Sage

Sage has been used in connection with the following conditions (refer to the individual health concern for complete information):

Rating	Health Concerns
	Excessive perspiration Gingivitis (periodontal disease) (as mouthwash, in combination with peppermint oil, menthol, chamomile tincture, expressed juice from echinacea, myrrh tincture, clove oil, and caraway oil) Indigestion
	Infection Menopause Pregnancy and postpartum support Sore throat
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

Historical or traditional use (may or may not be supported by scientific studies): Sage has one of the longest histories of use of any culinary or medicinal herb. It was used by herbalists externally to treat sprains, swelling, ulcers, and bleeding.² Internally, a tea made from sage leaves has had a long history of use to treat sore throats and coughs—often used as a gargle. It was also used by herbalists for rheumatism, excessive menstrual bleeding, and to dry up a mother’s milk when nursing was stopped. It was particularly noted for strengthening the nervous system, improving memory, and sharpening the senses.³ Sage was officially listed in the United States Pharmacopoeia from 1840 to 1900.

Active constituents: The volatile oil of sage contains the constituents alpha- and beta-thujone, camphor, and cineole.⁴ It also contains rosmarinic acid, tannins, and flavonoids. In modern European herbal medicine, a gargle of sage tea is commonly recommended to treat sore throat, inflammations in the mouth, and gingivitis (inflammation of the gums).⁵ Test tube studies have found that sage oil has antibacterial, antifungal, and antiviral activity which may partially explain the effectiveness of sage for these indications.⁶

Sage is also approved in Germany for mild gastrointestinal upset and excessive sweating.⁷ An unpublished, preliminary German study with people suffering from excessive perspiration found that either a dry leaf extract or an infusion of the leaf reduced sweating by as much as 50%.⁸ A report from the United Kingdom indicates that herbalists there employ sage to treat symptoms of menopause such as hot flashes.⁹

How much is usually taken? For treatment of sore throats, inflammation in the mouth, or gingivitis, 3 grams of the chopped leaf can be added to 150 ml of boiling water and strained after 10 minutes.¹⁰ This is then used as a mouthwash or gargle several times daily. Alternatively, one may use 5 ml of fluid extract (1:1) diluted in one glass of water, several times daily. For internal use, the same tea preparation described above may be taken three times per day.

Are there any side effects or interactions? Concern has been expressed about the internal use of sage due to the presence of thujone.¹¹ Even when consumed in small amounts for long periods of time, thujone may cause increased heart rate and mental confusion. Very high amounts (several times greater than one receives if taking sage as instructed above), may lead to convulsions. If one takes sage internally, it is best to limit use to the amounts listed above and to periods of no more than one to two weeks. Extracts of sage made with alcohol are likely to be higher in thujone than those made with water. Sage oil should never be consumed without being first diluted in water. Sage should not be used internally during pregnancy. These concerns do not extend to the use of sage as a gargle or mouth rinse. Sage should be avoided when fever is present.

At the time of writing, there were no well-known drug interactions with sage.

References:

1. Blumenthal M, Goldberg A, Brinkman J (eds). Herbal Medicine: The Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications, 2000, 330–4.

2. Foster S. 101 Medicinal Herbs. Loveland, CO: Interweave Press, 1998, 176–7.

3. Foster S, Tyler VE. Tyler’s Honest Herbal. New York: Haworth Press, 1999, 327–9.

4. Wichtl M. Herbal Drugs and Phytopharmaceuticals. Boca Raton, FL: CRC Press, 1994, 440–3.

5. ESCOP 1996. Salviae folium (Sage leaf). Monographs on the Medicinal Use of Plant Drugs. Exeter, UK: European Scientific Cooperative on Phytotherapy, 1997.

6. ESCOP 1996. Salviae folium (Sage leaf). Monographs on the Medicinal Use of Plant Drugs. Exeter, UK: European Scientific Cooperative on Phytotherapy, 1997.

7. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council and Boston: Integrative Medicine Communications, 1998, 198.

8. ESCOP 1996. Salviae folium (Sage leaf). Monographs on the Medicinal Use of Plant Drugs. Exeter, UK: European Scientific Cooperative on Phytotherapy, 1997.

9. Beatty C, Denham A. Review of practice: Preliminary data collection for clinical audit. Eur J Herbal Med 1998;4:32–4.

10. Wichtl M. Herbal Drugs and Phytopharmaceuticals. Boca Raton, FL: CRC Press, 1994, 440–3.

11. Foster S, Tyler VE. Tyler’s Honest Herbal. New York: Haworth Press, 1999, 327–9.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2003.