Salvia Officinalis a Literature Review Introduction and History of Use

Salvia officinalis, or sage, is also called garden sage or common sage. It is a perennial, evergreen shrub (Clebsch & Barner, 2003). The leaves are grayish in color, and the flowers are purple or blue (Watters, 1901). Stems are woody, and the plant is native to the Mediterranean (Clebsch & Barner, 2003). However, it has now been naturalized in a number of places throughout the world. Its history is long, mostly detailing both culinary and medicinal uses. Modern times have also seen its popularity rise as an ornamental garden plant (Kintzios, 2000). There are many other species that also carry the common name "sage." Some are related and some are not. Sage was first described in 1753 by Carl Linnaeus, and has been grown for centuries (Sutton, 2004). Its healing properties are impressive, and it is also used in the preparation of many different foods. In some of the older writings, the healing that was attributed to the plant was nearly miraculous in nature. Other scientific names have also been used for the plant, including six different ones since 1940 (Kintzios, 2000).

Since ancient times, Salvia officinalis has been used for warding off evil, increasing fertility in women, and treating snakebites, as well as other medicinal issues (Kintzios, 2000). The Romans used the plant as a treatment to stop excessive bleeding (Sutton, 2004). They also used it as a diuretic and a local anesthetic for the skin (Sutton, 2004). During the Middle Ages, many people referred to it as S. salvatrix, meaning sage the savior (Clebsch & Barner, 2003). The Four Thieves Vinegar -- a blend of herbs that was designed to ward off the plague -- also contained the plant (Kintzios, 2000). The recommendations that the plant should be used for nearly everything medicinal led to its widespread use all around the world through many different time periods. Each group of people who became interested in the plant used it for ailments they had been taught about, but also for other concerns they had, to see if it would benefit them in some way. They often got results, and so the list of ailments sage would treat got longer and longer throughout history.

Figure 1: The flowers of the Salvia officinalis plant. Copyright © 2004, Kurt Stuber.

Evidence Base for Main Use -- Essential Oil and Folk Medicine

The main use of Salvia officinalis is growth for distillation of essential oil (Kintzios, 2000). Throughout many parts of Europe, common sage is grown for that reason. It is believed that the essential oil can then be used to treat many common ailments, so it is important to have it available to those who want and need it. Whether it can actually cure specific diseases is something the medical community is still studying, because the plant has such a long and recorded history of having an effect on the health and well-being of people who used it when they were ill or needed treatment for a disease or injury. The idea of using sage spread through a number of countries and cultures, all with the same message that it could help with a large number of ailments and had properties that set it apart from many other herbs. For example, the Austrians used Salvia officinalis for problems with the skin, gastrointestinal tract, respiratory tract, and mouth (Sutton, 2004).

Figure 2: Painting from Koehler's Medicinal Plants (1887). Copyright © 1897, Franz Eugen Kohler, Kohler's Medizinal-Pflanzen.

First Additional Use -- Culinary

Another common use for Salvia officinalis is in the culinary arts. The British have listed sage as an "essential herb" for generations, and it is highly popular in many European cuisines (Clebsch & Barner, 2003). Italian, Middle Eastern, and Balkan cookery use sage quite often for its slightly peppery and savory flavor (Kintzios, 2000). American and British cooks often use the plant as part of the seasoning for stuffing when they have a turkey or chicken, and it is commonly used at Thanksgiving and Christmas (Kintzios, 2000). Sage Derby cheese, Lincolnshire sausages, and pork casserole are other popular uses for sage (Kintzios, 2000). The one place one would expect to see sage would be in French cooking, due to the frequent use of herbs in that style of cuisine. However, sage never caught on there, and it is rarely used in French dishes (Clebsch & Barner, 2003).

Second Additional Use -- Modern Medicine

The folk medicine of generations ago and the modern medicine of today are very different, but they have one thing in common. They both indicate that...

There is evidence using modern scientific testing that indicates sage may work as an anti-sweating agent, as well as a tonic, an astringent, an antifungal, an antibiotic, and an antispasmodic (Akhondazdeh, et al., 2003). It may also have value for those who are hypoglycemic, people with hyperlipidemia, and menopausal women whose bodies are not producing enough estrogen any longer (Perry, 1998; Vogl, et al., 2013). One of the biggest breakthroughs, however, is the indication that Salvia officinalis may have benefit for those with mild to moderate Alzheimer's disease (Akhondazdeh, et al., 2003; Dos Santos-Neto, et al., 2006; Iuvone, et al., 2006; Kianbakht, et al., 2011). The studies are still in their early stages, but they were double-blind and placebo controlled, so there is a possibility that sage could be used in the future to slow down or even prevent the problems that come with Alzheimer's disease and other forms of dementia. With many people struggling with such a debilitating disease, finding ways to treat it would be highly valuable to the scientific community.
Standardization and Identification of Active Constituents

The essential oil of Salvia officinalis contains the strongest active constituents, which provides the most benefit for those who are looking for medicinal value from the plant. These have been identified as:

Cineole -- also known as eucalyptol, and toxic if ingested at too high of a dosage.

Borneol -- a bicyclic organic compound and a natural repellent against insects.

Thujone -- a ketone and a monoterpene with a menthol odor, also found in absinthe (Kintzios, 2000).

There are also many constituents in the sage leaves, including Fumaric Acid, Cornsolic Acid, Cornsole, Ursonic Acid, Ursolic Acid, Tannic Acid, Oleic Acid, Niacin, Caffeic Acid, Flavones, Flavonoid Glycosides, Nicotinamide, Chlorogenic Acid, and Estrogenic substances (Sutton, 2004). With such a number of different compounds found in the leaves and other areas of the plant, it is not surprising that there are many medicinal properties to sage. Each one of the constituents has its own properties, and can also be found in other plants. However, it is most likely the combination of compounds and not an individual one that lends so much value to Salvia officinalis. Without the way the compounds work together, the medicinal properties might not be possible.

This is also true for the flavors created when sage is used in cooking, because the compounds all break down differently and provide different subtleties. Whether a person is using the plant for culinary or medicinal purposes (or both), it is clear that what makes up sage has been addressed and cataloged. That can help those who want to use the plant find better ways to do so. It is possible that the future will bring new and better uses for the plant, as well, because there is more information being discovered about it each and every day. The more science learns about sage, the more interesting the plant becomes and the more it has to offer to those who seek its properties.

Figure 3: Sage essential oil, which contains its strongest active constituents. Copyright © 2009, Itineranttrader, Wikimedia Commons.

Effect of Standardization and Identification on Use

The standardization and identification of Salvia officinalis, or sage, has had an effect on its use in modern medicine (Clebsch & Barner, 2003). During ancient times, the only issue was to identify that the right plant was being grown or picked, in order to avoid poisoning someone who was supposed to receive a treatment for an illness or injury (Sutton, 2004). Now, the issue is much more scientific in nature. The goal is to understand the plant and what it has to offer (Sutton, 2004). The more analysis that can be done on sage, the more its medicinal properties can be addressed. In that sense, making it more standard as a medicine and as a seasoning in the culinary world removes a lot of the stigma that comes with herbal or alternative medicine (Sutton, 2004).

That can be very valuable, since many alternative medicines are downplayed and even ignored or laughed at by the medical community. That is not the case with sage, because its properties have been well documented for such a long period of time. Standardization only adds to the value of what sage will have to offer for people in the future, especially when it comes to medical treatment (Kintzios, 2000). For those who focus on sage from the standpoint of its culinary usage, there are not really any new uses for the plant. It is,…