Do You Know the History of Sage?

History and Cultural Significance

The genus name Salvia derives from the Latin salvere, meaning “to save,” perhaps referring the healing properties of plants in this genus.3,12 Salvia officinalis was used medicinally by ancient societies in Greece, Egypt, and Rome.3 Traditionally, it was employed to increase fertility, stop bleeding, heal minor skin wounds, treat hoarseness or cough, and improve memory function.3 The English herbalist John Gerard (1545-1607) claimed that sage (usually a tea made from the leaves) was good for the head, brain, and memory,13 and the physician/herbalist Nicholas Culpeper (1616-1654) also thought that it improved memory.14

In India, sage leaves were also used to treat intestinal gas, upset stomach, and infections of the mouth, nose, and throat.3 Historically, sage has been used to promote regularity in a woman’s menstrual cycle and to decrease breast milk production to facilitate weaning.1,2 Since ancient times in most Mediterranean countries, sage has been popular as a culinary herb for its powerful and intense flavor, especially in meat and poultry dishes.12

Current uses of sage include the following: indigestion, treatment of inflammation of the mouth and throat, and excessive sweating, including that associated with peri-menopause; relief of pressure spots that result from the use of a prosthesis; and as a flavoring for food.1-3,11-12,15 Sage oil has also been employed as a fragrance in soaps and perfumes.1,3

In 1985, the German Commission E approved the use of sage internally for dyspepsia (upset stomach or indigestion) and excessive perspiration, and externally for inflammation of the nose and throat.3 One of the constituents of sage, salvin (a phenolic acid), has antimicrobial effects against Staphylococcus aureus,1 a common bacteria responsible for skin and upper-respiratory tract infections. Sage has also shown strong antioxidant properties.1,2 The German Standard License for sage leaf infusion indicates its use for inflammation of the gums and the mucous membranes of the mouth and throat, for pressure spots caused by prostheses, and in supportive treatment of gastrointestinal catarrh (inflammation of the mucous membranes).2

In 2009, the European Medicines Agency (EMA) published a final monograph which supersedes monographs of EU national authorities (including the German monographs) for the registration of traditional herbal medicinal products in the European Community that contain sage as an active ingredient.16 Traditional uses approved for sage leaf (dry extract, herbal tea, liquid extract and tincture) are (a) for symptomatic treatment of mild dyspeptic complaints such as heartburn and bloating; (b) for relief of excessive sweating; (c) for the symptomatic treatment of inflammations in the mouth and throat; and (d) for relief of minor skin inflammations.10 A prerequisite of registration is that the quality complies with the corresponding quality standards monographs of the European Pharmacopoeia (e.g., Sage Leaf PhEur or Sage Tincture PhEur). Concerning sage essential oil, the EMA has concluded that the risks do not outweigh the benefits; thus, a European Community herbal monograph will not be developed until new evidence of clinical safety and efficacy become available.17

In the United States, sage leaf is regulated as a food ingredient and as a dietary supplement component. Sage leaf is listed as GRAS (Generally Recognized as Safe) for use as a spice, seasoning, or natural flavor,18 while sage essential oil is a GRAS flavoring agent.19 For use of the essential oil as a flavoring, a quality standards monograph for “Dalmatian Type Sage Oil” is published by the United States Pharmacopeia Convention in the Food Chemicals Codex.20 For therapeutic use, as part of the US Food and Drug Administration's (FDA) ongoing review of over-thecounter (OTC) drug products, the Dental Plaque Subcommittee of the Nonprescription Drugs Advisory Committee recently evaluated the safety and efficacy of sage oil combined with peppermint oil (Mentha x piperita, Lamiaceae). While the Subcommittee concluded that sage oil is safe for the intended use, they also concluded that there are insufficient data from controlled studies to permit final classification of the effectiveness of combined peppermint and sage oils as OTC active ingredients for the reduction of plaque and gingivitis.21

Continued tomorrow

References

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3. Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Austin, TX: American Botanical Council; Newton, MA: Integrative Medicine Communications; 2000.
4. Foster S. Medicinal plants of Montenegro. HerbalGram. 2006;72:48-54.
5. European Herb Growers Association. Production of medicinal and aromatic plants in Europe. Status 2010. Available at: www.europam.net/ index.php?option=com_content&view=article&id=6:inventory-production-of-mapsq&catid=8:inventory-production-of-mapsq&Itemid=11. Accessed January 17. 2011.
6. Kathe W, Honnef S, Heym A. Medicinal and Aromatic Plants in Albania, Bosnia-Herzegovina, Bulgaria, Croatia and Romania: A study of the collection of and trade in medicinal and aromatic plants (MAPs), relevant legislation and the potential of MAP use for financing nature conservation and protected areas. Bonn, Germany: German Federal Agency for Nature Conservation. 2003. Available at: www.bfn.de/fileadmin/MDB/documents/skript91.pdf. Accessed January 17, 2011.
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8. Baricevic D, Bernáth J, Maggioni L, Lipman E, compilers. ECPGR Report of a working group on medicinal and aromatic plants: First Meeting, 12-14 September 2002, Gozd Martuljek, Slovenia. 2004. Available at: www.bioversityinternational.org/fileadmin/bioversity/publications/ pdfs/984.pdf?cache=1295290021. Accessed January 17, 2001.
9. Censkowsky U, Helberg U, Nowack A, Steidle M. Overview of Word Production and Marketing of Organic Wild Collected Products. Geneva, Switzerland: International Trade Centre UNCTAD / WTO. 2007. Available at: www.intracen.org/organics/documents/Overview_World_ Production_Marketing_Organic_Wild_Collected_Products.pdf. Accessed January 17, 2011.
10. Donnelly R, Helberg U, in cooperation with Flora and Fauna International, UK, and Pecanac D. Balkans Herbal Development Initiative — Phase 1. Final Summary Report — Bosnia and Herzegovina. Environmental and Social Assessment, Economic & Activity Mapping, Export potential of Balkan Herbs to the European Union. Prepared for Southeast Europe Enterprise Development (SEED) and The Corporate Citizenship Facility (CCF). 2003. Available at: www.ifc.org/ifcext/enviro.nsf/AttachmentsByTitle/art_CCF-HDISerbMont/$FILE/HDI+Report+Serbia+and+Mo ntenegro.pdf. Accessed January 17, 2011.
11. Houghton PJ. Activity and constituents of sage relevant to the potential treatment of symptoms of Alzheimer’s disease. HerbalGram. 2004;61:38
12. Katzer G. Sage Gernot Katzer’s Spice Pages.1999. Available at: www.unigraz.at/~katzer/engl/Salv_off.html. Accessed April 4, 2005.
13. Woodward M, ed. Gerard’s Herbal: The History of Plants. London: Senate; 1994.
14. Culpeper N. Culpeper’s Complete Herbal. London; Bloomsbury Books; 1992.
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16. European Pharmacopoeia Commission. Sage Leaf; Sage Tincture. In: European Pharmacopoeia, Seventh Edition (PhEur 7.0). Strasbourg, France: European Directorate for the Quality of Medicines. 2010; 12301232.
17. European Medicines Agency (EMEA). Public statement on Salvia officinalis L., aetheroleum. London, UK: European Medicines Agency. July 15, 2010. Available at: www.ema.europa.eu/docs/en_GB/document_library/Public_statement/2010/10/WC500098002.pdf. Accessed January 17, 2011.
18. United States Food and Drug Administration (FDA). 21 CFR Part 582.10. Substances Generally Recognized as Safe. Washington, DC: National Archives and Records Administration; 2010. Available at: www. gpo.gov/fdsys/pkg/CFR-2010-title21-vol6/pdf/CFR-2010-title21-vol6sec582-10.pdf. Accessed January 18, 2010.
19. United States Food and Drug Administration (FDA). 21 CFR Part 582.20. Substances Generally Recognized as Safe. Washington, DC: National Archives and Records Administration; 2010. Available at: www. gpo.gov/fdsys/pkg/CFR-2010-title21-vol6/pdf/CFR-2010-title21-vol6sec582-20.pdf. Accessed January 18, 2011.
20. United States Pharmacopeial Convention. Dalmatian Type Sage Oil. In: Food Chemicals Codex 7th Edition. Rockville, MD: United States Pharmacopeial Convention. 2011;900-901.
21. United States Food and Drug Administration (FDA). 21 CFR Part 356. Oral Health Care Drug Products for Over-the-Counter Human Use; Antigingivitis/Antiplaque Drug Products; Establishment of a Monograph. Federal Register. May 29, 2003;68(103);32232-32287. Available at: www.gpo.gov/fdsys/pkg/FR-2003-05-29/pdf/03-12783.pdf.

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