Home Supplements That Start With D Danshen Benefits: Cardiovascular Support, Key Uses, and Potential Risks

Danshen Benefits: Cardiovascular Support, Key Uses, and Potential Risks

August 29, 2025 Modified date: August 29, 2025

Danshen (Salvia miltiorrhiza), sometimes called red sage or Chinese sage, has been used for centuries in East Asian medicine to “invigorate blood” and support circulation. Modern research focuses on its phenolic acids (like salvianolic acid B) and lipid-soluble tanshinones (such as tanshinone IIA), which appear to influence blood flow, inflammation, and oxidative stress. People typically consider Danshen for cholesterol management, stable angina symptoms, and general cardiovascular support. Evidence is mixed: some randomized trials—especially with proprietary “compound Danshen” products—report improvements in lipids or angina symptoms, while others show little or no benefit when the herb is used alone. As with any bioactive herb, safety and drug interactions matter; Danshen can potentiate blood-thinning medicines, and product quality varies widely across brands and preparations.

Essential insights for Danshen users

Complementary cardiovascular support is the main use; benefits are most consistent when Danshen is combined with conventional therapy.
Key actives (salvianolic acids and tanshinones) target inflammation, oxidative stress, endothelial function, and platelet activity.
Typical oral dosage ranges: 400–800 mg/day of standardized extract in recent human trials, or 9–15 g/day of crude root in traditional decoction.
Avoid Danshen with warfarin or similar anticoagulants unless a clinician closely monitors INR; stop before surgery or dental procedures.

What is Danshen?
Benefits you can realistically expect
How Danshen works in the body
Dosing: how much and when
Safety, side effects, and interactions
Evidence in context: what studies show

What is Danshen?

Danshen is the dried root and rhizome of Salvia miltiorrhiza Bunge. In Traditional Chinese Medicine (TCM), it’s categorized as a herb that “moves blood,” historically used for conditions attributed to blood stasis—pain, menstrual irregularities, and chest tightness. In the supplement market today, it’s positioned primarily for cardiovascular support.

Common names and forms

Names: Danshen, red sage, Chinese sage, Salvia miltiorrhiza.
Preparations: whole root (decoction or granules), aqueous or hydroalcoholic extracts (capsules, tablets), and proprietary combinations (e.g., “compound Danshen” dripping pills). In hospital settings in China, injectable preparations and sodium tanshinone IIA sulfonate exist, but those are not typical dietary supplements outside Asia.

Key constituents you’ll see on labels

Water-soluble phenolic acids: salvianolic acid B (Sal B), danshensu, rosmarinic-like derivatives. These contribute to antioxidant and endothelial effects and may reduce platelet activation.
Lipid-soluble diterpene quinones (tanshinones): tanshinone IIA, cryptotanshinone, dihydrotanshinone I, etc. These are often linked to anti-inflammatory, anti-fibrotic, and vasomodulatory actions.

Quality markers and standardization

Quality varies. Reputable products often standardize to minimum percentages of salvianolic acids and/or tanshinones. In the Chinese Pharmacopoeia, quality standards specify minimum levels of Sal B and total tanshinones for raw materials and certain extracts. For consumers shopping outside Asia, look for:

Standardized extracts with declared marker compounds (e.g., “≥3% salvianolic acid B” or “≥0.5% tanshinone IIA,” figures vary by product).
Third-party testing seals for identity and contaminants (heavy metals, pesticides, residual solvents).
Transparent sourcing and batch numbers.

Where Danshen fits among alternatives

People sometimes compare Danshen with hawthorn, garlic, or nattokinase for heart health. Compared with these, Danshen research is heavily concentrated in China and often uses proprietary multi-herb products. Hawthorn has more Western monographs for mild heart failure symptoms; garlic shows modest lipid and blood-pressure effects; nattokinase has fibrinolytic activity but with heterogeneous quality data. If your aim is lipid or angina support as an adjunct, Danshen is plausible—provided you and your clinician manage drug interactions and monitor outcomes.

Benefits you can realistically expect

TL;DR: The most encouraging data concerns adjunct use in cardiovascular settings—especially lipid management and symptom relief in stable angina—often with Chinese proprietary formulations. Results with single-ingredient extracts are mixed, and benefits are modest when present.

Lipids and metabolic markers

A recent systematic review and meta-analysis of randomized trials found that when Danshen-based therapies were added to statins or standard care, lipid profiles improved (lower total cholesterol and LDL-C, lower triglycerides, higher HDL-C) compared with standard therapy alone. Most trials were conducted in China and used standardized pills or capsules; the quality varied, but the overall signal favored add-on use over monotherapy.

Stable angina symptoms

Earlier meta-analyses and individual trials of “compound Danshen” products (that combine Salvia miltiorrhiza with other actives such as Panax notoginseng and borneol) reported better symptom control versus isosorbide dinitrate or placebo in short-term studies. However, heterogeneity and risk-of-bias concerns temper confidence. If you consider proprietary formulas, choose those supported by consistent trial protocols and clinical oversight.

Microcirculation and endothelial function

Claims about “improving microcirculation” are common in marketing, but clinical results are mixed. A randomized, double-blind, cross-over trial in hyperlipidemic, hypertensive adults using a high dose of aqueous Danshen extract (equivalent to ~15 g/day of crude root) found no improvement in LDL, blood pressure, endothelial function, or related biomarkers over four weeks. This underscores how results depend on the preparation (aqueous vs. alcohol extract), dose, and the population studied.

Other emerging areas

Lower urinary tract symptoms (LUTS) in men: A multicenter, double-blind, placebo-controlled trial tested 400–800 mg/day of a standardized root extract and explored symptomatic relief over 12 weeks. Findings suggest this is an active research area with potential but not a cardiometabolic benefit per se.
Neurovascular health: Preclinical and translational work on salvianolic acid B and tanshinone IIA shows antioxidant, anti-inflammatory, and vasoprotective effects. Some clinical use in China involves injections in acute settings, but that doesn’t translate directly to over-the-counter supplements.

What a “win” looks like in practice

If Danshen helps, expect adjunctive benefits over 8–12 weeks: slightly better lipid numbers on top of statin therapy, fewer angina episodes with specific proprietary formulas, or improved exercise tolerance. Meaningful outcomes (e.g., fewer cardiovascular events) have not been convincingly demonstrated in high-quality long-term trials of oral supplements.

When to reconsider

No measurable change in your target (lipid panel, angina frequency) after 8–12 weeks despite adherence.
You need an alternative because of drug interactions (see safety section).
Your clinician prefers options with stronger Western guideline backing for your specific goal.

How Danshen works in the body

Danshen’s actions reflect two families of constituents:

1) Salvianolic acids (water-soluble)
These polyphenols, especially salvianolic acid B (Sal B), are potent antioxidants. In experimental models they:

Scavenge reactive oxygen species and upregulate endogenous antioxidant defenses.
Support endothelial nitric-oxide (NO) signaling, helping vessels dilate more appropriately.
Inhibit platelet activation and aggregation in vitro, contributing to “blood-moving” effects described in TCM.
Modulate inflammatory signaling (e.g., NF-κB, interleukins), potentially preserving microvascular integrity.

2) Tanshinones (lipid-soluble)
Tanshinone IIA receives the most attention. Mechanistically it has been shown to:

Influence multiple signaling hubs (e.g., Nrf2, AMPK, PI3K/Akt/mTOR, MAPKs, JAK/STAT).
Modulate endothelial function and smooth-muscle tone, contributing to vasomodulation.
Affect lipid handling (e.g., SREBP-2/Pcsk9 pathways) and anti-fibrotic processes relevant to the heart and vasculature.
Interact with drug-metabolizing enzymes (notably CYPs), which is helpful to know for safety.

Why the preparation matters

Aqueous extracts concentrate salvianolic acids; alcohol extracts concentrate tanshinones. Proprietary “compound” products combine S. miltiorrhiza with other herbs and adjuvants (e.g., borneol) to alter absorption and pharmacodynamics. This partly explains why one trial can show benefit and another can’t: the phytochemical fingerprint—not just the plant name—drives the effect.

Clinical translation

Endothelial and microcirculatory support likely comes from antioxidant and NO-mediated pathways (salvianolic acids).
Anti-inflammatory and anti-fibrotic effects relate more to tanshinones’ broad signaling impacts.
Antiplatelet/anticoagulant tendencies are relevant to benefits and risks: they may support flow but also heighten bleeding risk with certain drugs.

Dosing: how much and when

Important: Product strengths vary widely. Start at the lower end of a standardized range, use a single product at a time, and monitor your objective outcome (lipids, symptom diary). If you take prescription medicines—especially blood thinners—discuss Danshen with your clinician first.

Typical ranges seen in clinical and pharmacopoeial sources

Standardized extract (capsules/tablets): 400–800 mg/day, often in divided doses with meals, was used in a recent multicenter, randomized, double-blind trial of a Danshen root extract. This provides a practical benchmark for modern supplements.
Traditional crude root (decoction): 9–15 g/day of dried root is the classical Chinese Pharmacopoeia range when prepared as a water decoction; in one randomized trial, an aqueous extract equivalent to ~15 g/day of crude root was used.
Proprietary “compound Danshen” products: Clinical trials commonly used 10 small tablets, three times daily (doses vary by brand and formulation). These are regulated medicines in China rather than dietary supplements in most Western countries, and dosing should follow product-specific instructions under clinical supervision.

How to choose your starting dose

Define a target and baseline. For lipids, get a fasting panel; for angina, track frequency and nitrate use; for exercise tolerance, use a simple walk test or time-to-symptoms log.
Select a single, reputable product. Look for standardization (e.g., declared salvianolic acids/tanshinones), batch testing, and transparent labeling.
Start low and titrate. For extracts, begin at 400 mg/day with food for 1–2 weeks. If well-tolerated and you’re aiming for cardiometabolic support, consider increasing to 600–800 mg/day.
Trial period. Re-check your target after 8–12 weeks. If there’s no measurable benefit, discontinue or reassess with your clinician.
Cycle and reassess. Even with benefit, take stock every 3–6 months to ensure continued value and safety.

Timing and co-administration tips

With meals can reduce stomach upset and smooth absorption.
Separate from other supplements/meds with narrow therapeutic windows by at least 2–3 hours (conservative spacing; not a guarantee against interactions).
Avoid combining with other “blood-thinning” botanicals unless supervised (e.g., ginkgo, garlic, high-dose ginger).

Special populations

Older adults / polypharmacy: Start low, monitor blood pressure, bruising, and any changes in energy or dizziness.
Menstrual considerations: Danshen’s “blood-moving” tradition and antiplatelet tendencies suggest avoiding use during heavy menses if you’re prone to anemia or significant bleeding.
Pre-procedure: Stop Danshen well in advance of surgeries or invasive dental work (see safety section).

Safety, side effects, and interactions

Common tolerability
Most people tolerate oral Danshen without major issues at standard doses. Mild gastrointestinal upset, dry mouth, or dizziness can occur—often resolving by taking with food and adequate hydration.

When to avoid or use only with clinician oversight

If you take anticoagulants or antiplatelets. Danshen can potentiate warfarin and may enhance bleeding tendencies with other blood thinners. Serious over-anticoagulation has been reported when Danshen was combined with warfarin. Newer research with specific compound products shows mixed interaction findings and even genotype-dependent effects, but the conservative rule is to avoid self-directed co-use and, if medically necessary, to monitor INR and clinical signs closely under supervision.
Before surgery or dental procedures. Because of antiplatelet/anticoagulant effects, discontinue Danshen well ahead of procedures—at least 1–2 weeks is a common precaution—after coordinating with your surgeon and prescribing clinician.
If you’re pregnant or breastfeeding. There’s insufficient safety data, and theoretical uterotonic/blood-moving effects argue against use.
If you have active bleeding, bleeding disorders, or low platelets. Avoid unless a specialist directs otherwise.
If you’re on multiple medications metabolized by CYP enzymes (e.g., CYP2C9, CYP3A4). Tanshinones may alter drug metabolism; interact with your pharmacist or clinician to screen for specific risks.

Red flags: stop and seek care

Unexpected bruising, nosebleeds, black/tarry stools, or bleeding gums.
Marked dizziness or syncope, especially if you take blood-pressure medications.
Allergic reactions (hives, wheeze, facial swelling).

Quality and contamination risks

Choose brands with third-party testing. As with many botanicals, the market includes products with inconsistent actives; poor standardization can mean under- or over-dosing relative to what labels claim.

Practical interaction management (if a clinician OKs co-use)

Document baseline INR (if on warfarin) and re-check 3–5 days after starting, after any dose change, and after stopping.
Keep a symptom diary for bruising/bleeding, blood pressure changes, headaches, or chest discomfort.
Avoid stacking with other platelet-active supplements (e.g., high-dose fish oil, ginkgo) unless medically indicated.

Evidence in context: what studies show

Add-on lipid benefits are the current bright spot. A 2024 meta-analysis reported that Danshen therapies—often as add-ons to statins—improved LDL-C, triglycerides, and HDL-C relative to standard care. Most trials were Chinese, short- to medium-term, and used proprietary pills or capsules rather than off-the-shelf Western supplements. The mechanistic plausibility is strong (antioxidant, anti-inflammatory, endothelial, and platelet pathways), but effect sizes and durability across diverse populations remain to be clarified.

Monotherapy is hit-or-miss. When a high-dose aqueous extract equivalent to ~15 g/day of crude root was tested for four weeks in Western participants, it didn’t improve LDL, blood pressure, endothelial function, or inflammatory markers. Negative results like this are valuable—they help set realistic expectations and emphasize the importance of extract type and phytochemical profile.

Cardiovascular symptoms: Trials of compound formulations in stable angina have frequently shown symptom improvements. Yet heterogeneity and risk-of-bias caution against over-generalization. If you’re considering proprietary Chinese products, involve a clinician familiar with these formulations.

Safety and interactions are the other through-line. Case reports and a classic review highlight clinically meaningful potentiation of warfarin with Danshen. Newer clinical work with compound products suggests the interaction may be modest in healthy volunteers and influenced by genetics (e.g., EPHX1 variants). Real-world patients are more complex than volunteers, so the safest approach is to avoid unsupervised co-use and to monitor diligently if combined under medical direction.

Bottom line for consumers and clinicians

Consider Danshen only as an adjunct, with clear goals and timelines.
Pick a standardized product and a measurable outcome (lipids, symptoms).
Build a monitoring plan for safety if you take any medication that affects bleeding or is metabolized by CYP enzymes.
Reassess at 8–12 weeks to determine whether continued use makes sense.

References

Disclaimer

This article is informational and does not replace personalized medical advice, diagnosis, or treatment. Danshen can interact with prescription medicines—including anticoagulants and antiplatelets—and may not be appropriate for everyone. Always consult a qualified healthcare professional before starting, stopping, or combining supplements with medications, and before any medical or dental procedure.

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