THE USE OF SALVIA FOR PATIENTS WITH RENAL FAILURE
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon
Renal failure is increasingly common, primarily because of high rates of diabetes and hypertension (1).
Despite ongoing public alerts about essential dietary controls and exercise requirements for maintaining
health, there is heavy reliance on risk-reducing and disease modifying drugs as well as surgical interventions
for dealing with the adverse impact of modern lifestyle problems. Renal failure also occurs as the result of
systemic autoimmune disorders (e.g., lupus), chronic use of certain nephrotoxic drugs, repeated or severe
renal infections, and primary kidney disorders, such as glomerulonephritis and polycystic kidney disease.
Except for cases of temporary decline in renal function that may occur from several causes, kidney disease
is usually progressive once a significant fraction of nephrons are damaged, and the disorder becomes end-
stage renal disease (ESRD). A summary of the incidence and primary causes of ESRD have been monitored
and reported. The U.S. data available at this writing comes from reports produced up from 1999 to 2005.
Here are the basic statistics showing the increasing frequency of ESRD and the primary causes (2):
Incidence (annual new cases) of ESRD: 89,252 (1999); 93,327 (2001); 106,912 (2005)
Prevalence (existing cases) of ESRD: 361,031 cases (1999); 392,023 cases (2001); 485,012 cases (2005)
3/4 of the cases attributed to these primary diseases (number of cases indicated):
The cost of treating people with ESRD has been estimated to be $32 billion dollars per year, as of 2005.
Most patients are treated by in-center hemodialysis, and to a much lesser extent via other dialysis techniques,
and then, when possible, by kidney transplant. The first hemodialysis center was established in Seattle in
1962 and this method became routine in the U.S. in the 1970s; kidney transplantation became a routine
procedure in the 1980s.
According to the Annual Report of the Organ Procurement and Transplantation Network (3), the kidney
transplant waiting list more than doubled in the decade from 1993 and 2003 to over 50,000, and reached
79,000 by the end of 2007. The number of kidney transplants performed in the U.S. increased from less than
10,000 per year before 1990 to over 16,000 per year in 2004. The combined number of those on waiting lists,
those who receive transplants, and those in need of transplants but not on the list, now comes to about 100,000
per year. About 2/3 of transplanted kidneys are from cadavers (mainly from auto accidents and other sudden
causes of death); the other one-third are from living donors. Both kinds of transplants require
immunosuppression, but matched family donors can provide organs that need minimal suppression.
During dialysis (e.g., hemodialysis, peritoneal dialysis) and after renal transplant, there is considerable
concern about foods, beverages, drugs, nutritional supplements, and herbs that might be taken, since the
potential action of their constituents on the remaining kidney function or on other physiological responses that
might influence the kidney condition (such as immune system effects) are often unknown or poorly known.
Nonetheless, some patients desire assistance with herbs and other natural therapies. An herb of interest is
salvia (Chinese: danshen), which has been used in China for patients with early renal failure, for those who
are on dialysis, and after renal transplant. Rhubarb (Chinese: dahuang) has also been used for preventing
progression of early renal failure and treatment of patients who could not access dialysis or transplant.
SALVIA AND RENAL FAILURE
Salvia has been used in treatment of chronic renal insufficiency in China for at least thirty years. In 1978, an
article in the Shanghai Journal of Traditional Chinese Medicine reported on this application (4). In 1989,
Japanese researchers reported on isolation of a constituent of salvia responsible for promoting renal function,
which was identified as lithospermate B (5). This ingredient, like the whole root of salvia, was reported to
enhance plasma blood flow and reduce glomerular filtration rate in the kidneys of laboratory animals
suffering renal failure; it was later shown to be of potential benefit for diabetic nephropathy (6) and for
improving renal microcirculation (7). In 1993, Chinese researchers in Hangzhou reported on the effect of
salvia injection in patients undergoing peritoneal dialysis for renal failure, claiming it could markedly increase
the clearance rate and ultrafiltration rate of creatinine, urea nitrogen, and uric acid (8). A study in Japan
published in 2000 further noted that salvia inhibited nitrogen oxide (NO) production which was thought to be
a contributor to both acute and chronic renal failure (9), while a study in Korea published in 2004 suggested
that scavenging of free radicals was part of the mechanism of action for both salvia and its component
lithospermate B (10)
Salvia has also been used in the treatment of patients who have undergone organ transplants to help
prevent rejection and aid longevity of the transplants. Pharmacological studies appeared to confirm the value
of this application (11). A review of its use in renal transplant patients was published in 2004 (12). Claimed
benefits included improvement in nearly all blood parameters that monitor renal function, improved recovery
from the transplant, and better protection of the kidney. In a summary statement, the authors noted:
According to TCM theory, many symptoms of patients after renal transplantation belong to
the category of blood stasis. Many animal experiments proved that salvia has the actions of
activating blood circulation and removing blood stasis; it could ameliorate renal ischemia,
improve blood circulation and microcirculation in the kidney, thereby enhancing the oxygen
utilization ability of the graft’s tissue and accelerating its repair process, which is favorable to
preventing rejection. In observing the effect of salvia in treating acute vascular rejection after
renal transplantation (Wu Kun et al.,), 81 allograft recipients were treated in two groups:
methylprednisolone impulse (control group) and methylprednisolone impulse plus salvia (treated
group). Salvia was administered by adding 30 ml of salvia injection in 5% glucose saline (250
ml) for IV dripping. The total therapeutic course was 14 days. Seven parameters—blood urea
nitrogen, serum creatinine, creatinine clearance rate (CCr), urine albumin, N-aceytl-D-
glucosamine (NAGase), D-dimer (DD), and antineutrophil cytoplasm antibody—were observed
and the efficacy of treatment was estimated as effective when the SCr of the recipients decreased
by more than 20% or the CCr rose by more than 20%, or when the clinical symptoms were
relieved or disappeared; the other cases were considered ineffective. Results showed that the
levels for all seven parameters were significantly improved in both groups. Comparisons between
the effects in the two groups showed that the results for the treated group were superior to that of
the control group in the total effective rate and in the improvement of the levels of NAGase and
DD. The authors concluded that salvia could enhance the curative effect of methylprednisolone
impulse in controlling acute vascular rejection. Further study showed that DD, as the simplest
degradation product of fibrin monomers, increased in vascular rejection, suggesting that a
hypercoagulative state and hyperfibrinolysis might affect the microcirculation of the allograft and
result in microthrombus formation in the allograft. NAGase is a renal tubular lyosomal enzyme;
increase in its activity reflects the damage to the renal parenchyma. Salvia treatment could reduce
the titer of the two parameters, the mechanism is related to its effects in regulating capillary
tension, improving hemorrheological properties, impacting activity of fibrinolysis, suppressing
platelet aggregation, reducing blood viscosity, inhibiting the excessive expression of nitrogen
monoxide (NO) and peroxide, and improving microcirculation, and thus improving function of
the transplanted kidney. Huang Zufa, et al., also reported that salvia is able to enhance the
curative effect of immunosuppressant, protect renal tubular epithelial cells, and accelerate the
recovery of renal function of the graft.
RHUBARB AND RENAL FAILURE
China had limited ability to provide dialysis or renal transplant until recently, primarily due to economic
conditions. Herbal therapies were devised to treat patients with early renal failure. The common ingredient in
virtually all the treatments was rhubarb root; it could be used alone, but was usually incorporated into
formulas, and it might be given by retention enema, IV injection, or in decoctions given orally. A difficulty
with rhubarb treatment is that it usually produced loose stool or diarrhea. This method of treatment persisted
into the 1990s, but is used less now that dialysis and transplantation are available. Still, it is worth
investigating, because low to moderate doses of rhubarb may provide some benefits.
The traditional medicine rationale for using rhubarb in treatment of patients with renal failure is that the
disease is marked by an underlying condition of deficiency (which allows the deterioration) and an overlay of
excess, namely stagnation of blood and accumulation of damp and turbidity. Rhubarb is applied to address
the excess through its purgative and diuretic qualities, as well as its blood-vitalizing activity. While
alleviating this secondary condition, therapies for the underlying deficiencies might be applied, relying mainly
on tonic formulas that address the specific types of deficiency (e.g., yin deficiency, qi deficiency, etc.).
In a study published in 1995 (13), patients with chronic renal failure were treated by traditional Chinese
medicine according to standard methods of differential diagnosis; tonic formulas selected accordingly, but
each prescription was also accompanied by rhubarb, with 8–12 grams in a daily decoction. The dosage of
rhubarb was adjusted so that the patients experienced no more than two soft stools daily, thus avoiding
electrolyte imbalances or other problems from the purgative action of the herb. Both the herb-treated patients
and a control group were provided modern medical therapies, such as restricting protein intake and treating
specific disorders with drugs (e.g., infections, hypertension). Patients were not undergoing dialysis.
According to the authors, the herb therapies resulted in slowed or partially reversed disease progression in
about 82% of cases.
Some researchers focused on use of specific formulas along with rhubarb, rather than multiple formulas.
For example, in a study of herb therapy for patients with chronic renal failure, the well-known traditional
formula Xiao Chaihu Tang was used with addition of rhubarb (6 grams per day) and leonurus. Xiao Chaihu
Tang belongs to the harmonizing group of herbal therapies. The case was made that this combined therapy
(harmonizing plus rhubarb) could alleviate several factors that contribute to progression of chronic renal
failure, including hypertension, high blood viscosity, and immune attack against nephrons. Use of the
formula led to the observed result of slowed progression of the disease (14).
Another approach described in the literature is to use herbs that invigorate spleen function to remove
accumulated dampness and turbidity, along with rhubarb and other herbs to activate circulation and reduce
excess (15, 16). A treatment was devised based on Liu Junzi Tang, a traditional formula for the spleen weak
and damp syndrome, adding rhubarb (15 grams/day) and several blood vitalizing herbs such as sparganium,
zedoaria, tang-kuei, and cnidium. This study was long-term (patients treated for 10–18 months) and involved
patients with chronic glomerulonephritis (15). Another long-term study (treatment duration 10–22 months)
relied on a qi tonic and damp-eliminating formula with astragalus, pseudostellaria, hoelen, alisma, and
pinellia, along with rhubarb (10 grams/day) and blood vitalizing herbs: red peony, cnidium, and millettia (14).
All patients were treated with modern medicine as appropriate, but no dialysis was utilized; the control group
did not receive the herb therapies. As with the other studies, improvements in blood markers were found and
progression of the disease was reported to be notably slowed in the herb group. A formula with salvia and
rhubarb, plus tonic herbs (such as astragalus, cordyceps, and codonopsis) was reported to display
nephroprotective effects in an animal model (17).
In presenting potentially useful herbal interventions, it is important to note that there are other important
considerations in treatment of patients with renal failure, some of them were prominently mentioned in the
study reports cited above, including low-protein diets and blood pressure control as the primary concerns.
Other interventions, such as the administration of lipid-lowering agents, anti-inflammatory drugs, and anti-
oxidant agents are emerging as particularly promising therapeutic approaches (18); salvia and rhubarb are
examples of herbs that may contribute all these potentially useful benefits.
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3. Organ Procurement and Transplantation Network, Scientific Registry of Transplant Recipients Data Reports,,
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