Sage is classified as a nootropic herb which simply indicates that it works well to improve clear thinking, memory, concentration and other cognitive functions. It works particularly well when the problem arises as a result of debility or poor circulation. Sage may be used to help enhance the state of mind and to improve mental capacity on a number of levels.

Sage is an excellent support for digestive function. It improves the assimilation of fatty foods and can be used to treat dyspepsia, heartburn, flatulence, poor digestion and bloating.

One of the most well-known traditional uses of sage is to reduce excessive perspiration. Due to this, it has become very popular for use during the menopause. Sage is also supportive for short term or intermittent use during the menopause for helping to improve mood and cognitive function.

Topically, sage is used as a gargle or mouthwash for inflammation in the mouth or throat mucosa. It may be made into a strong infusion or tea and used to treat pharyngitis, tonsillitis, stomatitis, gingivitis and glossitis.

As an excellent anti-inflammatory and anti-bacterial agent, sage may also be used as a wash topically for minor skin inflammations and infections. Balms or creams may also be made, however it is important to avoid using neat sage essential oil on open wounds due to its high thujone content. This compound is usually found in safe levels when using the fresh or dried leaf. However, the essential oil is far more potent and should be used with caution (see safety).

Sage is a deep tonic for nourishment and restoration, especially for the nervous system, digestive tract and cognitive organs. It is packed with a wide range of antioxidant, anti-inflammatory, nervine compounds as well as important trace minerals.

Sage is generally thought to be a gently, stimulating tonic whilst also being an effective herb for improving one’s mood and cognitive function. However, it is also effective for reducing anxiety. 

It acts primarily as a balancer of fluids in the body. It also serves as a deeply oily nutritive tonic, making it useful in more ways than one when it comes to moisture imbalance. Due to this oiliness and combined with sage’s effect on digestive function, it is especially appropriate for people who cannot digest fats well. When preparing sage tea for the oil constituents, it’s important to have a cover on the mug or teapot, to trap the medicinal volatile oils that evaporate when heated.

Sage effectively clears both dampness and heat and is a perfect choice as a constitutional tonic in conditions of dampness or congestion. This is especially useful where there is excessive phlegm, which may be indicated with a wet or engorged tongue, moist placid tissue states or copious sweating. 

This herb is high in aromatic oils and like many other highly pungent, aromatic herbs it has a warm and drying effect upon the tissues. Although it is also observed to have an amphoteric effect in terms of temperature balancing – it can either heat or cool depending on what is needed. Sage also has slightly acrid and bitter to very bitter qualities. 

Sage has a long history of use as a sacred smoke. It is used in ceremony for cleansing and purification on an energetic level. It is also thought to be a protective herb. The practice of burning herbs such as such is also traditionally used for its anti-bacterial and anti-viral properties. This herb offers protection on a number of levels.

Traditional Chinese medicine (TCM) has its own unique system of understanding health balance and disease. Principally, TCM understands that the body is an integrated whole (each and every structure in the body is an integral and necessary part of the whole). In TCM, sage is used to increase Qi (life force), resolve phlegm, restore the uterus and aid in skin/ mucosal health and repair.

Sage leaf was mentioned in the writings of the most historically important physicians and medics throughout ancient Europe. This includes the writings of Hippocrates, Paracelsus, Hildegard von Bingen, and Lonicerus, Bock and Matthiolus.

Its cultivation in Northern Europe dates back to medieval times, and it was introduced to North America during the 17th century. Sage was used in ancient Egyptian, Greek and Roman medicines.

Ancient Egyptians used it as a fertility drug. In Ancient Greece sage was used to staunch bleeding of wounds and to clean ulcers and sores, to soothe hoarseness and coughs, to enhance memory functions and for gargles to treat sore mouths and throats.

The herbals of Gerard, Culpeper and Hill all refer to sage for its ability to enhance memory. Culpepper additionally recommends it for headaches, rheumatic pains and joint pains.

Sage has been well known throughout history with good reference to its carminative, antispasmodic, antiseptic, astringent and anti-hidrotic properties.

The smoke of several of the most aromatic sages was also considered specific for fumigating areas contaminated by the sick or deceased, indicating its usefulness in warding off viruses and bacteria.

Reproductive system

Sage has a number of uses in herbal medicine for the treatment of female reproductive conditions. Its astringent effects on the uterine tissues make it a specific for heavy, painful menstruation.

It is also used to support with a number of menopausal symptoms such as hot flushes and cognitive and mood changes. The astringent antihidrotic effects of its tannins reduce the sweat reflex whilst its nervine effects allow for better cognitive and emotional balance.

These nervine effects are likely a response to improved movement of circulation to the brain and nervous system activation via its aromatic compounds.

A herbalist would likely use sage along with a number of specific herbs for the treatment of reproductive conditions as part of an integrated approach.

Respiratory system

Like other members of the mint family such as thyme and oregano – sage has an astringent and antibacterial effect on lung tissue. It also helps to dry out excess secretions in the respiratory system which can be helpful for a number of conditions.

Sage is an effective anti-inflammatory due to the effects of its phenolic compounds on cell oxidation (1). Additionally, the aromatic compounds in sage such as thujone have been shown to inhibit the lung metastasis of certain tumour cells in vitro in a laboratory (11). A clinical herbalist may use sage as part of an integrated and complementary approach to support cancer patients.

Integrated healthcare can be when allopathic and holistic medicines work collaboratively to optimize health, and it is always best to see qualified health practitioners for serious and life threatening conditions. You can find herbalists on our resources section here.

Nervous system

Sage inhibits the enzyme acetylcholinesterase (AChE) which breaks down one of the brain’s ‘chemical messengers’, acetylcholine. AChE inhibitors have a wide range of therapeutic outlines relating to cognitive and behavioural symptoms. This in part, demonstrates how sage positively improves symptoms of mood disorders such as anxiety and depression and helps memory, as acetylcholine plays an important role in memory function. Sage is able to bring about a sense of calmness, clarity and positivity.

Sage has also been shown to enhance cognitive function and reduce agitation in Alzheimer’s patients. Sage is a herb that is therefore indicated in neurodegenerative conditions and for the treatment of Alzheimer’s disease. These actions are thought to be related to a synergistic effect of sage’s volatile oils and undoubtedly a number of its other compounds.

Skin health

Sage’s effects on the skin are largely due to its astringent action to dry up secretions whilst also acting an anti-microbial agent at the same time. Sage contains tannins which constrict the sweat glands and reduces perspiration. It may also be used for oedema or other swellings.

The astringent and bacteriostatic properties of the tannins along with its antimicrobial essential oils also serve to protect the mucous membranes in the mouth and pharynx against bacteria and viruses, and accelerate the healing of small wounds.

Cellular health

Sage is often applied for its powerful antioxidant properties. Research has shown that this effect is attributed mainly to its phenolic compound, rosmarinic acid (1). Rosmarinic acid works in much the same way as luteolin by inhibiting enzymes linked to inflammatory responses.

As an antioxidant agent, sage can be applied in practice for any manner of conditions where cellular health is affected. Antioxidants help to neutralise harmful free radicals, reducing cell damage in our body which supports the function of our all physical systems.

A number of studies have been carried out on sage. Most interestingly there are studies that have identified positive in vitro cholinergic binding properties. This sequence of in vitro findings led to further exploration of the possible implications of sage’s anti-cholinergic effects. This made way for some great clinical trials whose focus is on the efficacy of sage in treating mood disorders and Alzheimer’s disease, with some interesting results.

Animal studies are not condoned by herbal reality, however for the purpose of including research from which some understanding of therapeutic actions can be confirmed, some animal studies have been included herein.

Anxiety, performance and mood

A double-blind, placebo-controlled, crossover study was carried out to investigate the effects of sage for mood, anxiety and performance. Thirty healthy subjects participated on three separate days, 7 days apart. Each time receiving a different treatment in counterbalanced order on each occasion (placebo, 300, 600 mg dried sage leaf). This study was carried out in part, to further backup a concomitant investigation where an extract of the sage leaf exhibited dose-dependent, in vitro inhibition of acetylcholinesterase and butyrylcholinesterase which may have implications for improvements in mood and cognition.

Mood was assessed both pre-dose and at 1 and 4 hours post-dosing. The study confirms that both doses of sage led to improved ratings of mood in the absence of the stressor. There was an interesting dose dependent effect; the lower dose reduced anxiety, the higher dose increased feelings of alertness, calmness and contentedness.

Task performance was improved for the higher dose at both post dose assessments, but reduced for the lower dose at the later testing session. The results confirm previous observations of the cholinesterase inhibiting properties of S. officinalis, and improved mood and cognitive performance following the administration of single doses to healthy young participants (5). These activities are thought to be associated with a synergistic effect of volatile oil components in sage (6).

Alzheimer’s disease

A double-blind, randomised and placebo-controlled trial was carried out to investigate the efficacy and safety of sage extract using a fixed dose (60 drops/day), in patients with mild to moderate Alzheimer’s disease. Patients were aged between 65 and 80 years old, and were randomised to placebo or fixed dose. The study took place over a 4-month period. The extract produced a significantly better outcome on cognitive functions than the placebo group. The study concludes that sage effectively helps in cases of mild to moderate Alzheimer’s disease. The study also found that the sage group showed reduced agitation (10).

Menopause

An in vitro study was carried out to establish the mechanisms of sage extract for the treatment of hot flush frequency and intensity.

In vitro methods were using 66 % ethanolic tincture, as well as the n-hexane, CHCl3, and aqueous ethanolic sub-extracts obtained from the tincture. Estrogenicity and selective serotonin reuptake inhibition were assessed.

The tincture showed no estrogenic effects whereas the aqueous ethanolic subextract exhibited estrogenicity in the ERLUX assay with an EC50 value of 64 µg/mL.

This study concludes that the synergy of estrogenic flavonoids contribute to the anti-hot flush effect of Salvia officinalis, a safe and commonly used herbal medicinal product during the menopause (9).

Antibacterial and antiviral

A number of in vitro studies have confirmed the strong antimicrobial properties of sage. This is thought to be attributed to the presence of thujones and other volatile components. Inhibitory activity of the oil against Gram-positive and Gram-negative bacteria and against a range of fungi has been demonstrated (1).

There is also evidence of antiviral acidity. This was established by a detailed spectroscopic analysis which identified that the two diterpenoids, safficinolide and sageone isolated from the aerial parts of sage showed antiviral activity (1, 3). Another in vitro test study of water-soluble polysaccharides isolated from the aerial parts of sage also confirmed immunomodulatory activity, as sage caused thymocytes to proliferate (4).

Helicobacter pylori bacteria pose a challenge in modern medicine due to rising antibiotic resistance and associated inflammations with the infection. Sage was processed through phytochemical screening, to evaluate its chemical profile and see which components were active against H. Pylori as well as anti-inflammatory.

Results showed that the main active compounds were flavonoids, sterols, volatile oil, saponins, and carbohydrates. In particular Carnosic acid (37.66%), epirosmanol (20.65%), carnosol1 (3.3%), and 12-O-methyl carnosol (6.15%) were dominant when measuring using GC-MS, while eucalyptol (50.04%) and camphor (17.75%) were dominant in LC-MS and GC-MS respectively. The alcoholic extract showed the strongest anti H.pylori activity followed by the oil. The alcoholic extract also showed the best anti-inflammatory action, when measured against Cox-2 expression. Overall the study found that sage could be useful for H.Pylori infection management (2).

The name Salvia comes from the Latin word ‘salvare‘ meaning to heal and ‘salvere‘ meaning to be healthy. The species name officinalis is derived from the Latin word opificina meaning herb store or pharmacy.

Sage is native to the Mediterranean region, especially in the area of the Adriatic Sea and is cultivated to some extent in different European countries. It is most often found in a range of habitats including dry shrubby vegetation, dry meadows, and rocky steppes.

According to the IUCN Red List of Threatened Plants Status sage is classified as ‘least concern’. The exact native distribution is not well understood however it is observed to be of satisfactory widespread distribution, stable populations and no major threats. It is cultivated and naturalized widely (8). White sage (Salvia apiana) however is now threatened, partially because “smudging” (ceremoniously burning white sage) has become so popular in the West. This was traditionally done by Native Americans, but the popularization of this ritualistic practice has now caused this species to be at risk of extinction in its native territory in the USA.

Habitat loss and over harvesting from the wild are two of the biggest threats faced by medicinal plant species. There are an increasing number of well-known herbal medicines at risk of extinction. We must therefore ensure that we source our medicines with sustainability in mind.

The herb supplement industry is growing at a rapid rate and until recent years a vast majority of medicinal plant produce in global trade was of unknown origin. There are some very real and urgent issues surrounding sustainability in the herb industry. These include environmental factors that affect the medicinal viability of herbs, the safety of the habitats that they are taken from, as well as the welfare of workers in the trade.

The botanical supply chain efforts for improved visibility (transparency and traceability) into verifiably sustainable production sites around the world is now certificated through the emergence of credible international voluntary sustainability standards (VSS). Read our article on Sustainable sourcing of herbs to learn more about what to look for and questions to ask suppliers about sustainability.

The tincture produced from sage leaf should contain minimum 0.1% m/m essential oil. The amount of thujone has to be specified in any given product. The daily exposure has to be below 6.0 mg thujone. Amounts higher than this may be of harm due to its neurotoxic effects (when used in excess) (12).

Herbal Medicines are often extremely safe to take, however it is important to buy herbal medicines from a reputed supplier. Sometimes herbs bought from unreputable sources are contaminated, adulterated or substituted with incorrect plant matter.

Some important markers for quality to look for would be to look for certified organic labelling, ensuring that the correct scientific/botanical name is used and that suppliers can provide information about the source of ingredients used in the product.

A supplier should be able to tell you where the herbs have come from. There is more space for contamination and adulteration when the supply chain is unknown.

Sage is easy to grow in a light, moist, but well-drained soil in full sun in a sheltered position. Excessive winter wet must be avoided. As a Mediterranean plant, it does require a good amount of sunlight and fairly dry conditions. Ideal position would be in a courtyard, patio or wall side border. It can grow happily directly in the soil or in a large pot or container.

• Sage can either be propagated by softwood cuttings in spring or semi-hardwood in late summer. Alternatively, it can be grown from seed sown in spring.
• Sage can suffer damage from sage leaf hopper, cased bugs and slugs. Therefore, protective measures must be taken.
• Dig a hole just big enough for your seedling or rooted cutting. Mix in more organic matter with the excavated soil and fill in the planting hole.
• It is fairly drought tolerant, but like all other drought-resisting plants needs watering until well established. Plants may also need watering during prolonged dry periods.
• Avoid high nitrogen feeds. High potash organic feeds which encourage flowering, better flavours and strong, hardy growth.
• Plants can tend to become leggy in time, so it is important to prune them annually to keep them bushy and full of flowers. Pruning after flowering helps to maintain a better, bushier shape and encourages plenty of new growth.
• Sage does not shoot readily from old wood, so never prune old, brown, leafless stems – otherwise the plant is likely to die.
• You can cover plants with horticultural fleece in winter to protect the leaves from the worst of the weather. Protection with fleece may be a good idea in very cold and exposed areas.

1. SAGE LEAF Labiatae Salviae offi cinalis folium. (n.d.). Available at: https://bhma.info/wp-content/uploads/2012/12/SalviaMonograph1.pdf [Accessed 6 Feb. 2023].
2. Alomar, H.A., Elkady, W.M., Abdel-Aziz, M.M., Ibrahim, T.A. and Fathallah, N. (2023). Anti-Heliobacter pylori and Anti-Inflammatory Potential of Salvia officinalis Metabolites: In Vitro and In Silico Studies. Metabolites, [online] 13(1), p.136. doi:https://doi.org/10.3390/metabo13010136.
3. Tada, M., Okuno, K., Chiba, K., Ohnishi, E. and Yoshii, T. (1994). Antiviral diterpenes from Salvia officinalis. Phytochemistry, 35(2), pp.539–541. doi:https://doi.org/10.1016/s0031-9422(00)94798-8.
4. Capek, P., Hríbalová, V., Svandová, E., Ebringerová, A., Sasinková, V. and Masarová, J. (2003). Characterization of immunomodulatory polysaccharides from Salvia officinalis L. International Journal of Biological Macromolecules, [online] 33(1-3), pp.113–119. doi:https://doi.org/10.1016/s0141-8130(03)00075-8.
5. Kennedy, D.O., Pace, S., Haskell, C., Okello, E.J., Milne, A. and Scholey, A.B. (2006). Effects of Cholinesterase Inhibiting Sage ( Salvia officinalis ) on Mood, Anxiety and Performance on a Psychological Stressor Battery. Neuropsychopharmacology, [online] 31(4), pp.845–852. doi:https://doi.org/10.1038/sj.npp.1300907.
6. Savelev, S.U., Okello, E.J. and Perry, E.K. (2004). Butyryl- and acetyl-cholinesterase inhibitory activities in essential oils of Salvia species and their constituents. Phytotherapy Research, 18(4), pp.315–324. doi:https://doi.org/10.1002/ptr.1451.
7. theodora.com. (n.d.). Salvia (Salviae officinalis folium) – Herbal medicines for human use – European Drugs Reference Encyclopedia. [online] Available at: https://theodora.com/drugs/eu/salviae_officinalis_folium_herbal.html [Accessed 6 Feb. 2023].
8. David Allen (IUCN (2014). IUCN Red List of Threatened Species: Salvia officinalis. [online] IUCN Red List of Threatened Species. Available at: https://www.iucnredlist.org/species/203260/2762648#habitat-ecology [Accessed 6 Feb. 2023].
9. Rahte, S., Evans, R., Eugster, P., Marcourt, L., Wolfender, J.-L., Kortenkamp, A. and Tasdemir, D. (2013). Salvia officinalis for Hot Flushes: Towards Determination of Mechanism of Activity and Active Principles. Planta Medica, 79(09), pp.753–760. doi:https://doi.org/10.1055/s-0032-1328552.
10. Akhondzadeh S, Noroozian M, Mohammadi M, Ohadinia S, Jamshidi AH and Khani M. Salvia officinalis extract in the treatment of patients with mild to moderate Alzheimer’s disease: a double blind, randomized and placebo- controlled trial. J. Clin. Pharmacy Ther. 2003, 28, 53-59
11. Siveen, K.S. and Kuttan, G. (2011). Thujone inhibits lung metastasis induced by B16F-10 melanoma cells in C57BL/6 mice. Canadian Journal of Physiology and Pharmacology, 89(10), pp.691–703. doi:https://doi.org/10.1139/y11-067.
12. European Union herbal monograph on Salvia officinalis L., folium Final Initial assessment Discussion in Working Party on European Union monographs and list (MLWP) Adoption by Committee on Herbal Medicinal Products (HMPC) for. (2016). Available at: https://www.ema.europa.eu/en/documents/herbal-monograph/final-european-union-herbal-monograph-salvia-officinalis-l-folium-revision-1_en.pdf [Accessed 6 Feb. 2023].