Herbs in History: Sage


Salvia officinalis L.


By Alain Touwaide & Emanuela Appetiti | October 2023

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Salvia officinalis L.

Illustration 1: Salvia officinalis L.

The Surprises of a Well-known Genus

Native to Southern Europe, sage (Salvia spp.) is now common and is known through different species (Illustration 1). This diversity is echoed in the literature from the Renaissance onward with such designations as Salvia major (greater sage), Salvia major vulgaris (common greater sage), Salvia latifolia (large-leaves sage), or, to mention just these, Salvia minor aurita and non aurita (eared and non-eared sage). As these names already indicate, the history of sage is full of surprises.
Sage grows in light and medium, well drained soils, from neutral and basic to very alkaline. It always prefers the sun, and it is drought-resistant, but not cold-resistant: wet and extremely cold winter kills it. It is in leaf all year and needs to be trimmed in late spring, with flowers from late spring to late summer, and ripened seeds from August to September. After a few years (circa four), plants might degenerate and should be replaced.
Though compatible with a great many plants such as rosemary, cabbage and carrots, sage is selective, however, in choosing its neighbors: it does not grow well with wormwood and does not like the company of basil, rue, cucumber, or species of the squash family. Similarly, it repels insects and is pollinated, instead, by bees.
With its several decorative species with white or purple flowers, it is now an appreciated ornamental plant, which can also be found in orchards for culinary and medicinal uses. Its Latin name refers to its salutary properties as it is believed to derive from the root salvare (saving), supposedly hinting at an all-heal activity further attested by the name of it medieval designation as Salvia salvatrix: the savior sage. The fragrant aroma of its leaves released when crashed or rubbed between the hands evokes medicines and herbal infusions.

Literary Contradictions

Little used in contemporary therapeutic practice, sage was highly regarded in the past, particularly at the medieval Medical School of Salerno, in Southern Italy, as the following verses from its Herbal attest (Flos Medicinae Scholae Salerni, Pars Secunda: Materia Medica, § 78 De Renzi, vol. 5, 1859: 31):

Why should a man die if sage grows in his garden?
Against the power of death there is no remedy in gardens.
Sage strengthens the sinews, and stops hands from trembling,
and by its helping action acute fever flees.
Sage, beaver musk and lavender, primrose,
nasturtium, tansy, all these heal paralyzed limbs.
Sage the Savior, reconciler of nature.
Sage gives a healthy head and does so for Hadrian.

The original Latin version of the first verse, followed here by its English adaptation, is almost proverbial:

Cur moriatur homo cui Salvia crescit in horto?
He that would live for aye,
Must eat Sage in May.


Death of Pasquino, according to the Decameron story

Illustration 2: Death of Pasquino, according to the Decameron story

This high reputation was surprisingly contrasted by a sinister story in the Decameron by Giovanni Boccaccio (1313-1375) (Fourth Day, Seventh Tale). The story takes place in Florence. A poor man’s daughter named Simona is in love with a wool-merchant’s porter named Pasquino. One day, they make love in a pleasant garden under a large sage bush. Afterwards, because they planned to have a picnic, Pasquino plucks a sage-leaf and rubs it against his teeth to keep the food from sticking to them. But while he’s still preparing the picnic, he suddenly dies (Illustration 2). Simona is accused of having murdered him; to show her innocence to the judge called to treat the case, she rubs a sage leaf on her teeth. Since she too suddenly dies, the judge orders a gardener to cut down and burn the sage bush under which both made love. In so doing, they discover a toad, the foul breath of which has poisoned the leaves of the Sage and is the cause of Pasquino and Simona’s deaths.
The whole story reflects the ancient belief of cross-contamination between natural kingdoms and species with the toad (believed to be venomous) poisoning the plant. This justifies the tradition to plant Rue (Ruta graveolens L.) with sage to keep toads and other possible venomous animals away from such a valuable plant.
In the Middle Ages, sage was credited with efficacy, indeed, against a great many affections, with a particular specialization for neuro-cerebral indications. The Renaissance inherited this belief as we can see in the Herball of the Englishman John Gerard (ca. 1545-1612) (Herball 1597: 624):

Sage is singularly good for the head and braine, quickeneth the senses and memorie, strengtheneth the sinewes, restoreth health to those that have the palsie ypon a mist cause,  taketh away shaking, or trembling of the members, and being put up into the nostrils, it drweth thinne flegme out of the head.

And, concluding:

No man needeth to doubt of the wholesomenesse of Sage ale, being brewed as it should be with Sage, Scaboous, Betonie, Spikenard, Squinanth, and Fennell seeded.

From medicine to ale, sage was much in use in those times. It even entered literature as we can see from the 1714 Shepherd’s Week by the English poet John Gay (1685-1732). Compared to the Greek poet Theocritus (ca. 300-after 260 BC) who celebrated the simple life in the countryside, Gay evoked the simple life in nature and its daily activities. A good example is his Shepherd’s Week, Tuesday; Or, the Ditty:

Marian that soft could stroke the udder’d cow,
Or lessen, with her sieve, the barley mow;
Marbled with sage the hardening cheese she press’d,
And yellow butter Marian’s skill confess’d;
But Marian now devoid of country cares,
Nor yellow butter nor sage cheese prepares.

The white-yellowish cheese is crossed by veins of bleu-green color typical of sage leaves.

The Mediterranean

Salvia pomifera L.

Illustration 3: Salvia pomifera L.

In the drier areas of Greece, one species (S. pomifera L. applebearing sage) has a special history that may go far back in time (Illustration 3). The ancient Greek phytonym traditionally considered to be that of sage is elelisfakos. Lexica of ancient Greek and historical studies explain this name as being composed of the two elements eleli- meaning whirling, and -sfakos, traditionally interpreted as referring to S. pomifera. This compound is translated as  “whirling sage-apple”, the exact meaning of which is unclear in addition to leaving open the question to know whether it refers to the plant itself or to its fruit.
Interestingly, scientists in Antiquity already were struggling to understand this Greek phytonym. In the first century, Pliny (23/24-79 AD) commented on it in his Naturalis Historia (Natural History) with the following explanation (24.147):

Our modern herbalists call this plant elelisphacus in Greek and salviam in Latin…

This comes after the description of elelisphacus, which reads as follows:

There is a wild lentil called elelisphacos by the Greeks smoother than the cultivated lentil, with a smaller, drier and more scented leaf …
It promotes menstruation and urine, and heals the wounds of the sting-ray, numbing the region affected. It is also taken in drink with wormwood for dysentery. With wine it also brings on delayed menstruation, while a draught of its decoction checks any excess. The plant applied by itself stanches the blood of wounds. It also cures snake bites, and if boiled down in wine allays pruritus of the testicles.

This paragraph closely corresponds to the one on elelisfakos in the Greek De materia medica (3.33) by Dioscorides (1st cent. AD), which is traditionally—and rightly so—considered to be about Salvia.
The problem tackled by Pliny is about the meaning of elelisfakos. He considered that its second element (that is, fakos) refers to the lentils, which are in effect called fakos in ancient Greek. On this basis, Pliny identified elelisfakos as a species of lentil and treated it after he dealt with lentils, whereas Dioscorides included elelisfakos  into a group comprising such aromatic plants as wormwood, hyssop, oregano, dittany, and thyme.
In the Renaissance, Pliny was scorned by the Italian physician and botanist Pietro Andrea Mattioli (1501-1577) who devoted most of his activity to translate and comment on Dioscorides, De materia medica (p. 711 in the 1567 Latin edition). Here is Mattioli’s comment on Pliny’s identification of elelisfakos:

The Greeks call Salvia elelisphakon, wherefrom Plinius, 21.25, fooled by the similarity of the names, believed totally wrongly that elelisfakos is a species of lentil, because the Greeks call lentils sfakos.


Sage apples

Illustration 4: Sage apples

Contrary to what Mattioli thought—but we know that he was often quick to condemn ancient and contemporary authors—Pliny might not have been wrong in a new surprise in this history. Salvia pomifera L. (applebearing sage), is indeed characterized by berries among the leaves. These berries are called sage apples (Illustration 4). In the ancient Greek plant lexicon, such berries might have been designated by the term used to identify lentils, fakos, which did not exclusively refer to the plant (Vicia lens (L.) Coss. & Germ. = Lens culinaris Medik.) but also to small round objects. It also designated a small weight used to measure quantities. The term elelisfakos is not about either lentils or whirling sage-apple, but describes round fruits wrapped by leaves forming a sort of crown around them.

The species S. pomifera L., which is now found in the Peloponnese, Attica, Crete and the Aegean islands, has traditionally been described as typical of Crete only. Its names listed in such work as the Pinax Theatri Botanici (Table of the Botanical Theater) by the Swiss Gaspard Bauhin (1560-1624) leave no doubt about its identification (pp. 237-238):

  • Salvia baccifera (berry-bearing sage)

  • Salvia fructuum instar gallae ferens (Sage bearing a fruit like oak gall)

  • Salvia Graeca (Greek sage)

  • Salvia Cretica (Cretan sage)

  • Salvia coccifera sive baccata (gall-bearing or berried sage)

  • Salvia Cretica baccifera (Cretan berry-bearing sage)

Assuming that this identification is correct, it suggests that the name elelisfakos was the name of one species (in fact, S. pomifera L.) and that this name was used in Antiquity as a generic term to identify the whole genus of Salvia. Several species might thus have been included.

Further proof of this is provided by the indications of elelisfakos according to Dioscorides (3.33). In the chapter in which he analyzes elelisfakos, indeed, when enumerating its therapeutic applications, he mentions some uses that imply a hemostatic property and others that result in a hemorrhagic action. A close analysis—botanico-therapeutic in nature—helped clarify this apparent contradiction, which reflects, in fact, the differentiated activity of two different species of Salvia that have been treated together—and possibly confused—in the same chapter S. fruticosa Mill. and S. officinalis L.

From Remedy to Delicacy

When mature and ripe, the excrescences of this applebearing sage are ¾ inch thick and as transparent as jelly. They can be found on present-day markets in Crete and Greek islands, and make a delicacy with a slightly astringent, yet pleasant flavor that recalls lavender. They are candied as sage apples and have powerful healthy properties.
The leaves of this species are also used to prepare an infusion. They are ritually harvested on May 1 before sunrise, and dried.
From one species to another, the history of sage, which could have been that of Salvia officinalis L., opens onto other species of sage used as substitutes for tea. This is particularly the case of S. fulgens Cav. (= S. grandiflora Sessé & Moc.), called balsamic sage, and also scarlet and cardinal sage. Its current accepted name and synonym suggest special characteristics: luminous/shiny and with large/noticeable flowers (Illustration 5). It is reported that an infusion of it with common gypsyweed (Veronica officinalis L.) and Betony (Betonica officinalis L.) makes a delicious breakfast-beverage that pleasantly substitutes tea, its flavor similar to Chinese green tea.
Two other species—S. glutinosa L., sticky or Jupiter’s sage, and S. sclarea L., clary sage—enter in the preparation of wines. In The Netherlands, the leaves of sticky sage are mixed to country wine to add a pleasant flavor, while in France the leaves and flowers of clary sage are boiled with wine to make the medicinal Toute bonne (All-heal) (Illustrations 6 and 7).
On a more daily basis, in present-day Italy, sage is still a condiment of some typical plates, mixed with golden butter or grilled. Grilled chicken with sage leaves on top of it is a delicate meal as is also a plate of tortellini covered with a pale-yellow, lemon-chrome butter-fondu sauce mixed with sage leaves. Or, much simpler but no less salutary, a thick piece of country-bread spread with olive oil and topped with fresh sage leaves is a true delicacy. And a promise of good health.

Salvia fulgens L.

  Salvia glutinosa L.   Salvia sclarea L.

Illustration 5: Salvia fulgens L.

  Illustration 6: Salvia glutinosa L.   Illustration 7: Salvia sclarea L.  

Herbal Medicine: Expanded Commission E
European Medicines Agency
European Union herbal monograph on Salvia officinalis L., Folium, 20 September 2016
Committee on Herbal Medicinal Products (HMPC)
package leaflet of medicinal products for human use’, must be included.
Scientific articles:
Luca S. et al. 2023. Chemical Profile and Bioactivity Evaluation of Salvia Species from Eastern Europe.  Antioxidants 12(8) (2023), 1514. https://doi.org/10.3390/antiox12081514
Heydarpour S, F. Sharifipour, F. Heydarpour 2023. Effect of Salvia officinalis scent on postmenopausal women's sexual function and satisfaction: a randomized controlled trial. BMC women's health 23(1) (2023), 442. https://doi.org/10.1186/s12905-023-02605-8
Sidiropoulou E. et al. 2022. In Vitro Antioxidant, Antimicrobial, Anticoccidial, and Anti-Inflammatory Study of Essential Oils of Oregano, Thyme, and Sage from Epirus, Greece. Life 12(11) (2022), 1783.
Poulios E., C. Giaginis, G.K. Vasios, G. K. 2020. Current State of the Art on the Antioxidant Activity of Sage (Salvia spp.) and Its Bioactive Components. Planta medica 86(4) (2020), pp. 224–238.
Sharma, Y., J. Fagan, and J. Schaefer. 2019. Ethnobotany, phytochemistry, cultivation and medicinal properties of Garden sage (Salvia officinalis L.). Journal of Pharmacognosy and Phytochemistry 8 (2019), pp. 3139-3148.
Jakovljević M. et al. 2019. Bioactive Profile of Various Salvia officinalis L. Preparations. Plants 8(3) (2019), 55.
Lopresti A.L. 2017. Salvia (Sage): A Review of its Potential Cognitive-Enhancing and Protective Effects. Drugs in R&D 17(1) (2017), pp. 53–64.
Ghorbani A., M. Esmaeilizadeh 2017. Pharmacological properties of Salvia officinalis and its components. Journal of Traditional and Complementary Medicine 7(4) (October 2017), pp. 433-440.
Bonesi M. et al. 2017. Anti-inflammatory and Antioxidant Agents from Salvia Genus (Lamiaceae): An Assessment of the Current State of Knowledge. Anti-inflammatory & anti-allergy agents in medicinal chemistry 16(2) (2017), pp. 70–86.
Miraj S., S. Kiani 2016. A review study of therapeutic effects of Salvia officinalis L. Der Pharmacia Lettre 8(6) (2016), pp. 299-303.
Martins N. et al. 2015. Evaluation of bioactive properties and phenolic compounds in different extracts prepared from Salvia officinalis L. Food Chemistry 170(1) (March 2015), pp. 378-385.
Hamidpour M. et al. 2014. Chemistry, Pharmacology, and Medicinal Property of Sage (Salvia) to Prevent and Cure Illnesses such as Obesity, Diabetes, Depression, Dementia, Lupus, Autism, Heart Disease, and Cancer. Journal of Traditional and Complementary Medicine  4(2) (April–June 2014), pp. 82-88.
Behradmanesh S. et al. 2013. Effect of Salvia officinalis on diabetic patients. Journal of Renal Injury Prevention 2(2) (2013), pp. 51–54.
Mayer E., H. Gescheidt-Shoshany, S. Weltfriend 2011. Allergic contact dermatitis caused by Salvia officinalis extract. Contact Dermatitis 64(4) (April 2011), pp. 237–238.
Raal A., A. Orav, E. Arak 2007. Composition of the essential oil of Salvia officinalis L. from various European countries. Natural Product Research (Formerly Natural Product Letters) 21(5) (2007), pp. 406-411.
Yinrong Lu, L. Yeap Foo 2001. Antioxidant activities of polyphenols from sage (Salvia officinalis). Food Chemistry 75(2) (November 2001), pp. 197-202.
Wang M. et al. 1998. Antioxidative Phenolic Compounds from Sage (Salvia officinalis). Journal of Agricultural and Food Chemistry 46(12) (1998), pp. 4869-4873.
Rivera D., C. Obón, F. Cano 1994. The Botany, History and Traditional Uses of Three-Lobed Sage (Salvia fruticosa Miller) (Labiatae). Economic Botany 48(2) (Apr. - Jun. 1994), pp. 190-195.
Andrews A.C. 1956. Sage as a Condiment in the Graeco-Roman Era. Economic Botany 10(3) (1956), pp. 263-266.

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