The Prevention and Treatment of Cardiovascular Disease: Part 2

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Sage Advice For the treatment of Coronary Heart Disease

It's not too often that a representative of a pharmaceutical company will call an herbalist asking what herb might be worth researching for a particular condition. Several years ago I had one such call and the representative was inquiring about herbs specific for cardiovascular disease and the relief of angina pectoris (periodic chest pains caused by cardiovascular malfunction). This condition is often a precursor to the number one disease in the Western world: coronary heart disease (CHD).

I thought that perhaps this was to be 'my day in the sun' with an opportunity to bring one of my favorite herbs to a much wider public. I considered mentioning hawthorn, but I knew of an herb that was even more effective for angina than hawthorn. In fact it's one that I've found to be practically 100% clinically effective for angina! (Of course, when it comes to healing, nothing is ever really 100% effective, but for the dozens of people complaining of angina to whom I recommended this herb, it proved to be 100% effective.)

I'm referring to the Chinese herb dan shen, known in the West as red sage root (Salvia miltiorrhiza).[i]

I put patients complaining of angina pectoris on red sage root, usually in pill form, dosed at approximately 3 grams, three times a day. In as few as two or three days on the herb, these patients reported no further angina attacks. Of course, this is a condition that will require a much longer period of treatment; for many, this may mean a lifetime commitment to dan shen.

What is angina pectoris?

Angina pain occurs when there is a reduction of blood flow to an area of the heart muscle. This can be due to damage to the inner layers of the coronary arteries caused by smoking, high blood lipids due to a high fat diet, high blood pressure, diabetes, or perhaps the most important cause of CHD, elevation of the amino acid homocysteine. When any of these occur, the result can be inflammation and scarring of the blood vessels. As these attempt to heal, atherosclerosis results: accumulated plaque hardens and narrows the arteries causing diminished flow of blood to the heart, which in turn causes the chest pain known as angina pectoris.

Other forms of plaque are soft and more likely to rupture and form blood clots, which in turn can block the coronary arteries and cause angina.

Four types of angina are recognized.

1. Stable angina

Physical exertion is the most common cause of this type of angina. Stable angina occurs when severely narrowed arteries do not allow enough blood to reach the heart to fulfill its demand for oxygen. It doesn't occur when one is sitting. Other causes of stable angina are

  • Emotional stress
  • Exposure to very hot or cold temperatures
  • Heavy meals
  • Smoking

2. Unstable Angina

This occurs when an artery is partially or totally blocked by blood clots. Blood clots may form, partially dissolve and reform so that angina occurs each time a clot interferes with arterial blood flow.

3. Variant Angina
This is caused by a spasm in a coronary artery that causes the walls to tighten and narrow. This type of angina can occur both in people with and without CHD. Some causes for this type can be:

  • Exposure to cold
  • Emotional stress
  • Medicines that tighten or narrow blood vessels
  • Smoking
  • Cocaine use

4. Microvascular Angina (MVD)

This type of angina is caused by reduced blood flow in the smallest coronary arteries, which can be caused by inflammation, plaque build-up, or spasms of damaged or diseased arterial walls.

Today, an estimated 6.5 million people in the US alone suffer from some form of angina pectoris. Barring an angioplasty, where a cardiologist operates to physically unblock clogged arteries, the standard of care usually involves the prescription of anti-platelet medications or blood-thinning drugs.

Enter red sage root, whose strikingly brassy red roots resemble the veins and arteries of the body.

Dan shen is used in Traditional Chinese Medicine (TCM) to 'regulate or move blood.' In Chinese medicine it is classified as having a bitter taste (usually meaning that it is moving and detoxifying) with a cool energy. It specifically enters the Heart, Pericardium and Liver meridians. The average effective daily dose is between 6 to 15 grams, divided into two or three doses per day. Apart from its use as a superior cardiovascular herb, it is used for many other conditions where promoting blood circulation and relieving blood stagnation (this would include blood clots) is needed, for clearing inflammation (recognized as a major cause of CHD), to calm the mind and soothe irritability (also associated with heart disease), and finally, to relieve stomach pain probably caused by ulcers and esophageal reflux. Those with an advanced understanding of herbal medicine recognize that the inclusion of blood-moving herbs in a formula greatly enhance the treatment of most chronic disease. This is especially true when treating angina and CHD diseases.

Despite my suggestion to the pharmaceutical industry to study red sage root for the treatment of CHD, to this day little Western research has been undertaken for this herb. However, a considerable number of Chinese studies support the therapeutic claims for this remarkable botanical. Both animal and human studies conducted in China have found that dan shen improves blood circulation by limiting the stickiness of blood platelets while inhibiting the production of fibrin. This significantly reduces the formation of arterial plaque and blood clots.

An in vitro study from Yamanashi Medical University, Japan[ii] found dan shen comparable to a typical calcium channel-blocker in its effect of increasing coronary blood flow, making it a potential treatment for angina without the invasive risks and side effects of conventional medical treatment.

Unlike pharmaceutical drugs that only thin the blood and make one vulnerable to bleeding disorders, dan shen actually promotes healing of traumas and wounds but also has a calming and relaxing effect, which is known to relax and widen the blood vessels around the heart. Needless to say, this makes dan shen particularly useful for the treatment of hypertension.

Danshen is also useful as:

  • A potent antioxidant preventing the oxidation of LDL cholesterol [iii]
  • Can be used for patients undergoing cardiovascular disease from heart damage during surgery[iv], [v]
  • Improves the survival rate of patients after a heart attack[vi]

Many doctors will give their aging patients a prescription of nitroglycerin to have on hand just in case they should ever suffer a heart attack. Wouldn't it be better if instead they recommended daily use of dan shen to prevent the slow buildup of conditions that lead to CHD? One study has shown that dan shen is more effective than nitroglycerin for improving heart function and circulation. [vii]

Much more can be said about this remarkable herb for treatment and prevention of CHD as well as many other diseases including diabetes, cancer, HIV/AIDS, osteoporosis, hearing loss, and Alzheimer's Disease.

Dan shen seems to be an ideal herb for the aged to take prophylactically, which is one reason it is so popular in China. It can be taken singly or in combination with other blood-moving, heart protective herbs, which in many cases will offer a wide range of benefits.

Thus far I have discussed a common Western herb, hawthorn berry and leaf, popular in North American and European herbology and now a Chinese herb that one can even grow in one's (seeds or plant starts available from Horizon Herbs. My next blog will conclude the series with a discussion of a powerful Ayurvedic herb for the heart.

Caution: Dan shen (or any blood-moving herb) should not be taken unsupervised by patients taking anticoagulant medications such as warfarin, heparin, or Ticlopidine.[viii] Further, CHD is a potentially lethal disease for which one should seek qualified medical assistance. I don't recommend simply substituting or dropping any prescribed drug without first consulting with your primary care physician. After carefully weighing all the pros and cons, I believe it is a patient's right to pursue whatever course of action they deem to be prudent.

Those seeking a personal consultation may call the East West Herb Clinic at (831) 429-8066.



[i]Ji XY, Tan BK, Zhu YZ., Department of Pharmacology, Faculty of Medicine, National University of Singapore, 10 Kent Ridge Crescent, Singapore 119260. Acta Pharmacol Sin. 2000 Dec;21(12):1089-94, .Salvia miltiorrhiza and ischemic diseases

[ii] Sugiyama A, Zhu BM, Takahara A, Satoh Y, Hashimoto K. Cardiac effects of salvia miltiorrhiza/dalbergia odorifera mixture, an intravenously applicable Chinese medicine widely used for patients with ischemic heart disease in China. Circ J. 2002 Feb;66(2):182-4.

[iii] O K, Lynn EG, Vazhappilly R, Au-Yeung KK, Zhu DY, Siow YL, Magnesium tanshinoate B (MTB) inhibits low density lipoprotein oxidation, Life Sci. 2001 Jan 12;68(8):903-12.

[iv] Zhou S, Shao W, Duan C. Observation of preventing and treating effect of Salvia miltiorrhiza composita on patients with ischemic coronary heart disease undergoing non-heart surgery. Zhongguo Zhong Xi Yi Jie He Za Zhi 1999 Feb;19(2):75-6.

[v] Tang MK, Zhang JT, Salvianolic acid B inhibits fibril formation and neurotoxicity of amyloid beta-protein in vitro, Acta Pharmacol Sin. 2001 Apr;22(4):380-4.

[vi] Ji X, Tan BK, Zhu YC, Linz W, Zhu YZ. Comparison of cardioprotective effects using ramipril and DanShen for the treatment of acute myocardial infarction in rats. Life Sci. 2003 Aug 1;73(11):1413-26.

[vii] O K, Cheung F, Sung FL, Zhu DY, Siow YL. Effect of magnesium tanshinoate B on the production of nitric oxide in endothelial cells.Mol Cell Biochem 2000 Apr;207(1-2):35-9.

[viii] Chan TY. Interaction between warfarin and danshen (Salvia miltiorrhiza). Ann Pharmacother. 2001 Apr;35(4):501-4.

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