I enjoyed the article by Dr Ronald Crock, “Herbal Medicine: Top 5 HerbsYour Patients Take . . . But Don’t Tell You” (CONSULTANT, September 1,2003, page 1199).
I enjoyed the article by Dr Ronald Crock, "Herbal Medicine: Top 5 HerbsYour Patients Take . . . But Don't Tell You" (CONSULTANT, September 1,2003, page 1199). I would like to bring to readers' attention a commonlyused Chinese medicinal herb called danshen (Figure), which many patientstake but do not mention to their physicians.Danshen, whose chemical formula is C10H17O6SNa, is derived from theroot of Salvia miltiorrhiza.1 Danshen improves microcirculation, causes coronaryvasodilatation, suppresses the formation of thromboxane, inhibits plateletadhesion and aggregation, and protectsagainst myocardial ischemia.1-3Hence, it is widely used--either aloneor in combination with other herbal ingredients--by patients with coronaryartery disease in China and in othercountries, including the United States.Because danshen is a common componentof many cardiotonic herbalpreparations, patients often may notbe aware that they are taking it.Danshen is usually administeredas an oral tablet; however, it has also been used in a nebulizer.4 The herb haseven been incorporated into some Chinese brands of cigarettes, and those whosmoke them may not be aware of its presence.3,5In addition to its other properties, danshen potentiates the anticoagulantaction of warfarin.3,5-11 Because warfarin is so widely used in clinical practice, itis important to be aware of the unreported or inadvertent use of any drug--Western or traditional--that interferes with warfarin's action. This includesdanshen and even ginseng.10-12---- Tsung O. Cheng, MD
Professor of Medicine
George Washington University
The International Textbook of Cardiology.
New York: Pergamon Press. 1987:1067-1070.
Cheng TO. In: Quinn J, ed.
Cardiovascular Diseases. China Medicine As We Saw It.
Bethesda, Md: TheFogarty International Center; 1974:261-288.
Cheng TO. Warfarin danshen interaction.
Ann Thorac Surg.
Cheng TO, Paul D. White Lecture-Cardiology in People’s Republic of China. In: Russell HI, ed.
NewHorizons in Cardiovascular Practice.
Baltimore: University Park Press; 1975:1-27.
Cheng TO. Ask patients which herbal drugs they smoke as well as eat.
West J Med.
Cheng TO. Warning about a medicinal herb. Hosp Pract. 1999;34(10):23.
Cheng TO. Herbal remedies.
Am Fam Physician.
Cheng TO. What to say about herbal medicines.
Cheng TO. Interaction of herbal medicine with Coumadin.
J Emerg Med.
Cheng TO. Herbal interactions with cardiac drugs. Arch Intern Med. 2000;160:870-871.
Cheng TO. Comment: Drug-herb interaction.
Cheng TO. Ginseng-warfarin interaction.
Am Coll Cardiol Curr J Rev.