Dan Shen (Salvia root): dose, uses, and drug interactions
Dan Shen, the root of Salvia miltiorrhiza (Salviae miltiorrhizae Radix), is the principal herb of Chinese medicine for invigorating the Blood and dispelling stasis without adding warmth. It is bitter and slightly cold, enters the Heart, Pericardium, and Liver channels, and does three things at once: it moves the Blood and breaks up stasis, it clears heat from the Blood and settles restlessness, and it nourishes the Blood and calms the Shen, the spirit housed in the Heart. The classical dose in decoction is 5 to 15 grams. Dan Shen potentiates warfarin and the other anticoagulant and antiplatelet drugs; taken alongside them it raises the INR and the tendency to bleed, and the combination is either avoided or the anticoagulant is monitored closely.
Nature, flavour, and actions
The Shennong Bencao Jing places Dan Shen in its upper class. The name means cinnabar root, for the deep red of the dried root, and the tradition reads the colour as the signature of the herb's affinity: red enters the Heart and the Blood. An old saying holds that the single herb Dan Shen does the work of the whole of Si Wu Tang, the four-substance decoction that nourishes and moves the Blood. The saying overstates the nourishing and understates the moving, but it fixes the herb's place: a Blood herb that treats both the stasis and the deficiency that stasis breeds.
Its actions, as the modern materia medica orders them:
- Invigorates the Blood, dispels stasis, unblocks the channels: chest and cardiac pain from stasis (xiong bi), painful menstruation, amenorrhoea from stasis, postpartum abdominal pain, fixed stabbing pain anywhere, abdominal masses, and the pain and swelling of injury.
- Clears heat and cools the Blood: warm disease in which heat has entered the nutritive level (ying fen), with restlessness, night agitation, and rashes; sores and abscesses with heat and stasis.
- Nourishes the Blood and calms the Shen: palpitations, insomnia, and restlessness when Heart Blood is deficient and a little heat disturbs the spirit.
Because it is cold, it suits stasis with heat or with a red tongue. For stasis with cold it is paired with warming movers such as Gui Zhi, cinnamon twig, or Tan Xiang, sandalwood, which is exactly what its most famous formula does.
Dose and preparation
| Form | Use | Dose |
|---|---|---|
| Raw root, decoction | Cooling the Blood, calming the Shen | 5 to 15 grams |
| Wine-fried (Jiu Dan Shen), decoction | Moving Blood, pain, menstrual stasis | 9 to 15 grams |
| Decoction as chief herb | Stasis-type chest pain | 15 to 30 grams in modern practice |
| Granule or tablet | By the maker's equivalence to the decoction | as stated on the preparation |
Frying with wine strengthens the moving of the Blood; the raw root is kept for cooling and calming. The compound preparations most people meet outside China combine Dan Shen with San Qi, notoginseng root, and Bing Pian, borneol, in tablets and dripping pills for chest pain; they carry the same interaction as the root.
Formulas
Dan Shen Yin, from the Qing text Shi Fang Ge Kuo, is the model of how the herb is used: Dan Shen as chief in a large dose, with Tan Xiang, sandalwood, and Sha Ren, amomum fruit, as deputies in small doses to move qi and warm the middle. It treats epigastric and chest pain in which qi and Blood are both stagnant, with a purple tongue and a wiry or choppy pulse. In Tian Wang Bu Xin Dan, the Heavenly Emperor's pill for nourishing the Heart, Dan Shen is an assistant that moves the Blood a little so that the heavy yin tonics do not congeal, and calms the Shen. In modern hospital practice it is the herb of Blood stasis in the chest and the herb of the sublingual veins, dark and distended.
The pattern that calls for it is Blood stasis: fixed, stabbing, or pressing pain that is worse at night; a dark or purple tongue, or purple spots on it; distended veins under the tongue; dark clotted menstrual blood; a choppy (se) or wiry pulse. Where the tongue is pale and the pulse thin and there is no stasis, the herb is not the answer, and the Blood is nourished first.
Cautions inside the tradition
Dan Shen is one of the seven herbs incompatible with Li Lu, Veratrum, under the eighteen incompatibilities, and the two are never written in one prescription. As a Blood-moving herb it is used with caution in pregnancy and not at all in threatened miscarriage. It is withheld where there is active bleeding without stasis and in any person whose only pattern is deficiency. Salvia miltiorrhiza is a sage, cousin to the garden sage of Western herbalism, but the two plants are not interchangeable in either tradition.
Not medical advice.