Dan Shen

What Is Dan Shen?

Dan shen is the dried red root of Salvia miltiorrhiza, a Chinese sage and one of the principal herbs of Chinese medicine for the heart and circulation. In Chinese medicine it is a classic herb for promoting blood circulation and removing blood stasis, with about a thousand years of recorded use ^{22Reference 22Chen et al. · 2014Systematic reviewThe anticancer properties of Salvia miltiorrhiza Bunge (danshen): a systematic review — reviewView study →}.

The plant is a perennial of the mint family, native to the hills of China and neighbouring East Asia, and is now grown mainly as a field crop ^{27,29Reference 27Zhang et al. · 2012ReviewTanshinones: sources, pharmacokinetics and anti-cancer activities — reviewView study →Reference 29Li et al. · 1994Salvia miltiorrhiza Bunge — species description, habitat and distribution — floraView study →}. Its thick taproot is scarlet on the outside ^{29Reference 29Li et al. · 1994Salvia miltiorrhiza Bunge — species description, habitat and distribution — floraView study →}.

The root holds two families of compounds: orange-red, fat-soluble diterpene quinones called tanshinones, including tanshinone IIA, and water-soluble phenolic acids led by salvianolic acid B ^{22,26,27Reference 22Chen et al. · 2014Systematic reviewThe anticancer properties of Salvia miltiorrhiza Bunge (danshen): a systematic review — reviewView study →Reference 26Su et al. · 2015ReviewSalvia miltiorrhiza: traditional medicinal uses, chemistry, and pharmacology — reviewView study →Reference 27Zhang et al. · 2012ReviewTanshinones: sources, pharmacokinetics and anti-cancer activities — reviewView study →}. Hundreds of Chinese clinical trials have tested dan shen preparations for angina and other heart and circulation problems, mostly as multi-herb dripping pills or injections, and trial quality is generally low ^{1,2Reference 1Jia et al. · 2017Meta-analysisHow efficacious is danshen (Salvia miltiorrhiza) dripping pill in treating angina pectoris? Evidence assessment for meta-analysis of randomized controlled trials — meta-analysis with GRADE assessmentView study →Reference 2Luo et al. · 2015Systematic reviewCompound danshen (Salvia miltiorrhiza) dripping pill for coronary heart disease: an overview of systematic reviews — systematic reviewView study →}.

Seventeen other Salvia species, including S. przewalskii and S. yunnanensis, are traded in Chinese herbal markets as substitutes, although S. miltiorrhiza is the only official source ^{27Reference 27Zhang et al. · 2012ReviewTanshinones: sources, pharmacokinetics and anti-cancer activities — reviewView study →}.

How Is Dan Shen Used?

• Dried root decoction — the root simmered in water, the traditional form, usually as part of a formula ^{26Reference 26Su et al. · 2015ReviewSalvia miltiorrhiza: traditional medicinal uses, chemistry, and pharmacology — reviewView study →}.
• Liquid extract — a 1:2 extract, used by herbal practitioners outside China.
• Compound danshen dripping pill — a multi-herb formula with dan shen as the main ingredient, listed in the Chinese Pharmacopoeia and the subject of most of the angina trials ^{1,2,27Reference 1Jia et al. · 2017Meta-analysisHow efficacious is danshen (Salvia miltiorrhiza) dripping pill in treating angina pectoris? Evidence assessment for meta-analysis of randomized controlled trials — meta-analysis with GRADE assessmentView study →Reference 2Luo et al. · 2015Systematic reviewCompound danshen (Salvia miltiorrhiza) dripping pill for coronary heart disease: an overview of systematic reviews — systematic reviewView study →Reference 27Zhang et al. · 2012ReviewTanshinones: sources, pharmacokinetics and anti-cancer activities — reviewView study →}.
• Injections — danshen and danshen-combination injections are given in Chinese hospitals for angina, stroke, lung-related heart disease and kidney disease ^{3,4,9,17,18Reference 3Wu et al. · 2017Meta-analysisDanshen injection as adjuvant treatment for unstable angina pectoris: a systematic review and meta-analysis — meta-analysis of randomised controlled trialsView study →Reference 4Li et al. · 2022Meta-analysisEfficacy and safety of eight types of Salvia miltiorrhiza injections in the treatment of unstable angina pectoris — network meta-analysisView study →Reference 9Ma et al. · 2024Meta-analysisSafety and effectiveness of Salvia miltiorrhiza and ligustrazine injection for acute cerebral infarction — systematic review and meta-analysis of randomised controlled trialsView study →Reference 17Liu et al. · 2014Meta-analysisSalvia miltiorrhiza injection on pulmonary heart disease: a systematic review and meta-analysis — meta-analysis of randomised controlled trialsView study →Reference 18Xie et al. · 2021Meta-analysisEfficacy and safety of Salvia miltiorrhiza (Salvia miltiorrhiza Bunge) and ligustrazine injection in the adjuvant treatment of early-stage diabetic kidney disease — systematic review and meta-analysisView study →}.

Traditional Uses

Traditional Chinese Medicine

Dan shen (丹参) is a classic herb for invigorating the blood and dispelling stasis ^{22Reference 22Chen et al. · 2014Systematic reviewThe anticancer properties of Salvia miltiorrhiza Bunge (danshen): a systematic review — reviewView study →}.

It is used for chest pain and angina-type symptoms (“chest bi”), heart palpitations and circulatory disorders, and for stroke ^{27Reference 27Zhang et al. · 2012ReviewTanshinones: sources, pharmacokinetics and anti-cancer activities — reviewView study →}. It also cools the blood and calms the spirit, and is given for insomnia and restlessness. It promotes menstruation where blood stasis is the cause.

The root has also been used for hepatitis, arthritis and high blood lipids ^{27Reference 27Zhang et al. · 2012ReviewTanshinones: sources, pharmacokinetics and anti-cancer activities — reviewView study →}. Externally, the prepared root is applied to sores, boils and carbuncles.

Indications

• Angina and coronary heart disease [compound dripping pill; injection; TCM] ⚠Caution: Hundreds of trials show better symptoms and ECG results, but trial quality is low and no benefit on deaths or heart attacks has been shown ^1,2.
• Heart palpitations and chest pain [root; TCM]
• Heart failure, alongside standard treatment [root decoction]
• Ischaemic stroke recovery [injection] ⚠Caution: A Cochrane review found the trials too poor in quality to draw reliable conclusions ⁸.
• High blood pressure [intravenous extract]
• Lung-related heart disease (cor pulmonale) [injection]
• Early diabetic kidney disease [injection with ligustrazine; with astragalus]
• Hepatitis and liver fibrosis [root; TCM]
• Insomnia and restlessness [root; TCM]
• Painful or irregular menstruation from blood stasis [root; TCM]
• Sores and boils [root, applied externally; TCM]

Botany

Dan shen is an erect, much-branched perennial herb 40–80 cm tall, with softly hairy stems ^{29Reference 29Li et al. · 1994Salvia miltiorrhiza Bunge — species description, habitat and distribution — floraView study →}. Its taproot is thick and fleshy, and scarlet on the outside ^{29Reference 29Li et al. · 1994Salvia miltiorrhiza Bunge — species description, habitat and distribution — floraView study →}.

The leaves are simple or divided into 3–5, occasionally 7, leaflets. The leaflets are round to broadly lance-shaped, 1.5–8 cm long, hairy, and more densely so underneath, with rounded teeth along the edge ^{29Reference 29Li et al. · 1994Salvia miltiorrhiza Bunge — species description, habitat and distribution — floraView study →}.

The flowers grow in whorls of six or more on spikes 4.5–17 cm long, spaced apart at the base and crowded at the tip. Each flower is purple-blue or white, 2–2.7 cm long, with a sickle-shaped upper lip, and sits in a purplish calyx about 1.1 cm long ^{29Reference 29Li et al. · 1994Salvia miltiorrhiza Bunge — species description, habitat and distribution — floraView study →}.

It flowers from April to August and fruits from September to October. The fruit splits into ellipsoid nutlets about 3 mm long ^{29Reference 29Li et al. · 1994Salvia miltiorrhiza Bunge — species description, habitat and distribution — floraView study →}.

Distribution

Dan shen grows wild in eastern and central China, in Anhui, Hebei, Henan, Hubei, Hunan, Jiangsu, Shaanxi, Shandong, Shanxi and Zhejiang. It also occurs in Japan ^{29Reference 29Li et al. · 1994Salvia miltiorrhiza Bunge — species description, habitat and distribution — floraView study →}. It grows on hillsides, along streams and in forests at 100–1,300 m ^{29Reference 29Li et al. · 1994Salvia miltiorrhiza Bunge — species description, habitat and distribution — floraView study →}.

Wild supplies became short as demand grew, and the plant has been widely cultivated in China since the 1970s. Most commercial dan shen now comes from field-grown plants, which take more than 20 months to mature ^{27Reference 27Zhang et al. · 2012ReviewTanshinones: sources, pharmacokinetics and anti-cancer activities — reviewView study →}.

Growing Conditions

Cultivation snapshot for Dan Shen

LifeperennialZoneUSDA 6–9

• Hardy roughly across USDA zones 6–9; tolerates winter cold to about −10 °C.
• Prefers rich, well-drained soil; dislikes waterlogging despite tolerating ample moisture.
• Happy in part shade to about half a day of sun — a woodland-edge plant rather than a full-baking-sun sage.
• Grown for its roots, so it is typically lifted after one or more seasons rather than kept as a permanent ornamental.

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Pharmacology & Research

Dan shen has a large human trial base, almost all of it in heart and circulation disease. A GRADE-assessed meta-analysis of the dripping pill for angina included 109 trials with 11,973 participants ^{1Reference 1Jia et al. · 2017Meta-analysisHow efficacious is danshen (Salvia miltiorrhiza) dripping pill in treating angina pectoris? Evidence assessment for meta-analysis of randomized controlled trials — meta-analysis with GRADE assessmentView study →}. An overview gathered 13 systematic reviews covering 34,071 people with coronary heart disease ^{2Reference 2Luo et al. · 2015Systematic reviewCompound danshen (Salvia miltiorrhiza) dripping pill for coronary heart disease: an overview of systematic reviews — systematic reviewView study →}. There are further meta-analyses of injections for angina, stroke, lung-related heart disease and diabetic kidney disease, and a Cochrane review for stroke ^{3,4,8,9,10,17,18,19Reference 3Wu et al. · 2017Meta-analysisDanshen injection as adjuvant treatment for unstable angina pectoris: a systematic review and meta-analysis — meta-analysis of randomised controlled trialsView study →Reference 4Li et al. · 2022Meta-analysisEfficacy and safety of eight types of Salvia miltiorrhiza injections in the treatment of unstable angina pectoris — network meta-analysisView study →Reference 8Wu et al. · 2007Systematic reviewDan Shen agents for acute ischaemic stroke — Cochrane systematic reviewView study →Reference 9Ma et al. · 2024Meta-analysisSafety and effectiveness of Salvia miltiorrhiza and ligustrazine injection for acute cerebral infarction — systematic review and meta-analysis of randomised controlled trialsView study →Reference 10Liu et al. · 2025Meta-analysisA systematic review and meta-analysis of randomized controlled trials on the efficacy and safety of tanshinone IIA sodium sulfonate injection in ischemic stroke — meta-analysisView study →Reference 17Liu et al. · 2014Meta-analysisSalvia miltiorrhiza injection on pulmonary heart disease: a systematic review and meta-analysis — meta-analysis of randomised controlled trialsView study →Reference 18Xie et al. · 2021Meta-analysisEfficacy and safety of Salvia miltiorrhiza (Salvia miltiorrhiza Bunge) and ligustrazine injection in the adjuvant treatment of early-stage diabetic kidney disease — systematic review and meta-analysisView study →Reference 19Liang et al. · 2025Meta-analysisEfficacy and potential pharmacological mechanism of Astragalus–Salvia miltiorrhiza combination in diabetic nephropathy — meta-analysis with network pharmacologyView study →}.

Most of these trials test multi-herb dripping pills or injections, added to standard treatment, rather than the root decoction. The preclinical work covers heart protection, fibrosis, nerve protection, cancer and bacteria ^{12,13,15,20,21,22,23,24,25,28Reference 12Yang et al. · 2024Meta-analysisProtective effect of salvianolic acid B against myocardial ischemia/reperfusion injury: a preclinical systematic review and meta-analysis of animal studies — animal-model meta-analysisView study →Reference 13Zhang et al. · 2024Meta-analysisEfficacy of tanshinone IIA in rat models with myocardial ischemia-reperfusion injury: a systematic review and meta-analysis — animal-model meta-analysisView study →Reference 15Wang et al. · 2019Salvianolic acid A attenuates CCl4-induced liver fibrosis by regulating the PI3K/AKT/mTOR pathway — animal studyView study →Reference 20Peng et al. · 2024Meta-analysisPulmonary fibrosis insights and therapy targets from disease models and administration of the lipophilic diterpene, sodium tanshinone IIA sulfonate: Review and meta-analysisView study →Reference 21Xie et al. · 2023Meta-analysisThe protective effect of an extract of Salvia miltiorrhiza Bunge (danshen, tanshinone IIA) on cerebral ischemic injury — animal-model systematic review and meta-analysisView study →Reference 22Chen et al. · 2014Systematic reviewThe anticancer properties of Salvia miltiorrhiza Bunge (danshen): a systematic review — reviewView study →Reference 23Cao et al. · 2017In vitroSalvia miltiorrhiza extract dihydrotanshinone induces apoptosis and inhibits proliferation of glioma cells — in vitro studyView study →Reference 24Gao et al. · 2018In vitroSimultaneous purification of dihydrotanshinone, tanshinone I, cryptotanshinone and tanshinone IIA from Salvia miltiorrhiza and their anti-inflammatory activities — in vitro and animal modelView study →Reference 25Yue et al. · 2025Systematic reviewSalviae Miltiorrhizae Radix et Rhizoma protects against doxorubicin-induced cardiotoxicity: a systematic review — review of preclinical studiesView study →Reference 28Luo et al. · 2021In vitroDihydrotanshinone I is effective against drug-resistant Helicobacter pylori in vitro and in vivoView study →}.

1. Angina & Coronary Heart Disease

More than 230 randomised trials have compared the danshen dripping pill with isosorbide dinitrate for angina. A 2017 meta-analysis included 109 of them, with 11,973 participants, and found the dripping pill better for symptoms (odds ratio 2.94) and ECG results (odds ratio 2.37). The trials had a high risk of bias, and the GRADE strength of evidence was low ^{1Reference 1Jia et al. · 2017Meta-analysisHow efficacious is danshen (Salvia miltiorrhiza) dripping pill in treating angina pectoris? Evidence assessment for meta-analysis of randomized controlled trials — meta-analysis with GRADE assessmentView study →}.

An overview of 13 systematic reviews of the compound danshen dripping pill, covering 34,071 people with angina or heart attack, found the same pattern. Symptoms and ECG results improved with few adverse reactions, but no benefit on hard endpoints such as death was shown, and the evidence ranged from very low to moderate quality ^{2Reference 2Luo et al. · 2015Systematic reviewCompound danshen (Salvia miltiorrhiza) dripping pill for coronary heart disease: an overview of systematic reviews — systematic reviewView study →}.

A meta-analysis of 17 trials (1,433 patients) found that danshen injection added to conventional treatment for unstable angina improved angina relief (risk ratio 1.23, 95% CI 1.17–1.29) ^{3Reference 3Wu et al. · 2017Meta-analysisDanshen injection as adjuvant treatment for unstable angina pectoris: a systematic review and meta-analysis — meta-analysis of randomised controlled trialsView study →}. A network meta-analysis compared eight danshen-based injections across 148 trials ^{4Reference 4Li et al. · 2022Meta-analysisEfficacy and safety of eight types of Salvia miltiorrhiza injections in the treatment of unstable angina pectoris — network meta-analysisView study →}.

Gap: no high-quality, low-bias trial of the root decoction on its own, and no demonstrated effect on death or heart-attack rates.

2. Antiplatelet & Antithrombotic

Dan shen affects blood clotting in several ways. It inhibits platelet aggregation, interferes with the extrinsic clotting pathway, has antithrombin III-like activity and promotes fibrinolysis ^{5Reference 5Chan · 2001Case reportInteraction between warfarin and danshen (Salvia miltiorrhiza) — review of case reportsView study →}. The water-soluble salvianolic acid B and salvianolic acid A are thought to carry much of the antiplatelet effect.

The clearest human evidence comes from its interaction with warfarin. Three published cases describe serious over-anticoagulation and bleeding in patients on long-term warfarin who also took danshen ^{5Reference 5Chan · 2001Case reportInteraction between warfarin and danshen (Salvia miltiorrhiza) — review of case reportsView study →}. In rats, danshen raised peak warfarin levels and prolonged prothrombin time ^{6Reference 6Lo et al. · 1992AnimalThe effects of danshen (Salvia miltiorrhiza) on pharmacokinetics and pharmacodynamics of warfarin in rats — animal pharmacokinetic studyView study →}. A systematic overview of warfarin interactions lists danshen among newly reported ones ^{7Reference 7Holbrook et al. · 2005Systematic reviewSystematic overview of warfarin and its drug and food interactions — systematic reviewView study →}.

Gap: the human evidence is a safety signal, not an efficacy result. No trial has tested dan shen as an antiplatelet treatment against a standard drug.

3. Ischemic Stroke

Dan shen preparations are widely used in China alongside standard care for acute ischaemic stroke. A 2007 Cochrane review included six trials with 494 patients. Dan shen was linked with more patients showing marked neurological improvement, but all the trials were of poor quality, none reported death or dependency at three months, and the authors concluded that reliable conclusions could not be drawn ^{8Reference 8Wu et al. · 2007Systematic reviewDan Shen agents for acute ischaemic stroke — Cochrane systematic reviewView study →}.

Later meta-analyses of injections are more positive. Across 38 trials (3,869 patients), danshen with ligustrazine injection improved response rates, stroke scores and daily-living scores ^{9Reference 9Ma et al. · 2024Meta-analysisSafety and effectiveness of Salvia miltiorrhiza and ligustrazine injection for acute cerebral infarction — systematic review and meta-analysis of randomised controlled trialsView study →}. Across 22 trials (2,289 patients), tanshinone IIA sodium sulfonate injection improved response and stroke scores, but not daily living ^{10Reference 10Liu et al. · 2025Meta-analysisA systematic review and meta-analysis of randomized controlled trials on the efficacy and safety of tanshinone IIA sodium sulfonate injection in ischemic stroke — meta-analysisView study →}.

Gap: the Cochrane review found the evidence insufficient, and the newer meta-analyses draw on low-quality, China-only trials of injections, not oral root.

4. Antioxidant

The salvianolic acids, especially salvianolic acid B, scavenge free radicals. Tanshinone IIA activates the Nrf2 antioxidant pathway and reduces oxidative damage in models of heart and liver injury ^{11Reference 11Guo et al. · 2020ReviewPharmacological activity and mechanism of tanshinone IIA in related diseases — reviewView study →}.

This activity underlies the herb’s heart-, liver- and nerve-protective findings in animals. No human trial has measured a clinical outcome attributable to it.

5. Cardioprotection — Ischemia-Reperfusion

A preclinical systematic review of salvianolic acid B pooled 32 studies (732 animals). It reduced heart-attack size and cardiac enzyme release and improved heart function after blood flow was restored ^{12Reference 12Yang et al. · 2024Meta-analysisProtective effect of salvianolic acid B against myocardial ischemia/reperfusion injury: a preclinical systematic review and meta-analysis of animal studies — animal-model meta-analysisView study →}.

A meta-analysis of 15 rat studies found that tanshinone IIA raised superoxide dismutase, lowered malondialdehyde and reduced infarct size in the same model ^{13Reference 13Zhang et al. · 2024Meta-analysisEfficacy of tanshinone IIA in rat models with myocardial ischemia-reperfusion injury: a systematic review and meta-analysis — animal-model meta-analysisView study →}.

A systematic review of 35 studies found that dan shen, eleven of its constituents and several danshen formulas protected against doxorubicin heart damage in cell and animal models ^{25Reference 25Yue et al. · 2025Systematic reviewSalviae Miltiorrhizae Radix et Rhizoma protects against doxorubicin-induced cardiotoxicity: a systematic review — review of preclinical studiesView study →}.

Gap: these are pooled animal studies. No human trial has tested dan shen for heart damage after reperfusion or for chemotherapy cardiotoxicity.

6. Heart Failure

A meta-analysis of nine trials (855 patients) found that adding danshen decoction to conventional treatment for heart failure improved response rates, ejection fraction and BNP levels compared with conventional treatment alone. The GRADE quality of evidence was moderate to low, and none of the trials reported adverse events ^{14Reference 14Li et al. · 2023Meta-analysisClinical effect of danshen decoction in patients with heart failure: a systematic review and meta-analysis — meta-analysis of randomised controlled trialsView study →}.

Gap: the trials report heart-function markers, not hospital admissions or deaths.

7. Hepatoprotective

Salvianolic acid A reduced liver fibrosis caused by carbon tetrachloride in rats. It inhibited PI3K/AKT/mTOR signalling, which blocked the activation of hepatic stellate cells, and reduced liver-cell death ^{15Reference 15Wang et al. · 2019Salvianolic acid A attenuates CCl4-induced liver fibrosis by regulating the PI3K/AKT/mTOR pathway — animal studyView study →}.

No controlled human trial has tested dan shen for liver disease.

8. Hypertension

A 2025 randomised, placebo-controlled trial in 320 people aged 30–75 with primary hypertension gave 20 mL of intravenous dan shen daily for 12 weeks. Systolic and diastolic pressure fell from week 4, reaching 136.8 and 85.4 mmHg by week 12, both lower than placebo. Cholesterol, triglycerides, fasting glucose and quality of life also improved, and side effects were mild ^{16Reference 16Li et al. · 2025RCTEffects of Dan Shen (Salvia miltiorrhiza) on blood pressure management in hypertensive patients — randomised double-blind placebo-controlled trialView study →}.

Gap: one trial, using an intravenous preparation. No trial has tested whether the oral root lowers blood pressure.

9. Cor Pulmonale

For cor pulmonale (heart disease caused by lung disease), a systematic review pooled 35 trials (2,715 patients) of dan shen and compound dan shen injection added to routine treatment. It reported benefits, limited by the methodological flaws of the trials ^{17Reference 17Liu et al. · 2014Meta-analysisSalvia miltiorrhiza injection on pulmonary heart disease: a systematic review and meta-analysis — meta-analysis of randomised controlled trialsView study →}.

10. Diabetic Kidney Disease

A meta-analysis of 22 trials (1,939 patients) found that danshen with ligustrazine injection, added to conventional treatment, lowered urinary albumin, serum creatinine and inflammatory markers in early diabetic kidney disease ^{18Reference 18Xie et al. · 2021Meta-analysisEfficacy and safety of Salvia miltiorrhiza (Salvia miltiorrhiza Bunge) and ligustrazine injection in the adjuvant treatment of early-stage diabetic kidney disease — systematic review and meta-analysisView study →}.

A separate meta-analysis of 15 studies (1,443 patients) of an astragalus and dan shen combination reported better clinical outcomes and kidney function in diabetic nephropathy, with lower fasting glucose after more than 12 weeks ^{19Reference 19Liang et al. · 2025Meta-analysisEfficacy and potential pharmacological mechanism of Astragalus–Salvia miltiorrhiza combination in diabetic nephropathy — meta-analysis with network pharmacologyView study →}.

Both test combination products in early disease. There are no data on progression to dialysis.

11. Pulmonary Fibrosis

Tanshinone IIA reduces lung fibrosis in animals. A preclinical systematic review of 12 studies (248 animals) found it lowered fibrotic scores, collagen I and III and hydroxyproline compared with untreated models, through reduced inflammation and oxidation and suppression of TGF-β1 ^{20Reference 20Peng et al. · 2024Meta-analysisPulmonary fibrosis insights and therapy targets from disease models and administration of the lipophilic diterpene, sodium tanshinone IIA sulfonate: Review and meta-analysisView study →}.

The evidence is entirely from animals.

12. Neuroprotective

A meta-analysis of 13 rodent studies of cerebral ischaemia found that tanshinone IIA reduced infarct volume, brain swelling and neurological deficit, and lowered markers of inflammation, oxidation and cell death ^{21Reference 21Xie et al. · 2023Meta-analysisThe protective effect of an extract of Salvia miltiorrhiza Bunge (danshen, tanshinone IIA) on cerebral ischemic injury — animal-model systematic review and meta-analysisView study →}.

The human stroke trials test compound injections, not isolated tanshinone IIA.

13. Anticancer

A systematic review of dan shen’s anticancer properties describes pro-apoptotic and growth-inhibiting activity of the tanshinones ^{22Reference 22Chen et al. · 2014Systematic reviewThe anticancer properties of Salvia miltiorrhiza Bunge (danshen): a systematic review — reviewView study →}. Dihydrotanshinone I, for example, induced apoptosis and inhibited proliferation in human glioma cells ^{23Reference 23Cao et al. · 2017In vitroSalvia miltiorrhiza extract dihydrotanshinone induces apoptosis and inhibits proliferation of glioma cells — in vitro studyView study →}.

None of this has reached clinical testing for cancer.

14. Antibacterial

Dihydrotanshinone I killed standard and clinical Helicobacter pylori strains in vitro, including drug-resistant ones, without resistance developing. In mice with multidrug-resistant infection, dihydrotanshinone I with omeprazole killed more bacteria than standard triple therapy ^{28Reference 28Luo et al. · 2021In vitroDihydrotanshinone I is effective against drug-resistant Helicobacter pylori in vitro and in vivoView study →}.

The purified tanshinones also showed anti-inflammatory activity in cells and in mice ^{24Reference 24Gao et al. · 2018In vitroSimultaneous purification of dihydrotanshinone, tanshinone I, cryptotanshinone and tanshinone IIA from Salvia miltiorrhiza and their anti-inflammatory activities — in vitro and animal modelView study →}.

Gap: the in vivo evidence is one mouse model. There is no human trial, and no evidence that oral root reaches antibacterial levels.

Mechanisms

Dan shen inhibits platelet aggregation and promotes fibrinolysis ^{5Reference 5Chan · 2001Case reportInteraction between warfarin and danshen (Salvia miltiorrhiza) — review of case reportsView study →}. Its water-soluble salvianolic acids scavenge free radicals, and salvianolic acid A has been studied for blocking the liver cells that drive fibrosis ^{15Reference 15Wang et al. · 2019Salvianolic acid A attenuates CCl4-induced liver fibrosis by regulating the PI3K/AKT/mTOR pathway — animal studyView study →}.

The fat-soluble tanshinones have been studied for activating the Nrf2 antioxidant pathway, suppressing TGF-β1 in lung fibrosis, killing cancer cells and killing H. pylori ^{11,20,23,28Reference 11Guo et al. · 2020ReviewPharmacological activity and mechanism of tanshinone IIA in related diseases — reviewView study →Reference 20Peng et al. · 2024Meta-analysisPulmonary fibrosis insights and therapy targets from disease models and administration of the lipophilic diterpene, sodium tanshinone IIA sulfonate: Review and meta-analysisView study →Reference 23Cao et al. · 2017In vitroSalvia miltiorrhiza extract dihydrotanshinone induces apoptosis and inhibits proliferation of glioma cells — in vitro studyView study →Reference 28Luo et al. · 2021In vitroDihydrotanshinone I is effective against drug-resistant Helicobacter pylori in vitro and in vivoView study →}. Most of this work uses isolated compounds in cells and animals.

Clinical Trials

Most of the large human trial base is in cardiovascular disease and tests compound preparations (danshen dripping pill, compound danshen tablet) or injections rather than the dried root. Most trials report symptoms and surrogate endpoints.

Last checked: July 2026.

Phytochemistry

More than 90 compounds have been identified in dan shen root: over 40 fat-soluble compounds and over 50 water-soluble ones ^{27Reference 27Zhang et al. · 2012ReviewTanshinones: sources, pharmacokinetics and anti-cancer activities — reviewView study →}. The fat-soluble group is led by the tanshinones, orange-red abietane diterpene quinones first isolated from the root in the 1930s. They include tanshinone IIA, cryptotanshinone, tanshinone I and dihydrotanshinone I ^{24,27Reference 24Gao et al. · 2018In vitroSimultaneous purification of dihydrotanshinone, tanshinone I, cryptotanshinone and tanshinone IIA from Salvia miltiorrhiza and their anti-inflammatory activities — in vitro and animal modelView study →Reference 27Zhang et al. · 2012ReviewTanshinones: sources, pharmacokinetics and anti-cancer activities — reviewView study →}.

The water-soluble group is made up of phenolic acids, chiefly salvianolic acid B, with salvianolic acid A and rosmarinic acid ^{22,26Reference 22Chen et al. · 2014Systematic reviewThe anticancer properties of Salvia miltiorrhiza Bunge (danshen): a systematic review — reviewView study →Reference 26Su et al. · 2015ReviewSalvia miltiorrhiza: traditional medicinal uses, chemistry, and pharmacology — reviewView study →}. The root also contains an essential oil ^{26Reference 26Su et al. · 2015ReviewSalvia miltiorrhiza: traditional medicinal uses, chemistry, and pharmacology — reviewView study →}.

The Chinese Pharmacopoeia uses tanshinone IIA and salvianolic acid B as quality markers. Dried root must contain at least 0.25% combined tanshinone IIA, cryptotanshinone and tanshinone I, and at least 3.0% salvianolic acid B ^{26Reference 26Su et al. · 2015ReviewSalvia miltiorrhiza: traditional medicinal uses, chemistry, and pharmacology — reviewView study →}.

Tanshinones also occur in more than 20 related Salvia species, several of which are sold as substitutes for dan shen ^{27Reference 27Zhang et al. · 2012ReviewTanshinones: sources, pharmacokinetics and anti-cancer activities — reviewView study →}. Findings on those species, and on the injections and multi-herb formulas, should be read separately from studies of the root itself.

Constituent Summary

The two groups of compounds in the dried root:

Dosage

• Dried root — about 9–15 g a day as a decoction ^{26Reference 26Su et al. · 2015ReviewSalvia miltiorrhiza: traditional medicinal uses, chemistry, and pharmacology — reviewView study →}.
• Liquid extract (1:2) — about 30–60 mL a week in Western herbal practice.
• Trial preparations — most of the clinical evidence comes from dripping pills and injections, which are not interchangeable with the root.

Safety & Pregnancy

The root is well tolerated. Its one important risk is that it strongly increases the effect of warfarin and other blood thinners.

Full Safety & Interactions Detail

Warfarin. Dan shen interacts with warfarin both by changing its blood levels and by adding its own effect on clotting. Three published cases describe serious over-anticoagulation and bleeding in patients on long-term warfarin who also took danshen ^{5Reference 5Chan · 2001Case reportInteraction between warfarin and danshen (Salvia miltiorrhiza) — review of case reportsView study →}. In rats, danshen raised peak warfarin levels and prolonged prothrombin time ^{6Reference 6Lo et al. · 1992AnimalThe effects of danshen (Salvia miltiorrhiza) on pharmacokinetics and pharmacodynamics of warfarin in rats — animal pharmacokinetic studyView study →}. The combination should be avoided ^{5,7Reference 5Chan · 2001Case reportInteraction between warfarin and danshen (Salvia miltiorrhiza) — review of case reportsView study →Reference 7Holbrook et al. · 2005Systematic reviewSystematic overview of warfarin and its drug and food interactions — systematic reviewView study →}.

Other blood thinners and surgery. Dan shen inhibits platelet aggregation and promotes fibrinolysis ^{5Reference 5Chan · 2001Case reportInteraction between warfarin and danshen (Salvia miltiorrhiza) — review of case reportsView study →}. The same caution therefore applies to other anticoagulant and antiplatelet drugs, and dan shen should be stopped well before planned surgery.

Drug metabolism. In healthy volunteers, ten days of danshen ethanol extract induced CYP3A and cut midazolam exposure by about 80%, so regular use can lower blood levels of drugs cleared by CYP3A4 ^{30Reference 30Qiu et al. · 2013Opposite effects of single-dose and multidose administration of the ethanol extract of danshen on CYP3A in healthy volunteers — clinical pharmacokinetic studyView study →}. A single dose did the opposite, briefly raising midazolam levels ^{30Reference 30Qiu et al. · 2013Opposite effects of single-dose and multidose administration of the ethanol extract of danshen on CYP3A in healthy volunteers — clinical pharmacokinetic studyView study →}.

The same extract also lowered levels of fexofenadine, a drug moved by the gut transporter P-glycoprotein rather than metabolised ^{32Reference 32Qiu et al. · 2014Effects of danshen ethanol extract on the pharmacokinetics of fexofenadine in healthy volunteers — clinical pharmacokinetic studyView study →}. A week of danshen capsules halved exposure to clopidogrel and weakened its antiplatelet effect ^{31Reference 31Zhou et al. · 2018Effects of Danshen capsules on the pharmacokinetics and pharmacodynamics of clopidogrel in healthy volunteers — clinical pharmacokinetic studyView study →}.

Tolerability. Across large cardiovascular datasets, adverse events were few and mild ^{2Reference 2Luo et al. · 2015Systematic reviewCompound danshen (Salvia miltiorrhiza) dripping pill for coronary heart disease: an overview of systematic reviews — systematic reviewView study →}. Nearly all of that data comes from dripping pills and injections rather than the loose root.

References

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2. Luo, J., et al. (2015). Compound danshen (Salvia miltiorrhiza) dripping pill for coronary heart disease: an overview of systematic reviews — systematic review. American Journal of Chinese Medicine. https://pubmed.ncbi.nlm.nih.gov/25582415/
3. Wu, J. R., et al. (2017). Danshen injection as adjuvant treatment for unstable angina pectoris: a systematic review and meta-analysis — meta-analysis of randomised controlled trials. Chinese Journal of Integrative Medicine. https://pubmed.ncbi.nlm.nih.gov/27921196/
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