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Salvia officinalis, the common sage or sage, is a perennial, evergreen subshrub, with woody stems, grayish leaves, and blue to purplish flowers. It is a member of the mint family Lamiaceae and native to the Mediterranean region, though it has been naturalized in many places throughout the world. It has a long history of medicinal and culinary use, and in modern times it has been used as an ornamental garden plant. The common name "sage" is also used for closely related species and cultivars.

Salvia officinalis has numerous common names. Some of the best-known are sage, common sage, garden sage, golden sage, kitchen sage, true sage, culinary sage, Dalmatian sage, and broadleaf sage. Cultivated forms include purple sage and red sage. The specific epithet officinalis refers to plants with a well-established medicinal or culinary value.[1]

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The plant had a high reputation throughout the Middle Ages, with many sayings referring to its healing properties and value.[8] It was sometimes called S. salvatrix (sage the savior). Dioscorides, Pliny, and Galen all recommended sage as a diuretic, hemostatic, emmenagogue, and tonic.[7] Le Menagier de Paris, in addition to recommending cold sage soup and sage sauce for poultry, recommends infusion of sage for washing hands at table.[9] John Gerard's Herball (1597) states that sage "is singularly good for the head and brain, it quickeneth the senses and memory, strengtheneth the sinews, restoreth health to those that have the palsy, and taketh away shakey trembling of the members."[10] Gervase Markham's The English Huswife (1615) gives a recipe for a tooth-powder of sage and salt.[11] It appears in recipes for Four Thieves Vinegar, a blend of herbs which was supposed to ward off the plague. In past centuries, it was also used for hair care, insect bites and wasp stings, nervous conditions, mental conditions, oral preparations for inflammation of the mouth, tongue and throat, and also to reduce fevers.[7]

In Britain, sage has for generations been listed as one of the essential herbs, along with parsley, rosemary, and thyme (as in the folk song "Scarborough Fair"). It has a savory, slightly peppery flavor. Sage appears in the 14th and 15th centuries in a "Cold Sage Sauce", known in French, English and Lombard cuisine, probably traceable to its appearance in Le Viandier de Taillevent.[12] It appears in many European cuisines, notably Italian, Balkan and Middle Eastern cookery. In Italian cuisine, it is an essential condiment for saltimbocca and other dishes, favored with fish. In British and American cooking, it is traditionally served as sage and onion stuffing, an accompaniment to roast turkey or chicken at Christmas or Thanksgiving Day, and for Sunday roast dinners. Other dishes include pork casserole, Sage Derby cheese and Lincolnshire sausages. Despite the common use of traditional and available herbs in French cuisine, sage never found favor there.

Common sage is grown in parts of Europe for distillation of an essential oil, although other species such as Salvia fruticosa may also be harvested and distilled with it.[citation needed]

Sage tea has been traditionally used for the treatment of digestive and circulation disturbances, bronchitis, cough, asthma, angina, mouth and throat inflammations, depression, excessive sweating, skin diseases, and many other diseases.[5,6,7] Salvia essential oils have been used in the treatment of a wide range of diseases like those of the nervous system, heart and blood circulation, respiratory system, digestive system, and metabolic and endocrine diseases. In addition, sage essential oil has been shown to have carminative, antispasmodic, antiseptic, and astringent properties.[8,9]

The essential oil of Salvia species has various compositions depending on the genetic, climatic, seasonal, and environmental factors.[10] Some chemical compounds like flavonoids, terpenoids, and essential oils are present in different species of Salvia [Figure 4].[3] Essential oils are very important sources for the screening of anticancer, antimicrobial, antioxidant, and free radical scavenging agents.[11] S. officinalis (common sage) is considered to have the highest amount of essential oil compared to the other species of Salvia.[5,12]

In all analyzed samples of S. officinalis, the major components, although present in different concentrations, are: 1,8-cineole, camphor, borneol, bornyl acetate, camphene, - and -thujone, linalool, - and -caryophyllene, -humulene, - and -pinene, viridiflorol, pimaradiene, salvianolic acid, rosmarinic acid, carnosolic acid, ursolic acid, etc.[7,12] Studies have shown that some biological properties of the essential oil of Salvia depend on camphor, 1,8-cineole, -thujone, and -thujone.[9] The essential oil of sage contains about 20% camphor, and as the leaves expand, the camphor content also increases.[13] In a study, the most powerful scavenging compounds were reported to be -thujone and -thujone, bornyl acetate, camphor, menthone, and 1,8-cineol in the essential oil.[11] In the same study, the essential oil of Melissa officinalis and S. officinalis showed better antioxidant activities than some other Lamiaceae plants.[11]

In a study conducted on the antioxidant activity of many plant extracts, like sage (S. officinalis), it was found that the phenolic and flavonoid compounds are mainly responsible for the antioxidant and free radical scavenging effects of these plants.[18,19] Phenolic compounds such as carnosol, carnosic and rosmarinic acids, rosmadial, rosmanol, epirosmanol, methyl carnosate, and luteolin-7-O--glucopyranoside have a high antioxidative activity and are usually extracted from sage with ethanol.[20] The phenolic compounds can either stimulate endogenous antioxidant defense systems or scavenge reactive species.[21]

A study shows that S. officinalis improves the memory and cognition, and with increasing dosage, the mood gets elevated as well as alertness, calmness, and contentedness increase.[29] A randomized, double-blind clinical study has shown that an ethanolic extract from common sage (S. officinalis) as well as Spanish sage (S. lavandulaefolia) is effective in the management of mild to moderate AD, and study on patients did not show any adverse effect on them on taking sage.[30,31] Administration of S. lavandulaefolia (Spanish sage) has been reported to be effective in improving the speed of memory and mood. Salvia essential oil also has been reported to improve immediate word recall.[27]

A number of studies have investigated the effects of the aromas of plant essential oils on cognition and mood.[32] The aroma of S. officinalis produced significant enhancement effect in the quality of memory factor derived from Cognitive Drug Research (CDR) system.[32] The findings suggest that the aromas of essential oils of Salvia species have some, but not all the effects found following the oral consumption of the herb.[32] The antioxidant and anti-inflammatory properties of the S. officinalis or S. lavandulaefolia may offer a long-term protection in the pathogenesis of dementia.[29] Also, the mood-enhancing properties of the herb may have applications in the treatment of advanced dementia, in which disturbed mood and agitation feature as a major problem.[29] There is no report of negative side effects associated with S. officinalis or S. lavandulaefolia despite many years of usage.[29]

Colorectal cancer (CRC) is a common type of cancer and a significant cause of mortality in Western societies. It develops by genetic and epigenetic alterations which transfer normal colon cells to proliferating cells.[38] This study has shown that dietary compounds can change the epigenetic status. Many food plants are rich in bioactive compounds and have shown to possess anticancer properties.[38] The effect of drinking sage (S. officinalis) herbal tea was studied on the prevention of colon cancer in rats. It was found that S. officinalis water extract significantly decreased the oxidative H2O2-induced DNA damage in vitro.[38]

A study showed that sage, along with different plant extracts was comparable to synthetic preservatives, and the result confirmed that the aqueous extract of S. officinalis can be used in biotechnology as a natural preservative ingredient in food industry.[24]

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