Danshen

Last Updated: April 26, 2023

Salvia miltiorrhiza (Danshen) is a Traditional Chinese Medicine used for circulatory and heart health; it appears to be somewhat effective at this claim and is one of the best selling Chinese Medicines for heart health.

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1.

Sources and composition

Salvia militorrhiza (also known as Danshen) is an asian herb historically known to have beneficial effects on the circulatory system. Danshen, as well as a blend called 'Fufang Dansehn' containing Panax notoginseng and Cinnamomum camphora, are the two most widely selling herbs in China.[1]

Over 80 different compounds have been identified in Danshen, 50 of which are water-soluble and the remaining 30 fat-soluble.[1] The fat-soluble components are diterpene compounds belonging to the subclass 'tanshinones', or which the two main studies tanshinones are tanshinone IIA and cryptotanshinone.[1][2][3] The water soluble components consist of various (up to 15) polyphenolic acids including salvianolic acids, protocatechuic aldehyde and acid, and danshensu (salvianic acid A). Other notable compounds are beta-sitosterol, ursolic acid, baicalin, and sometimes a vitamin E or tannin content.[4]

Out of all of these compounds, the main ones with pharmacological importance seem to be the salvinoic acids (including danshensu) and the tanshinones (including tanshinone IIA).

2.

Pharmacology

2.1

Absorption

Tanshinone IIA has been shown to be rapidly absorbed orally in either isolation or as Danshen; the compound cryptotanshinone is not taken up orally and metabolizes into tanshinone IIA upon intravenous injection, although a lipid nanoparticle transport alleviates this.[5]

Danshensu (salvinaic acid A) is also rapidly absorbed after oral ingestion, while salvinoic acid B has a much lesser uptake rate.[6][7][8]

It appears that Danshensu in the form of sublingual dripping pills results in higher bioavailability than orally ingested pills.[9][10]

2.2

Enzymatic Interactions

Fourteen days of supplementation with Danshen tablets (Salvia miltiorrhiza alongside Panax notoginseng and Cinnamomum camphora) thrice daily does not appear to significantly alter the pharmacokinitics of theophylline,[11] a drug mostly metabolized by CYP1A2 (to a lesser extent, CYP2E1).[12]

3.

Contributions of individual ingredients to its clinical efficacy

Danshensu (Salvianic acid A) has been shown to dilate coronary arteries, inhibit platelet aggregation, improve microcirculation and protect the myocardium from reperfusion injury of the ischemic heart. It can also inhibit myocardial cell apoptosis while protecting cells from free radicals and homocysteinemia.[1][13][14]

Salvionolic acid B can contribute to cardiac protection by inhibiting the oxidation of LDL proteins (preventing uptake by macrophages)[15] and inhibiting platlet aggregation.[16] It can also inhibit angiotension-II induced hyperplasmia, stress-activated protein (SAP) kinase activiy,[17] and the DNA synthesis of noncardiomyocytes while stimulating NO production of the endothelial cell. It also has protective effects against cerebral ischemia-reperfusion injury.[18][1]

Tanshinone IIA has been implicated in reducing myocardial infarct size and cardiac cell hypertrophy (via angiotension II inhibition).[19] It also serves as an anti-oxidant in myocardial mitochondrial membranes[14] and against the oxidation of LDL proteins.[20]

4.

Clinical uses

It has been historically used in China with efficacy to treat heart diseases such as angina pectoralis, and has recently shown efficacy in cerebrovascular diseases and hyperlipidemia; Essentially circulation ailments.

5.

Adverse interactions and Toxicity

Three studies noted slight thirst and gastrointestinal side effects when using a 'dripping pill' formulation of Danshen.[21]

Beyond that, the LD50 value for Danshen was found to be 25.807 g/kg in mice, which is 3934 times the therapeutic dose of 6.56 mg/kg bodyweight. 400 times the therapeutic dose for 90 days was found to be safe in mice.[1]

Due to Salvia Militorrhiza's anti-thrombotic and blood pressure lowering abilities, it adversely interacts with the pharmaceutical Warfarin[22] and causes enhanced bleeding and hindering of wound healing when combined.

Combining Danshen with salicyclate (derivative of aspirin) results in much less bioavailability of Danshen when using therapeutic doses of salicyclic acid, thus using Aspirin and Danshen is not advised.[23]

References
6.^Zhang Y, Akao T, Nakamura N, Duan CL, Hattori M, Yang XW, Liu JXExtremely low bioavailability of magnesium lithospermate B, an active component from Salvia miltiorrhiza, in ratPlanta Med.(2004 Feb)
11.^Qiu F, Wang G, Zhao Y, Sun H, Mao G, A J, Sun JEffect of danshen extract on pharmacokinetics of theophylline in healthy volunteersBr J Clin Pharmacol.(2008 Feb)
12.^Sarkar MA, Hunt C, Guzelian PS, Karnes HTCharacterization of human liver cytochromes P-450 involved in theophylline metabolismDrug Metab Dispos.(1992 Jan-Feb)
15.^O K, Lynn EG, Vazhappilly R, Au-Yeung KK, Zhu DY, Siow YLMagnesium tanshinoate B (MTB) inhibits low density lipoprotein oxidationLife Sci.(2001 Jan 12)
16.^Li M, Zhao C, Wong RN, Goto S, Wang Z, Liao FInhibition of shear-induced platelet aggregation in rat by tetramethylpyrazine and salvianolic acid BClin Hemorheol Microcirc.(2004)
20.^Niu XL, Ichimori K, Yang X, Hirota Y, Hoshiai K, Li M, Nakazawa HTanshinone II-A inhibits low density lipoprotein oxidation in vitroFree Radic Res.(2000 Sep)
23.^Gupta D, Jalali M, Wells A, Dasgupta ADrug-herb interactions: unexpected suppression of free Danshen concentrations by salicylateJ Clin Lab Anal.(2002)