Members of the Sage genus (Salvia spp.) have garnered a reputation across the world for their extensive healing capabilities. So much so that records of the plant's healing attributes began some 4,000 years ago.
Members of the Sage genus (Salvia spp.) have garnered a reputation across the world for their extensive healing capabilities. So much so that records of the plant's healing attributes began some 4,000 years ago. In ancient Egypt, it was a key ingredient for embalming so that pharaohs could transition into the afterlife with the plant's help. It was also used for epidemics such as the plague and to ease those grappling with infertility. The ancient Romans revered the plant, utilizing a special iron knife in order to harvest it properly. Across the ocean, various Indigenous groups of the Americas used Salvia as a sacred healing herb for medicine, ritual, as as a ceremonial tool. 
The name Sage itself originates from the world salvarem meaning to “save” or “cure” in Latin. Salvia has an estimated 900 different species. Traditional uses of the plant were based on which varieties were local to the area. Sages are part of the mint family. Many other herbs are also called sage, but are actually Artemisia spp. (ie “Sagebrush”). [2,3]
Sage has been researched as a potential treatment for life-threatening diseases such as dementia, cancer, diabetes, depression, lupus, heart disease, and more.  Salvia species are often used for issues of the nervous system (anxiety, pain, sleep disturbances, anxiety states, or other issues). Sage directly stimulates the glands of the pituitary and adrenals and also has an impact on the immune system. Sage’s simultaneous influence on the endocrine and nervous systems can be of benefit to the whole body. 
Two of the most commonly used types of sage around the world include Salvia officinalis and S. apiana.
Salvia apiana, commonly known as White Sage, can be found scattered throughout the Americas, with the highest concentration in southern California. The plant is considered a sacred medicine and tool for ritual work by various of American indigenous groups. The Chumash use this kind of sage for prayer, relaxation, and to treat a variety of ailments. 
Salvia officinalis (Garden Sage) originated in the Mediterranean and is the common spice found in kitchens to season savory dishes. It was used by the Romans to help better digest fatty foods. Dioscorides, the Father of pharmacognosy (the study of medicinal drugs obtained by plant sources), recognized sage as one of the most important herbs of his era.  While each sage species provide unique properties, the medical attributes of the Salvia family are commonly interconnected. A select few members of Salvia will be discussed here, indicating particular species when necessary.
Terpenes, Vitamins, Minerals
Sage’s pungent scent is due to its rich terpene profile and a blend of other active components, which may differ slightly from species to species. More than 120 individual components have been distinguished in Garden Sage (S. officinalis) essential oil. The primary terpenes include caryophyllene, pinene, borneol, camphor, cineole, elemene, humulene, and thujone. Interestingly, linalool (also found in lavender and some varieties of cannabis) is found in highest concentration in the plant’s stem while humulene, limonene, and thujone are most present in the leaves. Like cannabis, the array of terpenes and other phytochemicals are influenced by environmental and growing conditions. 
Garden Sage is packed with vitamins and minerals. The plant contains trace amounts of magnesium, copper, zinc, and Vitamins A, C and E. One teaspoon of the herb can provide 10% of your daily Vitamin K needs. Daily use many benefit bone health, as a Vitamin K deficiency is associated with thinning bones and fractures. Various acidic compounds in the plant (caffeic, chlorogenic, rosmarinic, and ellagic acids) and rutin are all associated with notable health benefits, such as a lower risk of cancer and improved brain function and memory. 
Is sage psychoactive?
Some sage species have a higher concentration of the monoterpenoid thujone, which is linked to the plant’s central nervous system action.  Thujone is found in some varieties of sage, but not all. Spanish sage, for example, does not contain thujone.  Thujone is also a predominant terpene in wormwood, which is said to grant the psychoactive effects of the infamous drink absinthe.
Thujone is naturally occurring in a variety of plants but not in doses high enough to hurt humans. This terpene can be toxic in very high amounts because it inhibits GABA receptors in the brain, which can lead to convulsions if taken in excess. Even when concentrated into absinthe, a person consuming it in large quantities would die from alcohol poisoning before they were influenced by the effects of thujone. And there is little to no evidence that consuming it can cause hallucinations, even in high doses. To be on the safe side, consumption of thujone containing varieties of sage or other plants can be limited to no more than six cups a day. [8,9]
Sage species have also inspired investigation on endocannabinoid interaction. A 2017 study found a water and alcohol extract of White Sage (S. apiana) showed moderate activity on CB1 receptors. Sageone, one of the compounds isolated for the first time in that study, demonstrated moderate activity at CB1, CB2, and opioid receptors. Other compounds in the plant only bound to opiate receptors, while others had no binding affinity at all. 
A sage variety ubiquitous in Mexico, Salvia divinorum (Diviner’s Sage), has been widely studied for its psychoactive attributes. The plant is held with the highest reverence by the indigenous groups that use it. The patient or healer (or sometimes both) take the plant in nightly ceremonies as a juice or by chewing its leaves to grant a healing voyage through the user’s consciousness. A healer will ask the plant for guidance to pinpoint the root cause of an illness, which are revealed via the user’s visions. 
The principle component responsible for the plant’s psychoactive effects is called Salvinorin A. Unlike many psychoactive plants and chemicals, Salvinorin A does not have affinity for serotonin receptors.  The compound has been found to be a highly selective antagonist of the kappa opioid receptor. This attribute has led to the compound being synthesized and researched as a non-habit forming medication for pain management.  Due to its analgesic properties, the plant was believed to have endocannabinoid system interaction. However, when researchers examined this theory, Salvinorin A was not found to activate CB1 receptors. Additionally, in mice trained to discriminate THC, Salvinorin A did not act as a substitute for the cannabinoid. The investigators reported that the pharmacological effects of Salvinorin A are “mediated by its activation of KOR rather than by any direct action of salvinorin A on the endocannabinoid system.”  Further investigation on this sage variety may uncover deeper understanding of its chemical impact within the body.
Now onto the expansive medicinal benefits of sage, to name a few.
Due to the increasing concern worldwide about treatment resistant bacteria and other pathogens, alternative treatments to pharmaceutical antibiotics are even more urgent. Sage species have been examined for antibacterial and antifungal activity in various studies. Isolated terpenes from the roots and buds such as cineol, thujone, and alcanfor have demonstrated considerable antimicrobial activity.  A 2016 study from Argentina discovered that Salvia apiana root extract inhibited the growth of Staph, Strep, E.coli, Candida albicans, and other treatment resistant microbes. This study demonstrated for the first time that S. apiana has potent antimicrobial effect on human pathogens and may have considerable therapeutic value as an antibiotic and antifungal. 
The antimicrobial effects of Sage may also be valuable for dental health, due to its ability to counteract microbials in the mouths that lead to dental plaque. A 2011 study found that a sage-based mouthwash effectively killed Strep bacteria, which is responsible for cavities and increasingly resistant to traditional treatments.  A 2013 in vitro study found that essential oil of sage slowed the spread of the Candida fungus in the mouth, which can also leads to tooth decay. 
Sinus infection is another area that Sage species may be of benefit, due to their ability to attack viral, bacterial, or fungal infections of the nasal cavity. The terpene eucalyptol (also known as cineole) in Salvia apiana was found to kill bacteria, reduce inflammation, and soothe the sinuses. If recurring sinus infections are an issue, consider drinking sage tea daily.  Another study from 2009 echoed the use of eucalyptol as a safe, effective treatment for sinus issues in lieu of traditional antibiotics. Eucalyptol also clears mucus and may act as a mild cough suppressant. 
Sage can also be used externally to ward off infection and sooth skin issues. Cooled sage tea can be applied as a compress to wounds to prevent infection and reduce irritation. Eucalyptol is known to speed up healing and decreases itching. Sage can also be used to treat athlete's foot and other fungal skin infections, effectively preventing them from coming back. 
Like cannabinoids, sage compounds have been investigated for their neuroprotective and antioxidant properties. Sage possesses over 160 distinct polyphenols, which are plant-based chemical compounds that act as antioxidants in the body.  Antioxidants help the body strengthen its natural defenses and counteract free radicals that may lead to premature aging and chronic disease. A 2009 study found that consuming two cups of Garden Sage tea per day significantly increased antioxidant defenses. It also regulated cholesterol levels by increasing HDL cholesterol (the good kind) and lowering LDL cholesterol (the bad) both during and two weeks after treatment. 
Sage can help support cerebral function and memory in a variety of ways. In animal models, an alcohol extract of Garden Sage was found to boost the memory retention in rats. Rosmarinic acid, found in sage and also predominant in rosemary, increased cognition in healthy rats and prevent learning deficits as a result of diabetes. 
Human clinical trials have supported these findings and noted that Garden Sage enhanced cognitive performance in both healthy individuals and those affected by dementia. The plant’s essential oil was found to enhance memory and attention span in healthy, older participants.  A randomized controlled trial demonstrated that a Garden Sage extract boosted cognitive function in those with mild to moderate Alzheimer's disease when taken for four months. Thirty-nine participants received 2 mL of a sage extract or a placebo each day. The sage group had marked improvement with memory, problem solving, and other cognitive tasks. 
Sage has been used traditionally as a remedy against diabetes. Garden Sage has been found to lower blood glucose both in healthy individuals and those with diabetes. A 2006 mouse study discovered that sage tea acts like metformin, a prescription medication for managing blood sugar in people with type 2 diabetes.  Sage leaf extract was found to improve insulin sensitivity and decrease blood sugar. Its actions provided a similar effect as the anti-diabetes drug rosiglitazone. 
Garden Sage has been discovered to decrease insulin resistance through the stimulation of the PPARγ (PPAR-gamma) receptor.  The activation of PPARs generally encourages the breakdown of glucose and lipids and insulin sensitivity. These properties make PPAR activation a promising treatment for type II diabetes and metabolic diseases. CBD (cannabidiol) has also been documented as PPAR-gamma agonist in a variety of studies.  This promising information can inspire further research on plant based remedies for diabetes and managing metabolic conditions.
Menstrual and menopausal issues
Sage is known as a women’s herb, although all genders may benefit from using it. Chumash women historically used sage to subdue heavy menstruation. Sage may also regulate hormone levels in order to bring on a delayed period. Two different clinical trials have looked at massage oils infused with Clary Sage (Salvia sclarea) essential with other plants to reduce menstrual pain. It is believed that the eucalyptol in Salvia may provide some of the analgesic effects to alleviate menstrual discomfort. [23, 24, 25]
Sage may also benefit those going through menopause. During this phase of a woman’s life, the body goes through a pronounced decline in estrogen. The drop in estrogen is what leads to hot flashes, irritability, sweating, and vaginal dryness.  Compounds in sage are believed to mimic the properties of this hormone by binding to GABA receptors in the brain, whereby they counteract hot flashes and excessive sweating. Due to the plant’s positive impact of the nervous system, it may also benefit brain fog and provide an overall calming effect. 
White sage (Salvia apiana) has been used by certain native groups of the Americas in ritual work for centuries. Bundles of sage leaves are sometimes lit by these communities (known as smudging) and wafted throughout an area for healing, connection to spiritual worlds, and clearing away negative energy. In the present day, the use of sage as incense has become a global phenomenon. The high popularity for sage bundles, especially in new age circles, has lead the demand for the plant to far outweigh supply. So much so that the sought after White Sage commonly harvested for smudge sticks has dramatically stressed the land and communities for which it is revered.
When growing in its native habitat, White Sage is a keystone species of its plant community. This means that it significantly influences the ecosystem and affects a large amount of other organisms. Its removal can drastically alter the environment and the plants and animals that live within it. Many endangered and threatened species rely on White Sage and the habitat that it is a part of. The threat of human development on lands where it grows is also a factor in its precarious future. 
Many indigenous groups have expressed concern and outrage at the commercialization of White Sage. They have cited the cultural appropriation that accompanies the marketing of smudge sticks. The mass consumption of the plant dismisses cultural awareness and signifies a lack of understanding about impact it makes on the earth.
The practice of smudging by specific groups of indigenous people of North America, such as the Chumash, is an integral part of their culture. And until 1978, it was illegal for Native Americans to practice their religion, which also included smudging with White Sage. Many people were killed or put in jail to maintain their traditions and cultural practices. 
Some (but not all) indigenous groups of North America practice sage smudging. In an interview with Bustle Ruth Hopkins, Dakota/Lakota Sioux writer, described the essential aspect of sustainability when using sage in her community. When harvesting, a prayer is said to the plant to thank it. Additionally, sage is always picked from the leaves only, never the root, which ensures that it can continue to grow. 
A vocal critic of White Sage’s precarious situation has been Meztli Projects, a Los Angeles based Indigenous arts and culture collaborative. They have brought attention to the illegal harvesting practices committed to fulfill the commercial market. For example, four people were arrested In June 2018 when they took 400 pounds of white sage from North Etiwanda Preserve in California. The commercial harvest of White Sage is also a great concern to conservationists and herbalists, who frown upon harvesting sacred plants for profit to the detriment of indigenous groups and Mother Nature. 
Even consciously purchased sage products do not meet the standards for many indigenous people. Several native cultures believe that medicine should be gifted and not involve monetary exchange whatsoever. "Sage that's used in smudging — prayer — should never be bought and sold" noted writer and activist Taté Walker (she is Mniconjou Lakota and a member of the Cheyenne River Sioux Tribe). She equated selling sage to walking into a Catholic Church and asking to buy holy water. Additionally, the act of lighting sage should be done with matches, and never with lighters as the butane in their flame is believed to negate the medicine. For sustainability’s sake, light one leaf at a time instead of the whole bundle. It is also possible to honor sage its healing abilities without burning it at all. 
Smudging is a specific spiritual and cultural spiritual practice reserved for those who have carried the tradition for generations. However, non-indigenous folks can burn herbs and other plant based incense in a practice called smoke cleansing (rather than smudging).  Consumers can consciously collect or purchase other botanicals, such as cedar leaves, which grow abundantly throughout many parts of the world. Cedar (also another sacred plant for many indigenous groups) can easily be made into bundles for burning as incense and provides a pleasant scent as well. Some folks choose to use Garden Sage (Salvia officinalis) as an alternative.
Others may decide to grow their own White Sage. If that is the case, develop a relationship with the plant, learn about its nuances, and only use what has been cultivated or gifted. Do extensive research on the plant and forge a strong bond with it. Work only with those who have awareness of its important role in the ecosystem and for native cultures. It is crucial to remember that the plant is sacred for some indigenous groups. The use of White Sage, and any plant for that matter, must respect its history. We must refrain from fueling the global lack of awareness that could lead these important botanicals to become a memory of the past.