Sample Entry:

Sage

Historical note

Sage has been used since ancient times as an antiseptic, astringent and to reduce sweating. 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.

OTHER NAMES

Broad-leafed sage, common sage, dalmatian sage, garden sage, meadow sage, Spanish sage, true sage

BOTANICAL NAME/FAMILY

Salvia officinalis, Salvia lavandulaefolia (family Labiatae or Lamiaceae)

PLANT PART USED

Leaf

CHEMICAL Components

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). Pharmacopoeial grade sage leaf must contain not less than 1.5% thujone-rich volatile oil (Blumenthal et al 2000).

MAIN ACTIONS

ANTIMICROBIAL

Sage is reported to have antimicrobial activity attributed to the thujone, thymol and eugenol content of the volatile oil (Shapiro 1994), as well as its rosmarinic acid content (Petersen & Simmonds 2003). The phenolic acids, salvins and monomethyl ethers have also been attributed with antimicrobial activity. Overall, activity has been reported in vitro against Staphylococcus aureus, Escherichia coli, Salmonella spp., Shigella sonnei, Klebsiella ozanae, Bacillus subtilis and various fungi including Candida albicans (Newell et al 1996). Phenolic extracts have also shown antibacterial activity against Enterococcus (Feres et al 2005). Sage had some in vitro antimicrobial effects on saliva samples from periodontally healthy and diseased subjects, although it had less activity than clove or propolis (Feres et al 2005). Sage essential oil has been shown to have effective inhibitory activity against microorganisms, such as Klebsiella spp., Enterobacter spp., E. coli, Proteus mirabilis and Morganella morganii, isolatedfrom urinary tract infection (Santos Pereira et al 2004). There are also reports thatsage may also be fungistatic and virustatic (Eidi et al 2005).

ANTIOXIDANT

Sage extracts have been shown to have strong anti-oxidant activity (Matsingou et al 2003, Pizzale et al 2002), with labiatic acid and carnosic acid reported to be the active compounds (Perry et al 2003). According to in vivo studies with animal models, ingestion of sage infusion improves the liver’s antioxidant status (Lima et al 2005) andprotects against azathioprine-induced toxicity (Amin & Hamza 2005). However, sage essential oil did not show protective effects against toxicity from an oxidative compound in isolated rat hepatocytes (Lima et al 2004).

ASTRINGENT

The high tannin content of sage supports its reported astringent activity.

ANTISPASMODIC

Sage oil has antispasmodic effects in laboratory animals (Newell et al 1996) and this is likely due to the irritating effects of the volatile oil. There is some evidence that sage oil may also exert a centrally mediated antisecretory action.

ANXIOLYTIC

Rosmarinic acid, which is a component of sage essential oil, produces an anxiolytic-like effect without exerting locomotor alterations or DNA damage in the brain tissue of rats (Pereira et al 2005). According to in vitro tests, compounds in the methanolicextract have an affinity for human brain benzodiazepine receptors (Kavvadias et al 2003).

OTHER ACTIONS

In vitro and in vivo studies suggest that sage essential oil and some individual monoterpenoid constituents inhibit acetylcholinesterase activity, as well as exert antioxidant, anti-inflammatory and oestrogenic effects (Perry et al 2003). The water soluble polysaccharide complex from sage has demonstrated immunomodulatory activity (Capek & Hribalova 2004) and the terpenoid fractions have shown antimutagenic properties in vivo (Vujosevicacute et al 2004).

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 oilloaded 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).

CLINICAL USE

Although sage has not been the subject of many clinical studies, many of its constituents demonstrate significant pharmacological effects, providing a theoretical basis for some of its uses.

REDUCES SECRETIONS

Sage has been traditionally used to treat excessive perspiration and salivation, as well as dysmenorrhoea, diarrhoea, galactorrhoea, sweats associated with menopause and to cease lactation (Fisher & Painter 1996). An open study of 80 patients confirmed that it can reduce perspiration (Blumenthal et al 2000). The high tannin content of the herb provides a theoretical basis for its use.

DYSPEPSIA AND LACK OF APPETITE

Sage’s reported antispasmodic action and bitter constituents support its use in treating loss of appetite, gastritis, flatulence, bloating and dyspepsia. These uses await support from clinical research.

INFLAMMATION OF MUCOUS MEMBRANES

Topically, sage is used as a gargle for laryngitis, pharyngitis, stomatitis, gingivitis, glossitis, minor oral injuries and inflammation of the nasal mucosa (Blumenthal et al 2000). These uses can be based on the pharmacological activity of its chemical Components. In an open-label, single-blind, RCT of 420 patients, the non-steroidal anti-inflammatory drug, benzydamine hydrochloride, was found to be more effective than sage in relieving postoperative pain when used as a mouthwash after tonsillectomy in children and adults (Lalicevic & Djordjevic 2004).

Sage has been found to have less antitussive effects than codeine, but a significantly higher or similar effect to dropropizine (Nosalova et al 2005). A small, double-blind study has suggested that use of an essential oil spray or gargle formulation that includes sage may help relieve snoring (Prichard 2004).

Contents

Adhatoda – Zinc

Includes Vitamins A – D