Sage
Salvia officinalis · Lamiaceae · leaf
Also known as garden sage, common sage, Dalmatian sage, Salbei (German), sauge (French). Not the same plant as red sage (Dan Shen), white sage, or rosemary; see About.
- Warming
- Drying
- Aromatic
- Bitter
- Astringent
- Antihidrotic (reduces sweating)
- Carminative
- Antimicrobial
Educational content, not medical advice. I am a certified clinical herbalist, not a physician. Nothing on this page diagnoses, treats, or cures any condition, and none of it replaces care from your own healthcare provider. Do not stop or change a prescribed medication based on anything you read here. Sage leaf tea and sage essential oil are different substances at very different strengths. The oil and concentrated alcohol extracts carry a seizure risk from thujone and can interact with medications and health conditions, so talk with your doctor or pharmacist before using sage beyond food amounts.
About Sage
Sage is a small woody shrub in the mint family, Lamiaceae, with square stems, gray-green wrinkled leaves that are soft and woolly underneath, and blue to violet flowers in whorls along a tall spike. Crush a leaf and the smell is sharp and camphor-like, which comes from the volatile oil described under Constituents. The plant lives for years and hardens with age, so herbalists cut fresh growth rather than the old wood.1
- Native range: King's American Dispensatory records sage as "a native of southern Europe," and the EMA places it on the Adriatic coast, which is why the best-known commercial grade is called Dalmatian sage. It was cultivated across northern Europe in the medieval period and carried to North America in the 1600s.1,7
- Where it grows now: dry, sunny, well-drained ground worldwide. The leaf sold in the United States comes mostly from Albania, Croatia, and Turkey. It overwinters in Zone 5 with good drainage and dislikes wet feet more than cold.
- Harvest: King's advises gathering leaves and tops during flowering in June and July and drying them with care.1 Oil content and thujone are highest in young top leaves and lower toward the base of the plant.7
- Identifying the dried leaf: the U.S. Pharmacopoeia description quoted in King's: leaves about 2 inches long, finely toothed, thick, wrinkled, gray-green, soft-hairy and glandular beneath; odor aromatic; taste aromatic, bitterish, and somewhat astringent.1
- Which traditions used it: Greek and Roman medicine, then every European herbal from Gerard and Culpeper onward, the Eclectic and Physiomedicalist physicians of the United States, and the German and European regulatory monographs of the past 50 years. Sage traveled from Greek medicine into India, where the EMA notes it appears in Unani and Ayurvedic practice under the name Salbia-sefakuss, but it is not a classical Ayurvedic or Chinese herb and this page does not treat it as one.7
Sage, red sage, white sage, and rosemary
The genus Salvia holds close to a thousand species and several share the name sage. Red sage on this site means Salvia miltiorrhiza, the Chinese root Dan Shen, which has different chemistry and a documented warfarin interaction. Maud Grieve also used "Red Sage" for a purple-leaved garden variety of Salvia officinalis, which is where the older label on this page came from; the two uses are unrelated.4 White sage, Salvia apiana, is the western North American species burned for smoke and is not covered here. Rosemary was moved into Salvia in 2017 on genetic evidence and is now Salvia rosmarinus, but it remains a separate species with its own page.24 Every source below refers to garden sage, Salvia officinalis, unless stated otherwise.
Traditional Use
The traditions below describe how practitioners have used sage. These are historical and clinical records, not instructions. None of this is medical advice.
Energetics
Sage is warm, dry, bitter, and aromatic, with a tightening (astringent) quality from its tannins. Woodville in 1790 called the taste "warm bitterish aromatic," and King's specific indications a century later describe the person sage was thought to fit: skin soft and relaxed, extremities cold, circulation feeble, and sweating that drains rather than relieves.1,3 Its defining action across every source is to reduce secretions: sweat, milk, saliva, and catarrh from the mucous membranes.1,4,5 It suits damp, cold, loose conditions. It is a poor match for someone who is already hot, dry, and thirsty, and King's notes it is "less likely to prove beneficial" when sweating comes with hectic fever and a dry, harsh skin.1
- Western herbalism: a drying astringent and warming carminative, with a long reputation for the mouth and throat and for checking sweat and milk.1,4,11
- Temperature depends on how it is served: King's, Felter, and Cook all record that warm sage tea raises a sweat while cold sage tea restrains it. That single observation shaped how every later source doses it for night sweats.1,2,25
The Eclectics
King's American Dispensatory (1898) calls sage "feebly tonic, astringent, expectorant, and diaphoretic," and Felter's 1922 Eclectic Materia Medica repeats the assessment as "a feeble tonic, astringent, and diaphoretic." In plain terms: a mild strengthener that tightens tissue and, taken warm, promotes sweating. The Eclectics used it for:1,2
- flatulence with debility, as an infusion
- "exhausting sweats" and colliquative (draining) sweating, as a cold infusion sipped through the day
- a gargle for inflamed or ulcerated throat and relaxed uvula, alone or with vinegar, honey, alum, or sumach berries; King's compound infusion combines sage with hyssop and borax for mouth sores and quinsy1
- a wine infusion applied to the breasts to check milk flow, a use King's credits to the Dutch physician Van Swieten
- spermatorrhea (involuntary loss of seminal fluid) and as an anaphrodisiac, on the authority of Dr. James Anton of Lebanon, Ohio, who King's says used it "in connection with moral, hygienic, and other aids"; a historical use recorded here for completeness
- the oil, in small doses as a carminative and rubbed in externally for rheumatism
Felter adds one caution of his own: "It is not a remedy for sweating associated with high fever."2
The Physiomedicalists
William Cook's Physiomedical Dispensatory (1869) makes a distinction the later texts lost. Steeped 10 minutes in lukewarm water, sage gives "a soothing and diffusive drink, relaxant and moderately stimulant," which settles nausea and brings on a gentle sweat, his family remedy for measles, fresh colds, and quinsy. Steeped long in boiling water, it becomes "a mild tonic and astringent" for gargles and for the draining sweats of hectic fever and typhus, and he warns that the strong version is "rendered worthless" for the gentle uses. Cook also records it for the diarrhea of measles, notes that cold sage "frequently acts upon the kidneys," calls it "reputed of some service in spermatorrhea," and cites Rafinesque for an application of the leaves to reduce milk.25
Older European practice
Woodville's Medical Botany (1790) gathers the earlier record: Quarin used a strong infusion for night sweats, Van Swieten found it useful for stopping milk after weaning, and Etlinger's experiments showed "a considerable share of antiseptic power," meaning the leaf slowed the spoilage of meat. Woodville also notes that the Chinese of his day valued sage tea above their own tea, a trade detail that appears in several herbals of the period.3 Maud Grieve (1931) records the gargle for sore throat, relaxed tonsils, bleeding gums, and "to prevent an excessive flow of saliva"; the tea for night sweats, nervous headache, and "haemorrhage from the lungs or stomach"; the fresh leaf rubbed on the teeth to "cleanse them and strengthen the gums," with sage as "a common ingredient in tooth-powders"; and the old belief, going back to Gerard and Culpeper, that sage strengthened memory.4 That last claim is the one modern trials have tested most.
European regulatory monographs
Germany's Commission E approved sage leaf internally for dyspeptic complaints and excessive perspiration, and externally for inflammation of the mouth and throat.5 The European Medicines Agency's 2016 monograph accepts four traditional uses on the strength of at least 30 years of documented medicinal use: relief of mild dyspeptic complaints such as heartburn and bloating; relief of excessive sweating; relief of inflammations in the mouth or throat, as a gargle; and relief of minor skin inflammations, as a compress. It states that the clinical data "cannot be considered to fulfil the criteria" for the higher well-established-use tier.6,7 The monograph is under periodic review, with a call for new data that closed in May 2025. ESCOP, the European scientific cooperative, lists the same uses plus hot flushes and raised blood sugar and lipids.10
Modern clinical use
David Hoffmann lists sage as carminative, antispasmodic, antimicrobial, astringent, and anti-inflammatory, uses the infusion as a mouthwash for gingivitis and as a gargle for laryngitis, pharyngitis, and tonsillitis, and gives it internally to reduce sweating and breast milk production.11 Contemporary herbalists reach for it in menopausal night sweats, for drying up a wet, congested head cold, as a daily mouth rinse for the gums, and, in combination with warming digestive herbs, for the sluggish gut described on my gut health page.
Constituents and What They Do
Sage chemistry splits into a volatile oil that carries both the antimicrobial action and the toxicity, and a set of water-soluble and alcohol-soluble compounds that carry the astringent, antioxidant, and cognitive effects. Figures are from the EMA assessment report unless noted.7
| Constituent | Amount and solubility | What studies show |
|---|---|---|
| Volatile oil: alpha-thujone, beta-thujone, camphor, 1,8-cineole, borneol, minor terpenes | Up to 3 percent of the dried leaf. Alpha-thujone 10 to 60 percent of the oil, beta-thujone 4 to 36 percent, camphor 5 to 20 percent, 1,8-cineole 1 to 15 percent, with wide batch variation. King's put thujone at 50 percent in 1898. Dissolves in alcohol and fat, poorly in water, and leaves with steam.1,7 | Sage oil inhibited a range of bacteria and Candida species in laboratory tests, an effect attributed mainly to the thujones.7 Thujone blocks the GABA-A receptor, the brain's main calming switch, which is the mechanism behind seizures at high doses in animals and in human case reports; camphor adds to that toxicity.7,8 1,8-cineole and alpha-pinene inhibited acetylcholinesterase, the enzyme that breaks down the memory neurotransmitter acetylcholine, in the test tube.7 |
| Rosmarinic acid and related caffeic acid compounds | Up to 3.3 percent of the leaf; hydroxycinnamic acids about 3.5 percent in total. Water and alcohol soluble. | Anti-inflammatory in laboratory work. A 5 percent rosmarinic acid application lowered gum inflammation and plaque scores in six rhesus monkeys.7 In human gum cells exposed to a sage infusion, the volatile compounds cut inflammatory signaling by more than half, and rosmarinic acid did not, so it is not the whole story for the mouth.7 |
| Phenolic diterpenes: carnosic acid, carnosol, rosmanol, safficinolide | Carnosol about 0.35 percent. Alcohol and oil soluble, not water soluble. Carnosic acid oxidizes to carnosol on storage. | Antioxidant activity and antiviral action against one test virus in laboratory work. Galdosol and related diterpenes bound the same brain receptor as diazepam in tissue from human brain, which may help explain the calming effect seen in trials.7 |
| Triterpene acids: ursolic acid, oleanolic acid | Ursolic acid up to 3.5 percent. Alcohol soluble, poorly water soluble. | Ursolic acid was twice as potent as indomethacin against induced ear swelling in mice. Both acids inhibited vancomycin-resistant enterococci and MRSA in the test tube, though far less strongly than clinical antibiotics.7 |
| Flavonoids: luteolin, apigenin, hispidulin, cirsimaritin and their glycosides | About 1.1 percent. Water and alcohol soluble. | Hispidulin bound benzodiazepine receptors; cirsiliol showed sedative effects in animals. Luteolin-7-glucoside showed weak estrogen-like activity in a test-tube study funded by the maker of a sage menopause product.7,17 |
| Tannins | Water soluble, and most fully extracted by a long steep in boiling water, which Cook noted in 1869 by contrasting it with a short lukewarm infusion.25 King's identified them because the infusion turns black with iron salts.1 | Responsible for the astringent, tightening feel of the gargle, the reduction of secretions from sweat glands, salivary glands, and mucous membranes described across the traditional record, and the gum-tightening effect of the rubbed leaf. Tannins can bind minerals when tea is taken with meals. |
| Polysaccharides: pectin, arabinogalactan | Water soluble, best pulled by a long steep. | A sage polysaccharide fraction reduced mechanically induced cough in cats and stimulated immune cell growth in rat tissue. Animal and laboratory data only.7 |
What the Research Shows
Sage has more human trials than most kitchen herbs and almost all of them share one problem: they are small, short, and run by a single research group or by the company selling the product. Read together, they point the same direction as the traditional record. Single doses of the leaf or its extract improved memory and mood scores in healthy volunteers and slowed cognitive decline over 4 months in one Alzheimer's trial. Two manufacturer trials reported fewer hot flashes. A throat spray beat placebo by a modest margin, and a sage gel improved gum bleeding after deep cleaning in a small dental trial. An extract lowered blood sugar and lipids in diabetic patients in one Iranian trial with effects large enough to need replication before anyone leans on them. The sweating use, the one sage is most famous for, rests on uncontrolled studies and tradition. The EMA reviewed most of this work in 2016 and judged it enough for "plausibility" of traditional use, not proof of efficacy.7
Sage leaf extract and mild to moderate Alzheimer's disease
- Design: 42 patients aged 65 to 80 with a diagnosis of probable Alzheimer's disease were randomized to 60 drops of sage extract or placebo drops daily for 16 weeks at three centers in Iran; 30 completed.14
- Findings: the sage group scored better than placebo on the Alzheimer's Disease Assessment Scale cognitive subscale and the Clinical Dementia Rating at 16 weeks. Agitation was reported less often in the sage group. Mild gastrointestinal complaints were slightly more common with sage but not significantly so.7,14
- Dose: 60 drops daily, about 3 ml, of a 1:1 extract, meaning roughly 3 g of leaf equivalent. Extract, not tea.
- Limitations: 30 completers is a small sample for a dementia trial, 4 months is short, and the result has never been repeated by an independent group. The same lead author published a near-identical positive trial of lemon balm in the same year using the same design. A 2014 systematic review rated the blinding and randomization reporting as inadequate.22 Funded by the authors' own institute, the Institute of Medicinal Plants in Tehran. Anyone with dementia needs a physician managing their care; this trial is a reason for further research, not a reason to self-treat.
Single doses of dried sage leaf, mood, and mental performance
- Design: 30 healthy adults, average age 24, took placebo, 300 mg, or 600 mg of dried sage leaf on three separate days a week apart, then completed mood scales and a 20-minute multitasking stress test.15 A follow-up by the same lab gave 20 adults over 65 four doses of a sage extract (167 to 1,332 mg) and placebo on five separate days, with memory testing over 6 hours.16
- Findings: in the young adults, 600 mg raised self-rated alertness, calmness, and contentedness and improved performance on the stress test; 300 mg reduced anxiety before the test but lowered alertness during it. In the older adults, the 333 mg dose improved secondary memory (recall after a delay) at every time point and improved accuracy of attention, with smaller effects at other doses. The extract inhibited cholinesterase enzymes in the test tube, which the authors propose as the mechanism.15,16
- Dose: 300 and 600 mg dried leaf, single dose; 167 to 1,332 mg extract, single dose. Both are inside the range of a strong cup of tea in leaf terms.
- Limitations: single doses in small groups of healthy people measured over hours, so nothing here shows what daily use does over weeks. The 300 mg dose cut both ways. Repeated testing can improve scores for reasons unrelated to treatment. Leaf and extract were supplied by MedicHerb UK, a herbal manufacturer, and the older-adult study had industry involvement in the extract. The Northumbria group has published most of the positive sage cognition work, so independent replication is thin.22
Fresh sage extract and menopausal hot flashes
- Design: the 2011 study gave 71 postmenopausal women with at least five flashes a day one tablet of fresh sage extract daily for 8 weeks, with no placebo group.17 The 2021 trial randomized 80 women aged 48 to 65 to the same product or placebo for 4 weeks under double-blind conditions.18 The 2023 review pooled four randomized trials totaling 310 women.19
- Findings: in the open study, the intensity-weighted hot flash score fell 50 percent by week 4 and 64 percent by week 8. In the placebo-controlled trial, the sage group improved more than placebo on the physical and psychological subscales of the Menopause Rating Scale and on sleep quality, with no difference on urogenital symptoms and three adverse events in total, none attributed to treatment. Pooled across four trials, sage reduced hot flash frequency compared with placebo, while the reduction in severity did not reach significance and the trials disagreed with one another substantially.17,18,19
- Dose: one tablet daily of extract equivalent to 795 to 1,370 mg fresh leaf (2011); 3,400 mg fresh-leaf extract daily (2021). Fresh-leaf ethanol extract, not dried leaf tea.
- Limitations: the 2011 study had no control group, and hot flashes respond strongly to placebo, so its percentages overstate the effect. Both trials were designed, funded, and co-authored by A. Vogel Bioforce, the manufacturer, and the 2021 trial lasted only 4 weeks in 80 women. The four pooled trials used different products and doses, and the review authors themselves called for confirmation. Estradiol levels did not change in the one trial that measured them, so the mechanism is not hormonal in any measured sense.19
Sage fluid extract spray and acute sore throat
- Design: 286 adults with viral sore throat of under 48 hours, negative for strep, were randomized across two study stages to sprays of 5, 15, or 30 percent sage extract or placebo, three puffs per application, for 3 days. Throat pain was rated every 15 minutes for the first 2 hours.20
- Findings: the 15 percent spray reduced throat pain more than placebo over the first 2 hours, about 44 percent versus 34 percent. The 5 and 30 percent sprays did not separate from placebo, so no dose-response pattern appeared. Side effects were mild dryness or burning.7,20
- Dose: 140 microliters of extract per application. Topical to the throat, not swallowed in any quantity.
- Limitations: the placebo contained matching alcohol plus 0.3 percent sage extract to mask the taste, so it was not fully inert. A 10-point difference on a 100-point pain scale is modest, and the sage group's improvement in the main study was about the same size as the placebo response in the first stage. The lead author was employed by Sidroga, the manufacturer. The EMA assessor noted that a spray at 15 percent is a different product from the 2.5 percent gargle in the traditional record and declined to count it as evidence for the gargle.7
Sage gel on the gums after periodontal cleaning
- Design: 14 otherwise healthy adults with periodontitis (gum disease with bone loss and pockets of 5 mm or deeper) had all affected sites scaled and root-planed. Sage gel was then applied to test sites and nothing extra to control sites in the same mouth, with bleeding on probing, pocket depth, and attachment level measured at baseline and one month.26
- Findings: bleeding on probing fell significantly at the sage sites and did not change at the control sites. Pocket depth and attachment level improved at both, with larger gains at the sage sites.26 This is consistent with Grieve's record of the gargle for bleeding gums and the rhesus monkey work on rosmarinic acid.4,7
- Dose: a topical gel applied once by the dentist after cleaning, not a mouthwash and not swallowed.
- Limitations: 14 people, one month, one clinic, and the control sites received no placebo gel, so patients and examiners knew which side was treated. The split-mouth design also allows the gel to affect the untreated side through saliva, which would shrink the measured difference rather than inflate it. Sage as an add-on to professional cleaning is the question tested here; sage instead of a dentist was not.
Sage leaf extract, blood sugar, and blood lipids in type 2 diabetes
- Design: 80 patients with type 2 diabetes and high cholesterol or triglycerides at one clinic in Karaj, Iran, took a 500 mg extract capsule or a placebo capsule of toast powder three times daily for 3 months alongside their usual medication.21
- Findings: compared with placebo, the sage group finished with fasting glucose 32 percent lower, HbA1c 23 percent lower, LDL cholesterol 36 percent lower, triglycerides 56 percent lower, and HDL 28 percent higher. Liver and kidney markers did not change and no adverse effects were reported. An earlier 2-month trial by the same group in 67 non-diabetic patients with high lipids reported the same lipid pattern.7,21
- Dose: 1,500 mg of concentrated extract daily, made from 20 kg of leaf yielding 5.1 kg of extract, so roughly 4 g of leaf equivalent per day.
- Limitations: effect sizes this large are unusual for any herb and exceed what many prescription drugs achieve, which is a reason to wait for an independent trial rather than to celebrate. Single center, 80 patients, one research group producing both trials, and a toast-powder placebo that may not have matched the extract in taste. A 2022 meta-analysis pooling the available trials found smaller but still favorable effects on glucose and lipids. Relevant to the medication caution in Safety: if these effects are even partly real, adding sage extract to diabetes drugs could push blood sugar too low.
Sweating: the traditional record and the uncontrolled studies
- Design: historical and regulatory records plus open studies. In one, 40 patients with idiopathic hyperhidrosis (heavy sweating without a known cause) took a dried water extract of sage (440 mg, about 2.6 g leaf) and 40 drank an infusion of 4.5 g leaf daily. An unpublished 1989 study followed 80 patients.7,10
- Findings: sweat output fell by less than half in both groups. Madaus recorded in 1938 that a concentrated sage preparation increased sweating in people who sweat little and decreased it in people who sweat heavily, an observation that matches the warm-versus-cold rule of King's and Cook.7,25 The EMA accepted long-term use for sweating on the basis of continuous German use since 1976 and allows up to 6 weeks before a practitioner check-in.6
- Dose: see the dosing table. Water preparations are the ones tested.
- Limitations: none of these studies had a control group, most date from the 1930s, and the largest was never published. Sweating varies with temperature, stress, and season, so uncontrolled reductions are easy to overread. The hot flash trials above are the closest thing to controlled evidence and they used a fresh-leaf extract rather than tea.
Dosing Perspectives
Not medical advice. The doses below are educational. They show how different herbalists, traditions, and regulators have approached sage so you can see where they agree and where they differ. They are not a recommendation for you. Work with your healthcare provider or a clinical herbalist before using sage beyond food amounts, especially if you are pregnant or nursing, have a seizure disorder, take diabetes or anti-seizure medication, or are considering the essential oil.
| Source | Preparation | Dose (as stated) | Use |
|---|---|---|---|
| Cook, Physiomedical Dispensatory (1869) | Lukewarm infusion (½ ounce leaves to 1 pint warm water, 10 minutes); strong infusion (1 ounce to 1 pint boiling water, covered, 1 hour) | Lukewarm infusion: 2 fluid ounces or more every hour, warm for sweating and nerves, cold for the kidneys. Strong infusion: "used freely as a gargle," with 1 drachm alum and 2 ounces honey to the pint | Internal (lukewarm); gargle (strong), external |
| King's American Dispensatory (1898) | Infusion; powdered leaves; strong tincture (8 ounces sage to 1 pint of 76 percent alcohol) | Infusion 2 to 4 fluid ounces, 3 or 4 times a day; powdered leaves 20 to 30 grains; tincture 1 to 60 drops | Internal; infusion as a gargle and wine infusion on the breasts, external |
| Felter, Eclectic Materia Medica (1922) | Leaves; tincture (8 ounces sage to 16 fluidounces of 76 percent alcohol); infusion (½ ounce to 16 fluidounces water) | Leaves 5 to 30 grains; tincture 1 to 60 drops; infusion 1 to 4 fluidounces | Internal; gargle external |
| German Commission E (1990) | Dried leaf; essential oil; tincture; fluidextract | Daily: 4 to 6 g dried leaf; 0.1 to 0.3 g essential oil; 2.5 to 7.5 g tincture; 1.5 to 3 g fluidextract. Gargle: 2.5 g leaf or 2 to 3 drops oil in 100 ml water, or 5 g alcoholic extract in a glass of water | Internal; gargle, rinse, and undiluted extract painted on the gums, external |
| European Medicines Agency (2016) | Dried leaf as infusion; tincture 1:10 in 70 percent ethanol; dry water extract 4-7:1 | Digestion: 1 to 2 g in 150 ml boiling water, 3 times daily; tincture 2 to 3 ml, 3 times daily. Sweating: 2 g in 150 ml; for night sweats, liquid extract 1 hour before bed. Gargle: 2.5 g in 100 ml, 3 times daily; tincture 5 to 10 ml in a glass of water. Skin: 2.5 g in 100 ml as a compress 2 to 4 times daily. Daily thujone below 6.0 mg. Not under 18 | Internal (digestion, sweating); gargle and compress, external |
| British Herbal Compendium (Bradley, 2006) | Dried leaf as infusion; liquid extract 1:1 in 45 percent ethanol | 3 to 6 g dried leaf daily; liquid extract 2 to 6 ml daily. Gargle: 2.5 g leaf to 100 ml water | Internal; gargle external |
| Barnes, Anderson, and Phillipson, Herbal Medicines (2007) | Dried leaf as infusion; liquid extract 1:1 in 45 percent alcohol | Leaf 1 to 4 g as an infusion three times daily; liquid extract 1 to 4 ml three times daily | Internal; gargle and mouthwash external |
| David Hoffmann, Medical Herbalism (2003) | Tincture 1:5 in 40 percent alcohol; infusion | Tincture 2 to 4 ml, three times a day; Commission E's 4 to 6 g dried herb daily, cited as the internal dose | Internal; infusion as mouthwash and gargle, external |
| Madaus, Lehrbuch der Biologischen Heilmittel (1938) | Tincture; warm infusion | Tincture 60 drops daily for sweating; 30 to 50 drops several times a day to stop milk; warm infusion of 2 to 3 full spoons (3.4 to 5.1 g) of leaf | Internal; gargle external. As recorded in the EMA assessment report |
The leaf figures agree more than most herbs on this site: 3 to 6 g a day from Commission E, Bradley, and the EMA, and 1 to 4 g three times daily from Barnes at the top end. Cook's hourly 2-ounce doses of a weak lukewarm infusion sit inside that range once you add them up over a day. The alcohol preparations are where the sources part ways. King's 76 percent tincture, the Pharmacopoeia's 70 percent, Bradley's 45 percent, and Hoffmann's 40 percent extract different amounts of the oil and the diterpenes, so 2 ml of one is not 2 ml of another. The EMA's thujone ceiling of 6 mg a day is the number that ties all of them together: a preparation is inside the limit or it is not, whatever the milliliters say.6,8
Preparations by What You Want to Extract
King's wrote in 1898 that sage "imparts its virtues to boiling water in infusion, but more readily to alcohol."1 Cook had already gone one step further in 1869: water temperature and steeping time decide which sage you get. A short steep in lukewarm water gives the aromatic, diffusive tea; a long steep in boiling water gives the bitter, astringent gargle; and he warned that the second is "rendered worthless" for the first purpose.25 With sage the choice of solvent also decides how much thujone you take in, so the water preparations are both the traditional ones and the safer ones. If the methods are new to you, start with my article on decoctions versus infusions.
Solubility of the constituents
- Volatile oil (thujone, camphor, cineole): alcohol and fat. Poorly soluble in water and lost with steam. A single 2.5 g gargle dose delivers under 0.5 mg of thujone into 150 ml of water, per the EMA's safety assessment.7 Lukewarm water pulls the least; boiling water pulls more but drives some off as vapor.
- Rosmarinic acid and flavonoids: water and alcohol. A 10-minute covered infusion pulls these well.
- Diterpenes (carnosol, carnosic acid) and triterpene acids: alcohol above about 60 percent, and oil. Water leaves most of them in the leaf.
- Tannins and polysaccharides: water, and the longer and hotter the steep, the more of both. This is the chemistry behind Cook's two teas: 10 minutes lukewarm is aromatic and mild, an hour in boiling water is bitter and puckering.25
Preparations that fit the chemistry
- Lukewarm infusion, for the stomach and a gentle sweat. Cook's method: ½ ounce of leaf to a pint of warm, not boiling, water for 10 minutes, strained, drunk warm.25 Wichtl's modern equivalent is 1 teaspoon (about 1.5 g) in 150 ml, 5 minutes.7 Short steeps keep the bitterness and tannin moderate. This is the everyday form.
- Cold infusion, for sweating. Make the same tea, let it cool completely, and sip through the day. King's, Felter, Cook, and Wichtl all specify cold for night sweats and draining sweats, and warm when a sweat is wanted at the start of a chill.1,2,7,25
- Strong infusion as a gargle and mouth rinse. The EMA's 2.5 g (about 1½ teaspoons) in 100 ml boiling water, covered, 10 to 15 minutes, used warm; or Cook's older version, 1 ounce to a pint of boiling water, covered, for an hour.6,25 The traditional additions: Cook's drachm of alum and 2 ounces of honey to the pint, King's vinegar, honey, alum, or sumach, and Grieve's hot malt vinegar poured over the leaf for a sharper throat gargle.1,4,25 Spit, don't swallow, and the thujone question nearly disappears, which is why the EMA accepts the gargle from age 4 in one member state while not recommending oral use under 18.7
- The fresh leaf on the teeth. Grieve's tooth-cleaning method is a fresh leaf rubbed over the teeth and gums.4 The leaf's texture lifts surface film, the volatile oil is antimicrobial in the mouth, and the tannins tighten the gums. It cleans; no source says it whitens enamel.
- Compress. The gargle-strength infusion on a cloth for minor skin inflammation, 2 to 4 times daily, is the EMA's fourth traditional use and a Polish standard since 1978.6
- Tincture, 1:5 in 60 to 70 percent alcohol. Captures the oil and the diterpenes that water misses. The Pharmacopoeia tincture is 1:10 in 70 percent; King's ran stronger still. Hoffmann's 40 percent works for the water-soluble fraction but under-extracts the oil, so his tincture is milder in both effect and thujone than the label ratio suggests.1,6,11 The EMA's 2-week limit for the digestive use applies to alcohol extracts.6
- Tincture diluted as a mouth rinse, or painted on the gums. 5 to 10 ml in a glass of water, or the undiluted tincture applied once daily to a sore spot, both from the German pharmacopoeial record.6 The 2024 dental trial used a gel built on the same 70 percent extract.26
- Sage honey and sage vinegar. Leaves steeped in raw honey or in cider vinegar for a few weeks give a gargle base with the traditional additions built in. Vinegar pulls tannin and some flavonoid; honey coats a raw throat. Neither extracts much oil.
Preparations to skip
- Essential oil by mouth. The EMA declined to write a monograph for sage oil at all, judging its benefit-risk balance negative because single-ingredient oil products carry "a high risk of exceeding" the thujone limit. Seizures are documented in children given the oil.7,8 The Commission E internal oil dose in the table above is historical and I do not use it.
- Decoction of the leaf. Boiling drives off the volatile oil that does the antimicrobial work in the mouth. Infuse, covered.
- Daily alcohol extract for months without a break. Commission E and the EMA both tie the seizure and vertigo reports to "prolonged use of alcoholic extracts or the pure essential oil." Tea is the form with a long-use record.5,7
- Glycerite as the main preparation. Glycerin pulls tannin and flavonoid but little oil or diterpene. Fine as a sweet carrier for children's gargles, weak as a standalone extract.
Safety and Cautions
Not medical advice. Herbs contain active compounds that can interact with medications and health conditions. The EMA reports no overdose ever recorded from sage leaf, and it lists no known adverse effects for the leaf at the doses in its monograph. The essential oil and concentrated alcohol extracts are different: thujone and camphor in the oil have caused seizures in animals and in people, and the EMA judged the oil's benefit-risk balance negative.6,7,8 Most cautions below concern the oil, alcohol extracts taken daily, and people with specific conditions. Where Francis Brinker grades a caution as empirical (observed in practice) or speculative (reasoned from mechanism), that grade is given in parentheses.25 Talk with your healthcare provider or pharmacist before using sage beyond cooking and an occasional cup of tea if any of these apply to you.
Thujone: the number that governs every other caution
Thujone is a monoterpene, a small volatile molecule, that makes up most of sage oil and also occurs in wormwood, tansy, and thuja. It blocks the GABA-A receptor, the main braking system of the nervous system, so at high doses neurons fire too easily and seizures can follow.7,8 The EMA and Health Canada both cap thujone from sage products at 6.0 mg per person per day, a figure that already subtracts about 1 mg for ordinary dietary intake from cooking.6,8,9 Water pulls thujone poorly, which is why leaf tea at the doses in the table stays inside that limit, and why the EMA restricts the alcohol extracts for digestion to 2 weeks. The EMA also notes that the near-absence of adverse reports from decades of use "indicates that thujone could be less neurotoxic than thought in the past," so this is a limit set with a safety margin, not a record of harm from tea.7 Low-thujone chemotypes exist and the EMA says they "should be preferred."6
Seizures and the essential oil
- Sage oil has caused seizures. Commission E and the EMA record a sensation of heat, racing heart, vertigo, and epileptiform convulsions after intake of sage oil corresponding to more than 15 g of leaf, or after prolonged use of alcoholic extracts or the pure oil. Clinical poisonings have required intensive care.5,7 Brinker's version: avoid prolonged use of the alcoholic extract or essential oil because of possible epileptiform cramps (speculative) or convulsions from excessive thujone exposure.25
- Children. A 33-day-old boy given sage oil for colic had repeated generalized seizures, and a healthy 5-year-old who swallowed about 5 ml of the oil seized within 20 minutes; both recovered.23 A separate report describes an 18-month-old who seized 2 hours after a tea made from home-grown sage, with an EEG suggesting a pre-existing seizure focus the tea may have unmasked.7 Keep the oil out of the house if you have small children, and do not give sage tea to infants or toddlers.
- Seizure disorders. Anyone with epilepsy or a history of seizures should avoid the oil and concentrated extracts entirely and ask their neurologist before regular sage tea. The Hubbert throat-spray trial excluded people with seizures for this reason.20
Medications
- Anti-seizure medications. No clinical interaction is documented, and the EMA removed its earlier precautionary interaction text for that reason.7 The mechanism still stands: thujone works against the same GABA system that many anticonvulsants support. Treat sage oil and daily alcohol extracts as off limits without your prescriber.
- Diabetes medications. Two randomized trials from one Iranian group reported large drops in fasting glucose and HbA1c with 1,500 mg of sage extract daily in people already on diabetes drugs, and no one was monitored for low blood sugar as an outcome.21 The EMA left blood-sugar lowering out of its monograph for lack of strong evidence.7 If you take insulin or a sulfonylurea, keep sage to food amounts unless your prescriber is watching your numbers.
- Drugs cleared by CYP2D6, low confidence. A commercial water extract of sage inhibited the CYP2D6 enzyme in a test-tube screen. The EMA assessors wrote that "no conclusions could be drawn" about interactions in people from this finding.7 Included so anyone on a narrow-margin drug metabolized by CYP2D6 (some antidepressants, tamoxifen, certain heart drugs) can mention it to their pharmacist.
- Sedatives. Sage extracts prolonged barbiturate sleep in mice and several constituents bind the same receptor as diazepam in tissue studies.7 Animal and laboratory data. Reasonable to be cautious combining concentrated extracts with sedative drugs.
- Iron and minerals. Tannins can reduce mineral absorption when strong tea is drunk with meals. Between meals sidesteps the question.
Pregnancy and nursing
The sources agree on the conclusion and differ on how firmly they state the reason. Brinker gives the fullest version: avoid in pregnancy because of sage's emmenagogue and abortifacient effects, which he grades empirical, meaning an action that brings on bleeding and can end a pregnancy, and because of potential fetotoxicity, which he grades speculative; he ties all three to thujone in the essential oil and alcoholic extracts.25 ESCOP and Barnes contraindicate sage in pregnancy on the same thujone reasoning, and Commission E and Wichtl say the pure oil and alcoholic extracts should not be taken in pregnancy.5,7,10,13 The EMA's own position is narrower: safety "has not been established," no reproductive toxicity studies exist for sage at all, and use is "not recommended" on that basis.6,7 Read together: the oil and extracts are contraindicated on mechanism and practice, and even tea has no safety data. Culinary sage in food is not what any of these sources are describing.
- Nursing. Brinker's rule: sage should not be used by nursing mothers "unless the intent is to help stop milk flow" (empirical).25 That use is sage's oldest documented one after the throat, from Van Swieten in the 1700s through Madaus in 1938 to Hoffmann today, and it is the reason nursing is listed as a contraindication in ESCOP and the EMA.1,3,6,7,10,11 A mother who is weaning on purpose may want that effect; one who is not should avoid medicinal amounts.
Children and adolescents
The EMA does not recommend oral sage under age 18 for lack of data. The gargle is a different case: one member state accepted it from age 4 because a single rinse holds under 0.5 mg of thujone, absorption from the mouth is judged negligible, and a child that age can gargle without swallowing.6,7 German product labels set the oral tea at 12 and older.7 The seizure case reports above are the reason for the caution.
Skin and allergy
- Allergy. Hypersensitivity to sage is the EMA's one formal contraindication. Two of 55 dermatitis patients in a spice patch-test series reacted to sage at the higher test concentration, and a case of allergic contact dermatitis from a sage extract is published.6,7,22 Anyone allergic to the mint family should avoid it.
- The oil irritates skin. Barnes and Newall describe sage oil as a moderate skin irritant "not recommended for use in aromatherapy."7,13 The infusion as a compress is the traditional skin preparation, not the oil.
Studied combinations
Luteolin, a flavonoid in sage, reduced the heart toxicity of the chemotherapy drug doxorubicin in mice, and Brinker notes the same compound accounts for the antimutagenic effect of water extracts of the fresh herb in the laboratory, alongside fresh thyme and peppermint (PO in mice; in vitro).25 Animal and test-tube data only. Anyone in cancer treatment should clear every herb with their oncology team, since the CYP2D6 finding above concerns tamoxifen and other drugs used in the same setting.
Energetic caution
Sage dries and tightens. King's rule from 1898 still holds: it fits the relaxed, damp, cold person with draining sweats and misfits the person with hectic fever, dry harsh skin, and thirst.1,2 Someone who is already dry, constipated, or running hot will feel worse on daily sage tea, and a moistening herb suits them better. Long daily use in anyone can be drying to the mouth, which the throat-spray trial recorded as its most common side effect.20
Frequently Asked Questions
Is it safe to drink sage tea every day?
For most healthy adults, a cup or two of leaf tea sits inside the EMA's dosing range and its 6 mg thujone ceiling, and the EMA allows long-term use for sweating with a practitioner check-in at 6 weeks. The people who should ask first are those who are pregnant or nursing, have a seizure disorder, take diabetes or anti-seizure medication, or are under 18. Daily alcohol extracts and the essential oil are a different matter and carry a 2-week limit or an outright no.
What is thujone and why does it matter?
Thujone is the main compound in sage essential oil and the reason sage has any safety limits at all. At high doses it blocks the brain's main calming receptor and can cause seizures, documented in children given the oil. Water extracts very little of it, which is why tea and gargles are the traditional forms and the oil is the one to avoid. Regulators cap it at 6 mg a day from sage products.
Does sage stop sweating and night sweats?
Every Western source from King's onward records cold sage tea for excessive sweating, the EMA accepts it as a traditional use, and open studies in the 1930s and 1980s reported reduced sweat output. No placebo-controlled trial has tested the tea for sweating. The nearest controlled evidence is two manufacturer-funded trials of a fresh-leaf extract for menopausal hot flashes, which reported fewer flashes than placebo over 4 weeks.
Does sage help memory?
Gerard and Culpeper thought so, and small modern trials point the same way: single doses improved recall and attention in healthy volunteers, and one 16-week trial in 30 people with Alzheimer's disease reported slower decline than placebo. Every one of those trials was small and most came from one or two research groups, so the answer is promising and unproven. Sage constituents inhibit the enzyme that breaks down acetylcholine, which is the proposed mechanism.
Can I drink sage tea while breastfeeding?
Sage has been used for centuries specifically to dry up milk, and Brinker, ESCOP, and the EMA all list nursing as a reason not to use it. Brinker's exception is the mother who is weaning on purpose. If you want to keep nursing, keep sage to cooking amounts and ask your provider or a lactation consultant.
Is sage safe in pregnancy?
Not in medicinal amounts. The oil and alcohol extracts are contraindicated because thujone is reported to bring on bleeding and end a pregnancy, effects Brinker grades as observed in practice, and the EMA says no safety data exist even for tea. Sage on your roast chicken is a different quantity and not what these cautions describe. Ask your provider.
What is the difference between sage, red sage, white sage, and rosemary?
All are in the genus Salvia, and that is where the similarity ends. This page covers garden sage, Salvia officinalis, the leaf. Red sage on this site is Salvia miltiorrhiza, the Chinese root Dan Shen, which moves blood and interacts with warfarin. White sage, Salvia apiana, is the North American species burned for smoke. Rosemary was reclassified as Salvia rosmarinus in 2017 but is a separate species with its own chemistry and page.
Does a sage gargle help a sore throat?
The gargle is the oldest and best-supported use: King's, Grieve, Commission E, and the EMA all list it, laboratory work shows the volatile compounds calm inflammatory signaling in gum cells, and a 286-patient trial of a sage throat spray beat placebo by a modest margin over 2 hours. The EMA suggests seeing a practitioner if symptoms last beyond a week. A strep infection needs a doctor regardless.
Is sage safe for pets?
Culinary amounts in food are not considered a problem for dogs. The essential oil is: cats in particular cannot clear many oil constituents, and thujone and camphor are neurotoxic to small animals at doses that seem trivial to us. Keep the oil and any diffuser away from pets and ask your veterinarian before giving any herb to an animal.
Sources
- Felter HW, Lloyd JU. Salvia (U.S.P.), Salvia. King's American Dispensatory, 1898. Public domain, hosted at Henriette's Herbal. Companion entry: Compound Infusion of Sage.
- Felter HW. Salvia. The Eclectic Materia Medica, Pharmacology and Therapeutics, 1922. Public domain, hosted at Henriette's Herbal.
- Woodville W. Salvia officinalis, Garden sage. Medical Botany, 1790. Public domain, hosted at Henriette's Herbal. Source for Van Swieten, Quarin, and Etlinger.
- Grieve M. Sage, Common. A Modern Herbal, 1931. Hosted at botanical.com.
- German Commission E monograph, Sage leaf (1985, revised 1990). In: Blumenthal M, ed. The Complete German Commission E Monographs. American Botanical Council, 1998. ABC Expanded Commission E, Sage leaf. ABC is a nonprofit funded in part by industry membership.
- European Medicines Agency, Committee on Herbal Medicinal Products. European Union herbal monograph on Salvia officinalis L., folium. Final, Revision 1. EMA/HMPC/277152/2015, adopted 20 September 2016. Source of dosing, indications, contraindications, overdose, and the 6.0 mg thujone limit. A Revision 2 call for data closed 15 May 2025; see the EMA sage leaf page.
- European Medicines Agency, Committee on Herbal Medicinal Products. Assessment report on Salvia officinalis L., folium and Salvia officinalis L., aetheroleum. Final. EMA/HMPC/150801/2015, 20 September 2016. Source of constituent percentages, the historical dosing table (Madaus, Wichtl, Bradley, Barnes), laboratory pharmacology, case reports, and the decision not to write a monograph for sage oil.
- European Medicines Agency, Committee on Herbal Medicinal Products. Public statement on the use of herbal medicinal products containing thujone. Revision 1. EMA/HMPC/732886/2010 Rev.1.
- Health Canada, Natural and Non-prescription Health Products Directorate. Sage, Salvia officinalis, Oral monograph. Cites Felter 1922, Cook 1869, BHP 1996, Mills and Bone 2005, EMA 2016. Sets the 6 mg daily thujone limit for licensed products.
- ESCOP. Salviae folium (Sage leaf). ESCOP Monographs, 2nd edition, 2003; online update. European Scientific Cooperative on Phytotherapy, an association of national phytotherapy societies with industry members.
- Hoffmann D. Medical Herbalism: The Science and Practice of Herbal Medicine. Healing Arts Press, 2003 (affiliate link). Salvia officinalis entry.
- Bradley P, ed. British Herbal Compendium, Volume 2. British Herbal Medicine Association, 2006. Sage leaf entry, as recorded in the EMA assessment report.
- Barnes J, Anderson LA, Phillipson JD. Herbal Medicines, 3rd edition. Pharmaceutical Press, 2007. Sage entry, as recorded in the EMA assessment report.
- Akhondzadeh S, Noroozian M, Mohammadi M, Ohadinia S, Jamshidi AH, 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. Journal of Clinical Pharmacy and Therapeutics. 2003;28(1):53-59. DOI: 10.1046/j.1365-2710.2003.00463.x. Funded by the authors' Institute of Medicinal Plants, Tehran.
- Kennedy DO, Pace S, Haskell C, Okello EJ, Milne A, Scholey AB. Effects of cholinesterase inhibiting sage (Salvia officinalis) on mood, anxiety and performance on a psychological stressor battery. Neuropsychopharmacology. 2006;31(4):845-852. DOI: 10.1038/sj.npp.1300907. Leaf supplied by MedicHerb UK.
- Scholey AB, Tildesley NTJ, Ballard CG, et al. An extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers. Psychopharmacology. 2008;198(1):127-139. DOI: 10.1007/s00213-008-1101-3. .
- Bommer S, Klein P, Suter A. First time proof of sage's tolerability and efficacy in menopausal women with hot flushes. Advances in Therapy. 2011;28(6):490-500. DOI: 10.1007/s12325-011-0027-z. Open-label, no placebo. Two authors employed by A. Vogel Bioforce AG, the manufacturer of the product tested (Menosan).
- Dimpfel W, Chiegoua Dipah GN, Bommer S. Effectiveness of Menosan Salvia officinalis in the treatment of a wide spectrum of menopausal complaints. A double-blind, randomized, placebo-controlled, clinical trial. Heliyon. 2021;7(2):e05910. DOI: 10.1016/j.heliyon.2021.e05910. Funded and co-authored by A. Vogel Bioforce AG.
- The effect of Salvia officinalis on hot flashes in postmenopausal women: a systematic review and meta-analysis. International Journal of Community Based Nursing and Midwifery. 2023;11(3). Four randomized trials, 310 women.
- Hubbert M, Sievers H, Lehnfeld R, Kehrl W. Efficacy and tolerability of a spray with Salvia officinalis in the treatment of acute pharyngitis: a randomised, double-blind, placebo-controlled study with adaptive design and interim analysis. European Journal of Medical Research. 2006;11(1):20-26. PubMed 16504956. Lead author employed by Sidroga GmbH, the manufacturer.
- Kianbakht S, Dabaghian FH. Improved glycemic control and lipid profile in hyperlipidemic type 2 diabetic patients consuming Salvia officinalis L. leaf extract: a randomized placebo-controlled clinical trial. Complementary Therapies in Medicine. 2013;21(5):441-446. DOI: 10.1016/j.ctim.2013.07.004. Companion lipid trial: Kianbakht S, et al. Phytotherapy Research. 2011;25(12):1849-1853, DOI: 10.1002/ptr.3506.
- Miroddi M, Navarra M, Quattropani MC, Calapai F, Gangemi S, Calapai G. Systematic review of clinical trials assessing pharmacological properties of Salvia species on memory, cognitive impairment and Alzheimer's disease. CNS Neuroscience and Therapeutics. 2014;20(6):485-495. DOI: 10.1111/cns.12270. Also the source for the Mayer 2011 contact dermatitis case.
- Halicioglu O, Astarcioglu G, Yaprak I, Aydinlioglu H. Toxicity of Salvia officinalis in a newborn and a child: an alarming report. Pediatric Neurology. 2011;45(4):259-260. DOI: 10.1016/j.pediatrneurol.2011.05.012.
- Drew BT, González-Gallegos JG, Xiang CL, et al. Salvia united: the greatest good for the greatest number. Taxon. 2017;66(1):133-145. DOI: 10.12705/661.7. The paper that moved rosemary into Salvia.
- Brinker F. Herbal Contraindications and Drug Interactions, 4th edition. Eclectic Medical Publications, 2010. Sage entry, p. 279. Evidence grades (empirical, speculative, PO in mice, in vitro) are his.
This monograph is updated as new research and sources become available.
Ivy Ham
I'm Ivy Ham, a clinical herbalist dedicated to blending traditional healing wisdom with modern science, and revealing how nature's remedies can enhance everyday wellness. Through my blog, I share insights on herbal solutions, nutrition, and holistic practices to guide you toward a more balanced, vibrant life.
Certified clinical herbalist · Missoula, Montana · Read more about Ivy
Meet the Other Salvias
Salvia is a genus of nearly a thousand species in the mint family (Lamiaceae). Two others have entries in this library, and neither is interchangeable with garden sage.
Red Sage (Dan Shen)
Salvia miltiorrhiza
A Chinese medicine root, not a culinary herb. Traditionally used to move blood and clear heat, and studied for cardiovascular support. Carries a documented warfarin interaction.
Read the red sage monographRosemary
Salvia rosmarinus
The warming, aromatic one. Traditionally used for circulation and digestion, and studied in small human trials for memory and hair growth.
Read the rosemary monograph