FWD 2 Expanded Commission E: Sage leaf

Herbal Medicine: Expanded Commission E

Sage leaf

Latin Name: Salvia officinalis
Pharmacopeial Name: Salviae folium
Other Names: broad-leafed sage, common sage, Dalmatian sage, garden sage, true sage


Sage is an evergreen perennial subshrub, native to the Mediterranean rim, especially around the Adriatic Sea, now cultivated in Albania, Turkey, Greece, Italy, France, the United Kingdom, and the United States (Bruneton, 1995; Budavari, 1996; Leung and Foster, 1996; Wichtl and Bisset, 1994). The material of commerce comes mainly from southeastern European countries, such as Albania and the former Yugoslavia (BHP,1996; Wichtl and Bisset, 1994). Its cultivation in northern Europe dates back to medieval times, and it was introduced to North America during the seventeenth century (Bown, 1995). The genus name Salvia is derived from the Latin salvere (to be saved), in reference to its curative properties. This name was corrupted to sauge in French and sawge in Old English, and eventually to 'sage' (Grieve, 1979).

This species was used in ancient Egyptian, Greek, and Roman medicines. Ancient Egyptians used it as a fertility drug (Bown, 1995). In the first century C.E. Greek physician Dioscorides reported that the aqueous decoction of sage stopped bleeding of wounds and cleaned ulcers and sores. He also recommended sage juice in warm water for hoarseness and cough. Pliny the Elder (ca. 2379 C.E.) reported that sage enhanced memory functions. He prescribed decoctions, boiled in water or wine, of sage, rosemary, honeysuckle, plantain, and honey for gargles to treat sore mouths and throats (Grieve, 1979). Its uses in traditional Greek medicine spread to India, where the dried leaf (Salbia-sefakuss in Hindi) and fluid extract are used in traditional Indian Ayurvedic, Siddha, and Unani medicines. Eight other related Indian species of Salvia (e.g., S. plebeia) are also listed in the Ayurvedic Pharmacopoeia and used interchangeably with the Mediterranean species. In India, its use is indicated for flatulent dyspepsia, pharyngitis, uvulitis, stomatitis, gingivitis, and glossitis (Karnick, 1994; Nadkarni, 1976).

In Germany, sage is licensed as a standard medicinal tea to treat gastrointestinal catarrh and night sweats. The tea is also applied topically as a rinse or gargle for inflammations. Sage fluidextract, tincture, and essential oil are all used in prepared medicines for mouth and throat and as gastrointestinal remedies in fluid (e.g., juice) and solid dosage forms (e.g., capsules, dragées) (Leung and Foster, 1996; Wichtl and Bisset, 1994). In the United States, sage is used as a component of dietary supplement products for similar conditions, usually in aqueous infusion or alcoholic tincture dosage forms. Sometimes the dry herb or dry extract is used in capsules and tablets. Sage was formerly official in the United States Pharmacopoeia from 1840 to 1900 as a gargle in inflamed sore throat (Boyle, 1991).

Very few clinical studies have been conducted. A few German studies have investigated its perspiration-inhibiting activity (ESCOP, 1997). One open study at an outpatient clinic investigated the equivalence of efficacy and compared tolerance between an aqueous dry extract product 'Sweatosan' and sage tea. Eighty patients suffering from idiopathic hyperhidrosis were treated for four weeks. Forty patients were treated with 440 mg aqueous dry extract, corresponding to 2.6 g of dry leaf, and the other 40 with an aqueous infusion, 4.5 g leaf daily. The reduction of sweat secretion reported (less than 50%) was comparable for both treatment groups, though somewhat stronger in the aqueous dry extract group (ESCOP, 1997; Rsing, 1989).

In 1997, the National Institute of Medical Herbalists in the United Kingdom sent out a questionnaire to its member practitioners on the clinical use and experience of sage. Of 49 respondents, 47 used sage in their practice and 45 used it particularly in prescriptions for menopause. Almost all references were to sage's application for hot flashes, night sweats, and its estrogenic effect. The age range of the menopause patients was 40 to 64, with an average of 49.76. Three-quarters were aged 47 to 52. Forty-three practitioners also noted its use in infections, mainly of the upper respiratory tract, 29 reported its use in sore throat, and 15 reported its use in mouth and gum disease, taken in the form of gargles and mouthwashes. Another main area emphasized by the respondents was its use as a general tonic, for fatigue, nervous exhaustion, immune system depletion, and poor memory and concentration, at any age. Dosage form preference was also reported. Sage was prescribed as tea (aqueous infusion) by 37 practitioners, alcoholic tincture by 30, fresh tincture by 14, alcoholic fluidextract by 2, fresh juice by 2, and fresh leaf by 1 (Beatty and Denham, 1998).

The approved modern therapeutic applications for sage leaf are supportable based on its history of use in well established systems of traditional medicine,on clinical data collection from medical herbalists in current practice, on phytochemical investigations, on in vitro and in vivo pharmacological studies in animals, and on some clinical studies.

Pharmacopeial grade sage leaf must contain not less than 1.5% (v/m) thujone-rich volatile oil calculated with reference to the anhydrous drug as determined by DAB (German Pharmacopoeia) method V.4.5.8 (DAB, 1997; ESCOP, 1997; AB, 1981; Ph.Helv.VII,1987; Wichtl and Bisset, 1994). It must contain not less than 16% water-soluble extractive, among other quantitative standards. Botanical identity requirements are carried out by thin-layer chromatography (TLC) as well as by examination of macroscopic and microscopic characteristics (BHP, 1996). Adulteration is determined with a TLC method that can be used to examine the volatile oil composition and flavonoids profile (DAB 1997; Wichtl and Bisset, 1994). The French Pharmacopoeia requires between 23% volatile oil (Bruneton, 1995; Ph.Fr.X., 1990).

Pharmacopeial grade sage tincture (Salviae Tinctura) must contain not less than 0.1% thujone-rich volatile oil. Its drug-to-extract ratio is 1:10 in ethanol 70% (v/v), manufactured by percolation according to the German Pharmacopoeia Tincture monograph. Botanical identity of the finished tincture is determined by DAB TLC method V.6.20.2 (DAB, 1997).


Sage leaf consists of the fresh or dried leaf of Salvia officinalis L. [Fam. Lamiaceae], and its preparations in effective dosage. The leaves contain at least 1.5% (v/w) thujone-rich essential oil, based on the dried herb. Principal components of the essential oil, in addition to thujone, are cineol and camphor. In addition, the leaves contain tannins, diterpene bitter principles, triterpenes, steroids, flavones, and flavonoid glycosides.

Chemistry and Pharmacology

Sage leaf contains 38% condensed catechin-type tannins (salviatannin); phenolic acids (rosmarinic, caffeic, chlorogenic, ferulic, and gallic acids); 13% flavonoids (apigenin and luteolin derivatives); 1.52.8% volatile oil, mostly monoterpenoids of which 1860% is a-thujone, 310% b-thujone, 4.524.5% camphor, 5.513% cineole, 012% humulene, 16.5% a-pinene, 1.57% camphene, 0.53% limonene, max. 1% linalool, and max. 2.5% bornyl acetate; diterpenoid bitter principles carnosol, carnosic acid, and rosmanol; triterpenoids oleanolic acid and ursolic acid; and resin (Bruneton, 1995; Budavari, 1996; ESCOP, 1997; Leung and Foster, 1996; Newall et al., 1996; Wichtl and Bisset, 1994).

The Commission E reported antibacterial, fungistatic, virustatic, astringent, secretion-promoting, and perspiration-inhibiting properties.

In an open study with 80 patients both an aqueous infusion and a dried aqueous extract comparably reduced sweat secretion (ESCOP, 1997). The Merck Index reported its therapeutic category as antisecretory agent (Budavari, 1996). Its volatile oil has antimicrobial activity attributed to its thujone content. Its traditional uses may be explained by its volatile oil and tannin content (Jalsenjak et al., 1987; Newall et al., 1996).


The Commission E approved the internal use of sage leaf for dyspeptic symptoms and excessive perspiration, and external use for inflammations of the mucous membranes of nose and throat.

ESCOP indicates its use for inflammations such as stomatitis, gingivitis and pharyngitis, and hyperhidrosis (ESCOP, 1997). The German Standard License for sage infusion indicates its use for inflammation of the gums and the mucous membranes of the mouth and throat; pressure spots caused by prostheses and in supportive treatment of gastrointestinal catarrh (Wichtl and Bisset, 1984).


The pure essential oil and alcoholic extracts should not be used internally during pregnancy.

Side Effects

After prolonged ingestion of alcohol extracts or of the pure essential oil, epileptiform convulsions can occur.

Use During Pregnancy and Lactation

Not recommended (McGuffin et al., 1997).

Interactions with Other Drugs

None known.

Dosage and Administration

Unless otherwise prescribed: 4-6 g per day of cut leaf for infusions, alcoholic extracts, and distillates for gargles, rinses and other topical applications, and for internal use. Also pressed juice of fresh plants.


Dried leaf: 1-3 g, three times daily.

Infusion: 1-3 g in 150 ml water, three times daily.

Dry aqueous extract 5.5:1 (w/w): 0.18-0.36 g, three times daily.

Fluidextract 1:1 (g/ml): 1-3 ml, three times daily.

Fluidextract: 1.5-3 g (Erg.B.6).

Tincture 1:10 (g/ml): 2.5-7.5 g (Erg.B.6).

Essential oil: 0.1-0.3 ml.

Succus: Pressed juice of fresh plant in 25% alcoholic preservation.


Gargle or rinse: Use warm infusion: 2.5 g cut leaf in 100 ml water; or 2 to 3 drops of essential oil in 100 ml water; or use 5 ml of fluidextract diluted in 1 glass water, several times daily.

Paint: Apply the undiluted alcoholic fluidextract to the affected area with a brush or swab.


Beatty, C. and A. Denham. 1998. Review of Practice: Preliminary data collection for clinical audit. Eur J Herbal Med 4(2):32-34.

Bown, D. 1995. Encyclopedia of Herbs and Their Uses. New York: DK Publishing, Inc. 346.

Boyle, W. 1991. Official Herbs: Botanical Substances in the United States Pharmacopoeias 1820-1990. East Palestine, OH: Buckeye Naturopathic Press.

British Herbal Pharmacopoeia (BHP). 1996. Exeter, U.K.: British Herbal Medicine Association. 164.

Bruneton, J. 1995. Pharmacognosy, Phytochemistry, Medicinal Plants. Paris: Lavoisier Publishing.

Budavari, S. (ed.). 1996. The Merck Index: An Encyclopedia of Chemicals, Drugs, and Biologicals, 12th ed. Whitehouse Station, N.J.: Merck & Co, Inc.

Deutsches Arzneibuch (DAB 1997). 1997. Stuttgart: Deutscher Apotheker Verlag.

Ergänzungsbuch zum Deutschen Arzneibuch, 6th ed. (Erg.B.6). 1953. Stuttgart: Deutscher Apotheker Verlag.

ESCOP. 1997. 'Salviae folium.' Monographs on the Medicinal Uses of Plant Drugs. Exeter, U.K.: European Scientific Cooperative on Phytotherapy.

Grieve, M. 1979. A Modern Herbal. New York: Dover Publications, Inc.

Jalsenjak, V., S. Peljnjak, D. Kustrak. 1987. Microcapsules of sage oil: Essential oils content and antimicrobial activity. Pharmazie 42(6):419-420.

Karnick, C.R. 1994. Pharmacopoeial Standards of Herbal Plants, Vols. 12. Delhi: Sri Satguru Publications. Vol. 1:324325; Vol. 2:114.

Leung, A.Y. and S. Foster. 1996. Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics, 2nd ed. New York: John Wiley & Sons, Inc.

McGuffin, M., C. Hobbs, R. Upton, A. Goldberg. 1997. American Herbal Product Association's Botanical Safety Handbook. Boca Raton: CRC Press.

Nadkarni, K.M. 1976. Indian Materia Medica. Bombay: Popular Prakashan. 1094-1095.

Newall, C.A., L.A. Anderson, J.D. Phillipson. 1996. Herbal Medicines: A Guide for Health-Care Professionals. London: The Pharmaceutical Press.

Österreichisches Arzneibuch, 1st suppl. (ÖAB). 19811983. Wien: Verlag der Österreichischen Staatsdruckerei.

Pharmacopée Française Xe Édition (Ph.Fr.X.). 19831990. Moulins-les-Metz: Maisonneuve S.A.

Pharmacopoeia Helvetica, 7th ed. Vol. 14.(Ph.Helv.VII). 1987. Bern: Office Central Fédéral des Imprimés et du Matériel.

Rösing, S. 1989. Sweatosan-Studie: Untersuchungsbericht. Äquivalenz der Wirksamkeit und Vergleich der Vertrglichkeit von Sweatosan und Salbeitee bei Patienten mit idiopathischer Hyperhidrosis in der dermatologischen Poliklinik. Zyma (unpublished).

Wichtl, M. and N.G. Bisset (eds.). 1994. Herbal Drugs and Phytopharmaceuticals. Stuttgart: Medpharm Scientific Publishers.

Additional Resources

Braun, R. et al. 1997. Standardzulassungen für FertigarzneimittelText and Kommentar. Stuttgart: Deutscher Apotheker Verlag.

Brieskorn, C.H. 1991. Salbeiseine Inhaltsstoffe und sein therapeutischer Wert. Z Phytotherapie 12:61-69.

British Pharmaceutical Codex (BPC). 1934. London: The Pharmaceutical Press.

Council of Europe. 1989. Plant Preparations Used as Ingredients of Cosmetic Products, 1st ed. Strasbourg: Council of Europe.

Derbentseva, N.A, S.A. Matveenko, TIa. Omelchuk. 1965. Antymikrobna aktyvnist' preparativ z deiakykh vydiv shavlii [Antimicrobic activity of preparations from some sage species]. Mikrobiol Zh 27(3):76-80.

Food Chemicals Codex, 2nd ed.(FCC II).1972. Washington, D.C.: National Academy of Sciences.

Hartke, K., H. Hartke, E. Mutschler, G. Rücker, M. Wichtl (eds.). DAB 10Kommentar. Stuttgart: Wissenschaftliche Verlagsgesellschaft.

Marchenko, A.I., V.N. Pinchuk, I.V. Shvets. 1978. Primenenie mazi iz shalfeia pri lechenii treshchin guby [Use of a sage ointment in treating cracked lips]. Stomatologiia (Mosk) 57(1):86-87.

Reynolds, J.E.F. (ed.). 1993. Martindale: The Extra Pharmacopoeia, 30th ed. London: The Pharmaceutical Press.

Steinegger, E. and R. Hänsel. 1992. Pharmakognosie, 5th ed. Heidelberg: Springer Verlag. 343-345.

Taddei, I., D. Giachetti, E. Taddei, P. Mantovani, E. Bianchi. 1988. Spasmolytic activity of peppermint, sage and rosemary essences and their major constituents. Fitoterapia 59:463-468.

Takacsova, M., A. Pribela, M. Faktorova. 1995. Study of the antioxidative effects of thyme, sage, juniper and oregano. Nahrung 39(3):241243.

Todorov, S. et al. 1984. Experimental pharmacological study of three species from genus Salvia. Acta Physiol Pharmacol Bulg 10(2):13-20.

Tucakov, J. and M. Mihajlov. 1977. Prilog uporednom farmakognozijskom proucavanju pelima (Salvia officinalis L.) U Pastrovicima [Comparative pharmacognostic studies on sage officinalis (Salvia officinalis L.) of Pastrovici]. Glas Srp Akad Nauka [Med] (27):47-60.

Tucker, A.O. et al. 1980. Botanical aspects of commercial sage. Economic Bot 34:16-19.

Van Hellemont, J. 1988. Fytotherapeutisch Compendium, 2nd ed. Utrecht: Bohn, Scheltema & Holkema. 539-541.

Vion Dury, J., M.D. Steinmetz, G. Jadot, Y. Millet. 1986. Effets de l'essence de sauge sur le seuil epileptogene et l'embrasement amygdalien chez le rat. Rapport preliminaire [Effects of sage essence on the epileptogenic threshold and amygdaloid body in the rat. Preliminary report] J Toxicol Clin Exp 6(1):29-31.

Weiss, R.F. 1991. Lehrbuch der Phytotherapie, 7th ed. Stuttgart: Hippokrates Verlag. 296-297.

Wichtl, M. (ed.). 1997. Teedrogen, 4th ed. Stuttgart: Wissenschaftliche Verlagsgesellschaft. 416-419.

This material was adapted from The Complete German Commission E MonographsTherapeutic Guide to Herbal Medicines. M. Blumenthal, W.R. Busse, A. Goldberg, J. Gruenwald, T. Hall, C.W. Riggins, R.S. Rister (eds.) S. Klein and R.S. Rister (trans.). 1998. Austin: American Botanical Council; Boston: Integrative Medicine Communications.

1) The Overview section is new information.

2) Description, Chemistry and Pharmacology, Uses, Contraindications, Side Effects, Interactions with Other Drugs, and Dosage sections have been drawn from the original work. Additional information has been added in some or all of these sections, as noted with references.

3) The dosage for equivalent preparations (tea infusion, fluidextract, and tincture) have been provided based on the following example:

  • Unless otherwise prescribed: 2 g per day of [powdered, crushed, cut or whole] [plant part]
  • Infusion: 2 g in 150 ml of water
  • Fluidextract 1:1 (g/ml): 2 ml
  • Tincture 1:5 (g/ml): 10 ml

4) The References and Additional Resources sections are new sections. Additional Resources are not cited in the monograph but are included for research purposes.

This monograph, published by the Commission E in 1994, was modified based on new scientific research. It contains more extensive pharmacological and therapeutic information taken directly from the Commission E.

Excerpt from Herbal Medicine: Expanded Commission E Monographs
Copyright 2000 American Botanical Council
Published by Integrative Medicine Communications
Available from the American Botanical Council.