This study is an attempt to substantiate the traditional use of the Salvia miltiorrhiza plant, commonly known as dan shen, in eliminating blood stasis and enhancing blood circulation as indicated by Traditional Chinese Medicine. The Chinese have long used it to accelerate menstrual blood flow and is also prescribed to patients with cardiovascular diseases as well as other ailments.
Conducted in 2001, Chan’s work focused on the interaction of these two substances in humans. He reviewed the cases of three patients who were taking long term warfarin treatments and then took Salvia miltiorrhiza (commonly known as dan shen) after some time. They suffered from anticoagulant overdose with excessive bleeding that led to complications. Dan shen was identified as the cause of the overdose in the said cases because there were no other factors to which it could be attributed to.
As scientific evidence on dan shen’s effect on blood clotting time is insufficient, this study adds to the current knowledge on this aspect. It also points to the potentials of the herb for the development of an alternative anti-coagulant especially for patients suffering from stroke and the consequent blood clotting in the brain. Currently, established Western medicines have so far proved adequate for effective treatments.
There are limitations in the study. Because it only reviewed three cases of warfarin and dan shen use with bleeding complications, the sample would not seem to be representative of all the cases involving the use of both substances. Further, the researcher failed to ascertain the dosages of dan shen taken by the patients as well as the severity of overdose based on the dosages ingested that would help magnify the results of the study.
Also, subjecting the dan shen substances to chemical analysis so as to isolate its various components and identify which slows down prothrombin activity would have been beneficial to the study. It may also be possible that the warfarin medication used did not meet the established standard for the manufacture of the drug for it to cause adverse side effects but in assuming that it did meet standards, warfarin was eliminated as a factor in itself.
The prolonged use of the medicine, as was the case in the patients, could also have predisposed them to suffer from excessive bleeding. The differences in the lengths of warfarin treatment should also have been considered as a factor. However, it does caution physicians against allowing patients to take both warfarin and undetermined amounts of dan shen.
When seen in relation to the overall effort of establishing the anticoagulant activity of dan shen in humans, this study would only establish the probability for such properties because it is presumed to have caused the said overdose. However, it does not conclusively determine that the intake of the herb does result in such activity in humans such that when combined with drugs with the same properties, it would result in anti-coagulant overdose.
More compelling evidence can be accomplished for both the interaction of warfarin and dan shen if a double-blind study were to be conducted involving randomly selected participants divided into control and placebo groups. Double blind studies are also necessary to conclude on its anti-coagulant property and in order to be reliable.
Because dan shen has been traditionally established as an anticoagulant, a non-double-blind study would result in many possible biases that blur the conclusions. It should also be replicated to determine if all studies reach the same conclusions. In vitro studies involving dan shen treatment or the combination of dan shen and warfarin are also essential.
List of References
Oliff, H.S. (2001). Chinese Herb Danshen Interacts with Warfarin Causing Longer Bleeding Time. Retreived 4 April 2008 from http://www.physiologics.com/herbclip/review.asp?i=42690.