral use of leaf, contraindications: pregnancy
(EO/alcoholic extracts); adverse effects: prolonged use of EO/alcoholic
extracts may produce epileptiform cramps. Other sources report leaf, as herbal tea,
should not be used for prolonged period (AEH). “Contraindicated in pregnancy.
May interfere with anticonvulsant and hypoglycemic therapies; may potentiate or
synergize other sedatives. Human poisoning has followed ingestion of the
convulsant EO for acne. In rats, sagse oil is subclinically, clinically, and
lethally convulsant at 300, 500, and 3200 mg/kg, respectively (CAN). CAN
cautions that thujone and camphor in the volatile oil can be convulsant and
toxic (CAN). LD50 (EO) = 2600 orl rat, LD50 (EO) = 5000 ind rbt (CAN). Taking
more than 15 g or prolonged overuse can lead to thujone-induced convulsions,
dizziness, hot flashes, and tachycardia (BIS). No more than 1 cup tea/day
during pregnancy, max, for no more than 1 week (WAM).
CONTRAINDICATIONS
Pregnancy category is 5;
Breastfeeding category is 5A.
Sage should not be given to children. Persons with
hypersensitivity to sage should not use it, and those with diabetes mellitus
and seizure disorders should be monitored closely.
SIDE
EFFECTS/ADVERSE REACTIONS
CNS: Seizures
GI: Nausea, vomiting, anorexia, stomatitis, cheilitis, dry
mouth, oral irritation
INTEG: Hypersensitivity reactions
.
INTERACTIONS
Drug
Anticonvulsants:
Sage may decrease the action of
anticonvulsants; avoid concurrent use (theoretical).
Antidiabetics,
CNS depressants: Sage may increase the action of
antidiabetics, CNS depressants.
Iron salts: Sage tea may decrease the absorption of iron salts;
separate by 2 hours.
Herb
Hypoglycemic/sedative
herbs: Sage may increase the action of
hypoglycemic and sedating herbs (theoretical).
SIDE-EFFECTS, TOXICITY
CLINICAL DATA
There
is a lack of clinical safety and toxicity data for sage and further
investigation of these aspects is required. A case of human poisoning has been
documented following ingestion of sage oil for acne.(16) Convulsant activity in
humans (and animals) has been documented for sage oil.(17, 18) Sage oil is
reported to be a moderate skin irritant(19) and is not recommended for use in
aromatherapy.(G58)
PRECLINICAL DATA
In
rats, the subclinical, clinical and lethal doses for convulsant action of sage
oil are estimated as 0.3, 0.5, and 3.2 g/kg.(17) This toxicity has been attributed
to the ketone terpenoids in the volatile oil, namely camphor and thujone. Acute
LD50 values for sage oil are documented as 2.6 g/kg in rats for oral
administration and 5 g/kg in rabbits for intradermal administration.(19) S.
officinalis has no mutagenic or DNA-damaging activity in either the Ames test or
Bacillus rec-assay.(G52)
CONTRA-INDICATIONS, WARNINGS
Sage
oil is toxic (due to the thujone content) and should not be ingested. S.
lavandulifolia oil has a much lower content of thujone than does S. officinalis
oil.(12) In view of the toxicity of the essential oil, sage extracts should be
used with caution and not ingested in large amounts.
Drug interactions
None documented. However, the potential for preparations of sage to interact with
other medicines administered concurrently, particularly those with similar or
opposing effects, should be considered. There is limited evidence from
preclinical studies that sage has hypoglycaemic activity. Sage oil has a high content
of thujones, which are convulsants.
Pregnancy and lactation Sage
is contra-indicated during pregnancy. Traditionally, it is reputed to be an
abortifacient and to affect the menstrual cycle.(G30) The volatile oil contains
a high proportion of a- and b-thujones, which are known to be abortifacient and
emmenagogic. Sage should not be used during lactation.
EXTRACTS
Fair
source of COX-2 inhibiting oleanolic acid at ~0. 1% (COX). The whole sage
extract has more activity than the flavonoid extract at inhibiting
acetylcholine, histamine, and serotonin-induced muscle contractions. EO active
against Bacillus (Gram-positive), Escherichia, Klebsiella (Gram-negative),
Salmonella, and Shigella; and among fungi, Candida,
Cryptococcus, and Torulopsis (CAN).
CLIENT CONSIDERATIONS
ASSESS
·
Assess for hypersensitivity
reactions. If present, discontinue the use of sage and administer an
antihistamine or other appsropriate therapy.
ADMINISTER
·
Instruct the client to store
sage in a sealed container away from heat and moisture.
TEACH
CLIENT/FAMILY
·
Inform the client that
pregnancy category is 5 and breastfeeding category is 5A.
·
Caution the client not to give
sage to children.
PREGNANCY USE
Traditionally,
sage is reported to have abortifacient properties. Its use in pregnancy is
therefore not recommended (Mills & Bone 2000, Newell et al 1996).
PRACTICE POINTS/PATIENT COUNSELLING
·
Sage
is a widely used, popular spice and sage oil is used in a variety of culinary
applications.
·
Sage
has a long history of use in traditional medicine as an antispasmodic and
carminative, to relieve excess sweating and as a gargle for inflammations of
the mouth.
·
It
is also commonly prescribed in combination with other herbs to relieve
menopausal symptoms such as night sweats.
·
Sage
contains volatile oils and tannins that are thought to be the key constituents
responsible for most of its pharmacological actions.
·
It
also has antibacterial and some antifungal activities.
·
A
recent double-blind study suggests it may be useful in mild-to-moderate
Alzheimer’s disease. Other studies report that it improves memory in healthy
subjects.
·
Sage
is likely to be safe when taken in amounts typically found in foods.
PATIENTS’ FAQs
What will this
herb do for me?
Sage is used to
reduce symptoms of menopause such as night sweats; however, scientific testing
has not been conducted to confirm whether it is effective. Recent research
suggests that it may improve memory in Alzheimer’s disease and in healthy subjects.
When will it
start to work?
The study in Alzheimer’s
disease found effects established within 4 months’ use. In the case of menopause,
a time frame is unknown.
Are there any
safety issues?
When used in
appropriate doses, it appears to be a safe herbal medicine; however, it should
not be used in pregnancy.
PREPARATIONS
PROPRIETARY
SINGLE-INGREDIENT PREPARATIONS
Austria: Salvysat. Czech Republic: Caj ze Salveje; Florsalmin; List
Salveje Lekarske; Nat Salveje Lekarske; Salvejova Nat. Germany: Aperisan;
Salbei Curarina; Salvysat; Sweatosan N; Viru-Salvysat. Italy: Saugella
Dermoliquido.
PROPRIETARY
MULTI-INGREDIENT PREPARATIONS
Argentina: Acnetrol; Parodontax Fluor; Sigmafem; Sigmafen Free;
Tereonsit. Australia: Feminine Herbal Complex. Austria: Cional; Dynexan;
Mentopin; Paradenton. Canada: Original Herb Cough Drops. Chile: Eciclean. Czech
Republic: Diabetan; Diabeticka Cajova Smes-Megadiabetin; Pulmoran; Stomatosan; Tormentan.
France: Bolcitol; Gonaxine; Saugella; Tisane Hepatique de Hoerdt. Germany: Amara-Tropfen;
Melissengeist; Parodontal. Israel: Baby Paste รพ Chamomile; Kamilotract. Italy:
Donalg; Saugella Attiva; Saugella Dermolatte; Saugella Fitothym; Saugella
Salviettine; Saugella Solido ph 3.5. South Africa: Amara; Dynexan. Spain: Diabesor;
Menstrunat; Natusor Farinol; Natusor Low Blood Pressure. Switzerland: Strath
Gouttes pour les muqueuses; Tisane pectorale et antitussive; Wala Echinacea.
Venezuela: One Drop Spray. UK: Lane's Sage and Garlic Catarrh Remedy; Menopace
Plus; Napiers Echinacea Tea.
REFERENCE
Barnes, J., Anderson, L. A., and Phillipson, J. D.
2007. Herbal Medicines Third Edition. Pharmaceutical
Press. Auckland and London.
Braun, L and Cohen, M. 2010. Hebs and Natural
Supplements An Evidence Based Guide 3R D Edition. Elsevier Australia. Australia.
Duke, J. A. with Mary Jo Bogenschutz-Godwin, Judi
duCellier, Peggy-Ann K. Duke. 2002. Handbook of Medicinal Herbs 2nd
Ed. CRC Press LLC. USA.
Gruenwald, J., Brendler, T., Jaenicke, Ch. 2000. PDR for
Herbal Medicines. Medical Economics Company, Inc. at
Montvale, NJ 07645-1742. USA
Linda S-Roth. 2010. Mosby’s Handbook Of
Herbs & Natural Supplements, Fourth Edition. Mosby Elsevier. USA
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