Salvia miltiorrhiza is a traditional Asian herbal medication for circulatory ailments. It has shown efficacy in treating various markers of heart health. It is used traditionally to "invigorate" the blood or improve circulation. In patients with glaucoma, one report claimed to stabilize the visual field in patient with moderate to advanced glaucoma. The mechanism was presumed to be independent of IOP.**
- Full Spectrum Salvia with MSV 60
- Traditional Asian cardiovascular support supplement
- Features Chinese salvia
Full Spectrum Salvia with MSV 60 from Planetary Herbals is a dietary supplement that features one of the primary herbs used throughout Asia for supporting a healthy cardiovascular system: Chinese salvia (Salvia Miltiorrhiza also known as Dan Shen or Red Sage). MSV 60 (magnesium salvianolate B) has been identified as one of its primary active compounds.
Salvia Full Spectrum with MSV
1020 mg, 120 tablets
Item Catalog Number: PF0495
1 tablet twice daily with a meal.
Serving Size 1 Tablet
|Amount Per Serving||%Daily Value|
|Chinese Salvia Root||1 g||†|
|Chinese Salvia Root Extract (60% magnesium salvianolate B [MSV 60®])||20 mg||†|
†Daily Value not established.
Do not take with warfarin. Check with your physician before using this product if you are taking aspirin, ginkgo biloba, vinpocetine or other blood-thinners or if you are pregnant, may become pregnant or breastfeeding.**DISCLAIMER: Information on this page is not intended as a substitute for advice provided by a competent health care professional. You should not use this information in diagnosing or treating a health problem. No claim or opinion expressed on this web site is intended to be, nor should be construed to be, medical advice. If you are now taking any drugs, prescribed or not, or have a medical condition, please consult a competent physician who is aware of herb/drug interactions before taking any herbal supplements. The information presented herein has not been evaluated by the FDA or the Department of Health and is not intended to diagnose, prevent or treat any disease or illness.
by Douglas Rhee, MD
Salvia miltiorrhiza (Red Sage, Chinese Sage, dan shen) is a perennial flowering plant approximately 30-60 cm high that is native to China and Japan. In traditional Chinese medicine, red sage is believed to improve circulation and is used to treat hypertension and cardiovascular disease, especially acute myocardial infarction and strokes.
In patients with glaucoma, one report claimed to stabilize the visual field in patient with moderate to advanced glaucoma. (Wu ZZ et al. 1983). The mechanism was presumed to be independent of IOP.
Possible Beneficial Mechanisms of Action
There has been little direct study with red sage and glaucoma. In an experimental model of elevated IOP in rabbits, intravenous red sage resulted in near complete preservation of RGC compared to controls.(Zhu and Cai 1993) The same group also found less reduction of axoplasmic flow in this rabbit model in red sage treated group (intravenous); this beneficial effect was potentiated by concurrent use of topical timolol.(Zhu and Cai 1991)
Although there has been little direct study of glaucoma, there has been extensive study of red sage in other areas, with over 1,000 studies listed in pubmed (www.ncbi.nlm.nih.gov; search term “salvia miltiorrhiza”) in March 2010. Many of these studies have focused on the anti-oxidant and anti-inflammatory properties attributed to red sage or Tanshionone IIA (Tan IIA), its principle active ingredient, in cardiovascular, tumor, and acute hepatic injury research. In these studies, several proteins and pathways that have been associated with glaucoma have been affected, albeit in different cell types. A brief review is presented.
Anti-oxidant and Redox Scavenger
The predominant activity that is believed to be confered by red sage is as an anti-oxidant. In atherosclerotic lesions, smooth muscle cells grow in response to oxidative stress, such as homocysteine. In a rat model of atherosclerosis, an extract of red sage inhibited the growth of vascular smooth muscle cells and decreased the intracellular reactive oxygen species concentration.(Hung et al. 2010) By surveying several different signaling pathways, the investigators determined that the red sage was acting through the protein kinase C/ mitogen-activated kinase (PKC/MAPK). Although the receptor is unknown, they used two-dimentional immunoblotting and mass spectrometry to compare the protein extracts from cells treated with homocysteine compared to those receiving homocysteine and red sage to show significant change in cytoskeleton and chaperone proteins. Red sage exerted its protective effect through scavenging of reactive oxygen species and modulation of protein carbonylation to inhibit cell proliferation.(Hung et al. 2010)
In a separate study, red sage directly lowered total plasma homocysteine by increase the activity of trans-sulphuration enzymes that metabolize homocysteine.(Cao et al 2009)
Tan IIA alleviated oxidative damage induced by glutathione-induced hyperstimulation of the NMDA receptor (i.e. excitotoxicity) in human neuroblastoma SH-SY5Y cells.(Sun ZY et al 2010) There is some evidence indicating a direct effect mitigating NMDA receptor excitoxicity.(Sun X et al. 2003)
Red sage has been reported to have some protective effective effect on hepatic damage, apparently through an antioxidant mechanism.(Park et al 2009) Red sage was protective against reperfusion injury in liver through inhibiting oxidation and also antagonizing TNF-a.(Liang R et al 2009)
In an experimental model of myocardial infarction, Tan IIA blocked nuclear factor-kappaB2 (NF-kappaB2) and transforming growth factor beta-1 (TGFb1) secretion in rat cardiac cells.(Ren et al. 2010) In liver injury models, Tan IIA reduced levels of interleukins -2, -4, (tumor necrosis factor alpha (TNFa), and interferon-gamma.(Liu et al. 2010) In a prospective randomized controlled trial of an extract containing red sage, along with panax notoginseng and dryobalanops camphor, in 106 patients who had an ischemic stroke or TIA were managed with conventional therapy with or without this extract, the experimental group had a lower rate of recurrent stroke/TIA.(Xu et al 2009)
Effect on Blood Viscosity
In beagles, intravenously administered salvianolic acid B (another active compound found in red sage), decreased blood viscosity, while oral administration had no effect.(Gao et al 2009) In humans, red sage can potentiate the effects of warfarin, leading to bleeding complications.(Chan 2001)
In rat cardiac arterioles, red sage induced vasodilation by increasing production of nitric oxide from the endothelial cells either directly, or from a locally produced cytochrome P450 metabolite, via calcium-activated potassium channels.(Wu GB et al 2009)
In rats, whole red sage extract given intravenously can lower blood pressure.(Leung et al 2009) Further studies with Tan IIA showed it lower systemic blood pressure in rats with spontaneous elevated blood pressure via ATP-sensitive potassium channels to lower intracellular calcium.(Xiping et al 2009)
Effect on Extracellular Matrix ModulationTan IIA inhibits proliferation and induces apoptosis of tumor cells in breast and colon cancer cells, in vitro.(Lu et al 2009 and Shan 2009) Although seemingly unrelated to the pathogenesis of glaucoma, Tan IIA suppressed NF-kappaB signaling and reduced urokinase plasminogen activator and matrix metalloproteinases (MMPs) -2, -9, and increased tissue inhibitors of metalloproteinases (TIMPs) -1 and -2.(Hung YC 2010) In an experimental model of acute myocardial infarction, salvianolic acid regulated MMP-9 enzyme levels in cardiac cells.(Jiang 2009) In vitro testing of pure extracts of MMPs, red sage blocked rat MMPs-1, -2, and -9 activity.(Liang et al 2009)
In hepatoma HepG2 cells, red sage extract inhibited cell invasion by modulating smad2/3 signaling of TGFb1.(Liu et al 2010) In a rat model of diabetic nephropathy, Tan IIA decreased TGFb1 and collagen IV deposition.(Kim et al 2009) In rate mesangial cells, red sage decreased production of plasminogen activator inhibitor-1 (PAI-1) by antagonizing angiotensin II.(Yuan et al 2008)
Red Sage and the Eye
Red sage has been reported to be beneficial for the preservation of visual field in a single report via an IOP-independent mechanism. Using a rabbit model of ocular hypertension, Zhu and Cai implicate the anti-inflammatory and vasodilatory effects of red sage. Using modern molecular techniques in non-ocular tissues and animal models, red sage affects several pathways that may be involved in the pathogenesis of glaucoma.
Despite the failure of memantine to demonstrate a clear therapeutic advantage, NMDA-receptor mediated excitotoxicity still has significant experimental evidence implicating it as a contributor to secondary RGC death.(Seki and Lipton 2008) Oxidative stress has been implicated in the pathogenesis of open angle glaucoma, particularly exfoliative glaucoma.(Schlötzer-Scherhardt 2010 and Zhou L et al 1999) Furthermore, TGFß1 levels are increased in aqueous humor and deposits of exfoliation material in patients with exfoliative glaucoma.(Koliakos et al 2001 and Schlötzer-Schrehardt et al 2001) The relationship between TGFß1 and exfoliation syndrome is more complicated than a simple mutational one.(Krumbiegel 2009) TGFß1 likely contributes to the formation of deposits seen in the trabecular meshwork. Red sage has been shown to antagonize TGFb1. Downregulating NF-kappaB in RGC confirms protection against apoptosis.(Sappington and Calkins 2008 and Ando et al 2005) Capillary vasodilation and decreasing blood viscosity may confer increased blood flow to the optic nerve. However, caution should be applied as red sage can induce bleeding complications in patients on anti-coagulant therapy.
The effect on MMP and TIMP balance could be deleterious to IOP as the shifting of this balance toward greater MMP activity correlates to IOP lowering.(Ooi et al 2009) Red sage has a tendency to shift the MMP/TIMP balance towards decreased MMP activity.
ReferencesAndo A, Yamazaki Y, Kaneko S, et al (2005). Cytoprotection by nipradilol, an anti-glaucomatous agent, via down-regulation of apoptosis regulated gene expression and activation of NF-kappaB. Exp Eye Res 80:501-507
Cao Y, Chai JG, Chen YC, et al (2009). Beneficial effects of danshensu, an active component of Salvia miltiorrhiza, on homocysteine metabolism via the trans-sulphuration pathway in rats. Br J Pharmacol. 157(3):482-90. Epub 2009 Apr 30.
Chan, T.Y. 2001. "Interaction between warfarin and danshen (Salvia miltiorrhiza)" The Annals of Pharmacotherapy, Vol. 35, No. 4, pp. 501-504.
Gao DY, Han LM, Zhang LH, et al (2009). Bioavailability of salvianolic acid B and effect on blood vsicosities after oral administration of salvianolic acids in beagle dogs. Arch Pharm Res 32:773-779
Hung YC, Wang PW, Pan TL. (2010) Functional proteomics reveal the effect of Salvia miltiorrhiza aqueous extract against vascular atherosclerotic lesions. Biochim Biophys Acta. Feb 17 [Epub ahead of print]
Jiang B, Wu W, Li M, et al. (2009) Cardioprotection and matrix metalloproteinase-9 regulation of salvianolic acids on myocardial infarction in rats. Planta Med. 75:1286-92.
Kim SK, Jung KH, Lee BC.(2009) Protective effect of Tanshinone IIA on the early stage of experimental diabetic nephropathy. Biol Pharm Bull. 32:220-4.
Koliakos GG, Scholotzer-Schrehardt U, Konstas AG, et al (2001). Transforming and insulin-like growth factors in the aqueous humor of patients with exfoliation syndrome. Graefes Arch Clin Exp Ophthalmol. 239:482-487
Krumbiegel M, Pasutto F, Mardin CY, et al (2009). Exploring functional candidate genes for genetic association in german atients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Invest Ophthalmol Vis Sci. 50:2796-2801
Leung SW, Zhu DY, Man RY. (2009) Effects of the aqueous extract of Salvia Miltiorrhiza (danshen) and its magnesium tanshinoate B-enriched form on blood pressure. Phytother Res. Nov 26. [Epub ahead of print]
Liang R, Bruns H, Kincius M, et al (2009). Danshen protects liver grafts from ischemia/reperfusion injury in experimental liver transplantation in rats. Transpl Int. 22:1100-1109.
Liang YH, Li P, Huang QF, et al (2009). Salvianolic acid B in vitro inhibited matrix metalloproteinases-1, -2, and -9 activities. Zhong Xi Yi Jie He Xue Bao. 7:145-150.
Liu X, Yang Y, Zhang X, et al.(2010) Compound Astragalus and Salvia miltiorrhiza extract inhibits cell invasion by modulating transforming growth factor-beta/Smad in HepG2 cell. J Gastroenterol Hepatol. 25:420-406.
Lu Q, Zhang P, Zhang X, et al. (2009) Experimental study of the anti-cancer mechanism of tanshionone IIA against human breast cancer. Int J Mol Med 24:773-780
Ooi YH, Oh DJ, Rhee DJ. (2009) Effect of bimatoprost, latanoprost, and unoprostone on matrix metalloproteinases and their inhibitors in human ciliary body smooth muscle cells. Invest Ophthalmol Vis Sci 50:5259-5265 Epub May 14
Park EJ, Zhao YZ, Kim YC, et al. (2009) Preventive effects of a purified extract isolated from Salvia miltiorrhiza enriched with tanshinone I, tanshinone IIA and cryptotanshinone on hepatocyte injury in vitro and in vivo. Food Chem Toxicol. 47:2742-2748.
Ren ZH, Tong YH, Xu W, et al. (2010) Tanshionen IIA attenuates inflammatory responses of rats with myocardial infarction by reducing MCP-1 expression. Phytomedicine. 17:212-218
Sappington RM, Calkins DJ. (2008) Contribution of TRPV1 to microglia-derived IL-6 and NFkappaB translocation with elevated hydrostatic pressure. Invest Ophthalmol Vis Sci. 49:3004-3017
Schloetzer-Schrehardt U, Zenkel M, Kuchle M, et al.(2001) Role of transforming growth factor-beta1 and its latent form binding protein in pseudoexfoliation syndrome. Exp Eye Res. 73:765-780
Schlotzer-Scherhardt U. (2010) [Oxidative stress and pseudoexfoliation glaucoma] Klin Monbl Augenheilkd. 227:108-113
Seki M, Lipton SA. (2008) Targeting excitotoxic/free radical signaling pathways for therapeutic intervention in glaucoma. Prog Brain Res. 173:495-510.
Shan YF, Shen X, Xie YK, et al. (2009) Inhibitory effects of tanshionene II-A on invasion and metastasis of human colon carcinoma cells. Acta Pharmacol Sin. 30:1537-1542
Sun X, Chan LN, Gong X, et al.(2003) N-methyl-D-aspartate receptor antagonist activity in traditional Chinese stroke medicines. Neurosignals 12:31-38
Sun ZW, Zhang L, Zhu SJ, et al. (2010) Excitotoxicity effects of glutamate on human neuroblastoma SH-SY5Y cells via oxidative damage. Neurosci Bull. 26:8-16
Xiping Z, Jun F, Chengjun W, et al. (2009) Effect of salvia miltiorrhizae on pulmonary apoptosis of rats with severe acute pancreatitis or obstructive jaundice. Inflammation. 32:287-95.
Xu G, Zhao W, Zhou Z, et al. (2009) Danshen extracts decrease blood C reactive protein and prevent ischemic stroke recurrence: a controlled pilot study. Phytother Res. 23:1721-1725.
Wu GB, Zhou EX, Qing DX. (2009) Tanshinone II(A) elicited vasodilation in rat coronary arteriole: roles of nitric oxide and potassium channels. Eur J Pharmacol. 617:102-107.
Wu ZZ, Jiang YQ, Yi SM, et al. (1983) Radix Salviae Miltiorrhizae in middle and late stage glaucoma. Chin Med J 96:445-447
Yuan J, Wang X, Chen T, et al. (2008) Salvia miltiorrhiza depresses plasminogen activator inhibitor-1 production through inhibition of angiotensin II. Am J Chin Med. 36:1005-1015.
Zhou L, Lik Y, Yue BY. (2009)Oxidative stress affects cytoskeletal structure and cell-matrix interactions in cells from an ocular tissue: the trabecular meshwork. J Cell Physiol 180:182-189
Zhu MD, Cai FY. (1991) [The effect of inj. Salviae Miltiorrhizae Co. on the retrograde axoplasmic transport in the optic nerve of rabbits with chronic IOP elevation] Zhonghua Yan Ke Za Zhi 27:174-178
Zhu MD, Cai FY. (1991) Evidence of compromised circulation in the pathogenesis of optic nerve damage in chronic glaucomatous rabbit. Chin Med J (Engl). 106:922-927
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Planetary Herbals have been developed by expert herbalists, focusing predominantly on the thousands of years of experience of Ayurvedic and traditional Chinese herbalism, the hundreds of years of experience of Western herbal practitioners, and the more than 30 years of clinical experience of professional herbalists such as Michael Tierra, Lesley Tierra, Jill Stansbury, and Alan Tillotson.
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