Clary sage

Clary Sage (Salvia sclarea L.): A Comprehensive Reference

1. Identity and Botanical Classification

1.1 Nomenclature and Taxonomy

Salvia sclarea, the clary or clary sage — the word "clary" deriving from Middle English clarie, from Anglo-Norman sclaree, from Late or Medieval Latin sclarēia, meaning "clear" — is a biennial (short-lived) herbaceous perennial in the genus Salvia. It is a member of the Lamiaceae (mint) family. The genus name Salvia is derived from the Latin word salvare, meaning "to heal" or "to be healthy," summarizing the popular belief in its health-promoting properties.

Salvia species constitute around one-quarter of the Lamiaceae family and are highly diverse, with over 900 species worldwide. Common synonyms or related common names for Salvia sclarea include "clary," "clear eye," and "muscatel sage." It should not be confused with common or garden sage (Salvia officinalis), which is a distinct species with a different phytochemical profile.

1.2 Morphology and Geographic Origin

Clary sage belongs to the Lamiaceae family. This biennial or perennial plant species is native to southern Europe but is cultivated worldwide as an ornamental and essential oil–bearing plant, mainly in regions with temperate and subtropical climates. More precisely, it is native to the northern Mediterranean Basin and to some areas in North Africa and Central Asia.

Salvia sclarea reaches 3 to 4 feet (0.91 to 1.22 m) in height, with thick, square stems covered in hairs. The leaves are approximately 1 foot (0.30 m) long at the base and 0.5 foot (0.15 m) long higher up on the plant. The upper leaf surface is rugose and covered with glandular hairs. The flowers are held in verticils, with between two and six flowers in each, and are held in large colorful bracts ranging in color from pale mauve to lilac or white-to-pink with a pink mark on the edge.

1.3 Common Forms and Preparations

The flowers, leaves, and essential oil are used to make medicine. The fresh or dried leaves and flowers can be infused and drunk as a digestive tea. The plant is also the source of a steam-distilled essential oil that represents its primary commercial and therapeutic form in modern practice. Clary sage is also used to produce a concrete and absolute, which are widely used in the fragrance and flavour industries, obtained by solvent extraction of plant material. In foods and beverages, the oil from clary sage is used as a flavoring agent; in manufacturing, the oil is used as a fragrance in soaps and cosmetics. The plant has long been cultivated as an herb and is currently grown predominantly for its essential oil.

---

2. Traditional and Historical Use

2.1 Ancient Mediterranean World

Clary sage made its first documented appearance in written history in 77 AD, when the Salvia family of plants was described by Pliny the Elder, Roman author and naturalist. Earlier still, references to clary sage date back to approximately 50 CE, when Pedanius Dioscorides, an ancient Greek botanist, called it "Clear Eye" in his herbal text De Materia Medica.

The traditional use of clary sage is thought to date back to the Romans, who used it internally as an infusion to support the digestive and respiratory systems, as well as for support during the menstrual cycle. Its aroma was valued by the Romans, and the plant was used to scent bathhouses; clary sage was also sometimes used as a hop substitute to flavour beer or wine, as it was said to add bitterness and make the brew more intoxicating. The leaves were also used to imbue wine with a muscatel flavour, hence one of its common names, muscatel sage.

In ancient Greece, mucilage from the seed was mixed with water and applied to swellings and tumours. It was also used to draw out thorns, splinters, and other debris from the skin.

2.2 Medieval European Use

In the Middle Ages, it was traditionally used for digestive issues, kidney disease, uterine and menstrual problems, throat and respiratory infections, and as an overall nerve tonic. Medieval scholars revered it as herba sacra, or "sacred herb," using it in eye washes and compresses for eye ailments — a use which led to its name "Clary," derived from the Latin clarus, meaning "clear."

In medieval Europe, distillates of Salvia sclarea were sold as "muscatel water" for various ailments. Writings from the 15th century, such as those by German herbalist Hieronymus Bock, note its benefits for eye inflammations and digestive upset.

The 17th-century herbalist Nicholas Culpeper suggested dipping clary sage leaves in batter and frying them in butter. According to him, the fried leaves helped with back pain. He also warned about mixing clary sage leaves with wine, as he believed the combination acted as an aphrodisiac. Culpeper referred to it as "clear-eye" in his Complete Herbal (1653).

Historically, clary sage was in fact the most popular tea in the UK before black tea (Camellia sinensis) was imported. During the Middle Ages in Europe, clary sage continued to be a staple in herbal medicine. Monks and herbalists valued its soothing qualities, using it to make herbal remedies and tonics.

2.3 Use in Other Traditional Systems

Clary sage is considered a tonic herb and is understood in traditional Chinese medicine (TCM) to strengthen the qi, restore mental debility, and serve as a general tonic. In traditional healing systems such as Ayurveda, it is classed as an all-round beneficial tonic that brings the three doshas into balance. Travelers on Silk Road accounts also mention local use of clary sage in Persia for wound healing, with crushed leaves applied as a poultice.

By the 17th century, French perfumers recognized its muscat-like aroma, and clary sage oil became a cornerstone in fine fragrances.

---

3. Phytochemistry: Key Constituents and Active Compounds

3.1 Essential Oil Composition

Clary sage is a complex aromatic with over 250 different constituents. The chemical composition of the essential oil is known to vary considerably based on geographic origin, growing conditions, and the plant part used, but several constituents appear consistently as dominant components.

The essential oil of clary sage is rich in oxygenated monoterpenoids and monoterpenoid hydrocarbons, with key constituents such as linalool acetate (49.1%) and linalool (20.6%), with other components including (E)-caryophyllene (5.1%), p-cymene (4.9%), α-terpineol (4.9%), and geranyl acetate (4.4%).

The results of investigation exhibit that the chemical composition of clary sage essential oil is influenced by various ecological, geographical, and environmental conditions, but linalool and linalyl acetate are recognized as the main components. Detailed analysis of one clary sage oil sample showed 56 constituents, of which linalyl acetate (57.9%) and linalool (12.4%) were determined as the main ones, alongside α-pinene (4.5%), α-terpineol (3.5%), sabinene (3.3%), β-pinene (3.0%), geranyl acetate (1.6%), myrcene (1.5%), and neryl acetate (1.0%).

3.2 Sclareol

Sclareol is a diterpene alcohol isolated from clary sage (Salvia sclarea L.) and is far-famed as the predominant ingredient in the refined oil of Salvia sclarea. Clary sage concrete contains a high percentage of sclareol, an unusually large molecule not commonly found in botanical aromatics, which possesses a gentle, ambergris-like aroma. The concentration of sclareol in the essential oil varies widely depending on the method of extraction and the chemotype of the plant.

3.3 Non-Volatile Phenolic Compounds

The plant is rich in bioactive compounds including essential oils, flavonoids, terpenes, and phenolic acids, which contribute to its therapeutic properties such as antimicrobial, anti-inflammatory, antioxidant, and neuroprotective effects. Characterization of bioactive compounds by high-performance liquid chromatography has indicated the presence of significant amounts of polyphenolics, with rosmarinic acid as the prevalent one. Acacetin has been reported as the highest phenolic compound in extracts of S. sclarea.

3.4 Diterpenoids in Roots

In the roots of S. sclarea, several diterpenoids are found, including ferruginol, salvipisone, sclareol, aethiopinone, and 1-oxoaethiopinone. Evidence has indicated that the diterpenoids aethiopinone and salvipisone from S. sclarea exhibit cytotoxic activity toward HL-60 and NALM-6 leukemia cells.

---

4. Mechanisms of Action

4.1 Estrogenic and Endocrine Modulation

The high (up to 7%) sclareol content of clary sage essential oil makes it a selective oestrogen receptor modulator (SERM), and as such, it has a systemic oestrogen regulatory action, potentially improving menopausal symptoms, dysmenorrhoea, or PMS where there is low oestrogen, or severe forms of PMS where oestrogen is dominant. Its uterine tonic, relaxant, and spasmolytic actions are attributed to its stimulatory effects on the pituitary-gonadal axis, a critical part of the neuroendocrine system regulating sex hormones. This stimulatory activity is understood to be produced by the herb's linalyl acetate content, which can be up to approximately 66.5%.

It is important to note, however, that two other essential oils (geranium and rose otto) showed oestrogen-boosting effects in studies, but clary sage did not. While sage contains compounds with weak oestrogen-like properties (phytoestrogens), this does not translate to measurably increasing human oestrogen levels.

4.2 Neurological Pathways: Dopaminergic and Serotonergic Modulation

Investigation of the mechanism of clary oil's antidepressant action by pretreatment with receptor agonists and antagonists found that the anti-stressor effect of clary oil was significantly blocked by pretreatment with buspirone (a 5-HT_1A agonist), SCH-23390 (a D₁ receptor antagonist), and haloperidol (a D₂, D₃, and D₄ receptor antagonist). This indicates involvement of both serotonergic and dopaminergic pathways in the observed neurological effects.

Linalyl acetate has been reported to reduce systolic blood pressure and reactive oxygen species (ROS) production in a rat model of hypertension-related ischemic injury. In addition, linalyl acetate has been shown to exert drug-like effects by altering the expression of depression-related proteins, and to significantly reduce blood corticosterone levels in a rat model of type 2 diabetes induced by chronic stress and a high-fat diet, thereby alleviating stress.

4.3 Spasmolytic and Bronchodilator Action

Research has aimed at evaluating the traditional use of Salvia sclarea, finding possible mechanisms of its spasmolytic and bronchodilator actions in in vitro conditions supported by molecular docking analysis, along with antimicrobial effects. Characterization of bioactive compounds by high-performance liquid chromatography indicated the presence of significant amounts of polyphenolics, with rosmarinic acid as the prevalent one. The spontaneous ileal contractions were best inhibited by the extract prepared with 80% methanol and maceration.

4.4 Antifungal Membrane Disruption

The effects of clary sage oil and its two main components, linalool and linalyl acetate, on cells of the eukaryotic human pathogen yeast Candida albicans were studied. Dynamic and thermodynamic properties of the plasma membrane were investigated by electron paramagnetic resonance (EPR) spectroscopy. The monitoring revealed a break-point frequency decrease in the plasma membrane in a temperature-dependent manner. The results suggest a significant increase in fluidity of the treated plasma membranes close to the head groups, and the clary sage oil and linalyl acetate induced an increased level of fluidization at both depths of the plasma membrane. This membrane-disruption mechanism is thought to underlie the antifungal activity of the oil against Candida species.

4.5 Anticancer Mechanisms

Sclareol isolated from S. sclarea was found to inhibit proliferation and induce the apoptosis of several cancer cell lines. Evidence indicated that diterpenoids aethiopinone and salvipisone from S. sclarea exhibit cytotoxic activity toward HL-60 and NALM-6 leukemia cells. These compounds act through the induction of caspase-3, one of the major proteases involved in apoptosis, in a concentration-dependent manner after short-time exposure.

---

5. Scientific Evidence by Area of Use

5.1 Dysmenorrhea (Menstrual Pain)

Evidence strength: Preliminary; small randomized controlled trials (RCTs), typically using blended essential oils.

A 2012 randomized, double-blind clinical trial assessed the effectiveness of blended essential oils on menstrual cramps in outpatients with primary dysmenorrhea. Forty-eight outpatients were diagnosed with primary dysmenorrhea with 10-point numeric rating scales greater than 5. They were randomly assigned to an essential oil group (n=24) and a synthetic fragrance group (n=24). Essential oils blended with lavender (Lavandula officinalis), clary sage (Salvia sclarea), and marjoram (Origanum majorana) in a 2:1:1 ratio were diluted in unscented cream at 3% concentration for the essential oil group. This trial found that pain duration was significantly reduced from 2.4 to 1.8 days after the aromatherapy intervention (abdominal massage of the essential oil cream blend) in the essential oil group. The essential oil blend contained four analgesic components that totalled 79.29% of the formula; researchers attributed the analgesic effects to these constituents, two of which were linalyl acetate and linalool.

A separate earlier study, a randomized placebo-controlled clinical trial published in the Journal of Alternative and Complementary Medicine in 2006, explored the effects of aromatherapy on menstrual cramps in 67 female college students. Participants were divided into an experimental group receiving aromatherapy with lavender, clary sage, and rose oils in almond oil, a placebo group with almond oil only, and a control group with no treatment. Results showed significant reductions in menstrual cramps and dysmenorrhea severity in the aromatherapy group compared to placebo and control groups.

A 2026 randomized crossover trial examined clary sage inhalation specifically. This trial included 20 female collegiate athletes (mean age: 20.2 ± 1.2 years). Participants were randomly assigned to one of two conditions: clary sage essential oil (intervention) or water (control) inhalation. Each condition lasted for one menstrual cycle, with inhalation administered at bedtime for 60 minutes using a diffuser. Dysmenorrhea-related symptoms and their impact on athletic performance were assessed using a visual analog scale. Biochemical analyses included salivary antioxidant capacity and cortisol, estradiol, and progesterone level measurements. Data from 12 participants who completed the study were analyzed.

Limitations: All trials to date have used essential oil blends (not clary sage alone), making it impossible to isolate the contribution of S. sclarea specifically. Sample sizes are small, and the trials are largely limited to aromatherapy massage administration. The evidence is preliminary and cannot be considered definitive.

5.2 Menopause — Mood, Cortisol, and Serotonin

Evidence strength: Preliminary; single small clinical trial (n=22) with biochemical outcomes.

A study published in Phytotherapy Research (2014) examined the antidepressant-like effects of clary sage oil on human beings by comparing neurotransmitter level changes in plasma. The voluntary participants were 22 menopausal women in their 50s. Subjects were classified into normal and depression-tendency groups using Korean-version Depression Inventory instruments. The changes in neurotransmitter concentrations were then compared between the two groups. After inhalation of clary sage oil, cortisol levels were significantly decreased while 5-hydroxytryptamine (5-HT) concentration was significantly increased. Among the three inventories used, only KBDI-II differentiated the normal and depression-tendency groups with a significantly different cortisol level. The study concluded that clary sage oil has an antidepressant-like effect.

Clary sage was shown to both increase 5-HTP (serotonin precursor) production and lower cortisol in this small study of 22 menopausal women, some of whom experienced depressive symptoms. The change rate in cortisol levels was greater in women with depressive symptoms compared to normal groups, and the difference was statistically significant.

Limitations: The study population was very small (n=22), all female, and all menopausal. The study lacked a placebo control and was not blinded. These findings cannot be generalized to broader populations and must be replicated in larger, controlled trials.

5.3 Anxiety, Stress, and Depression

Evidence strength: Preliminary; one small clinical RCT in a specialized clinical population; supporting animal studies only for mechanistic data.

A randomized blinded controlled trial published in 2025 in Frontiers in Medicine analyzed the effects of inhaling clary sage (S. sclarea L.) or linalyl acetate on depression and psychological factors in patients with diabetic foot ulcers (DFU). Patients were categorized as having mild or moderate-to-severe depression based on visual analog scale (VAS) for depression scores. They were randomized to inhalation of 5% clary sage oil, 5% linalyl acetate, or almond oil (control) by natural breathing. Blood pressure, heart rate, depression-VAS, anxiety-VAS, and stress-VAS were measured before and after inhalation. This study enrolled 72 patients with DFU. Compared with inhalation of almond oil, inhalation of clary sage oil significantly reduced stress (p < 0.05 and p < 0.01) in patients with mild depression, whereas inhalation of linalyl acetate significantly reduced anxiety-VAS (p < 0.05) and depression-VAS (p < 0.05) in patients with moderate-to-severe depression. Inhalation of clary sage oil may have the potential to alleviate stress and anxiety in DFU patients with mild depression, whereas inhalation of linalyl acetate may have the potential to alleviate anxiety and depression in DFU patients with moderate-to-severe depression.

Animal data: The antidepressant effects of essential oils of chamomile, clary sage, rosemary, and lavender were assessed using a forced swim test (FST) in rats. Rats were treated with essential oils by intraperitoneal injection or inhalation. Serum levels of corticosterone were assessed by ELISA. Among the essential oils tested, 5% (v/v) clary oil had the strongest anti-stressor effect in the FST. These are preclinical findings and cannot be directly extrapolated to humans.

Limitations: The 2025 human RCT was conducted in a specialized clinical population (diabetic foot ulcer patients) and may not be generalizable. Animal studies provide mechanistic hypotheses but not clinical proof.

5.4 Antimicrobial and Antifungal Activity

Evidence strength: Moderate in vitro/laboratory evidence; no clinical trials in humans.

The plant's essential oils and extracts have demonstrated robust antimicrobial activity against both Gram-positive and Gram-negative bacteria, as well as antifungal properties against multiple Candida species and other fungal pathogens.

Three species of Staphylococcus genera were isolated from patients with wound infections, including S. aureus (n=28) and coagulase-negative species. In vitro results showed that Salvia sclarea essential oil has strong antistaphylococcal activity against clinical strains isolated from wound infections. The strains of S. aureus and S. epidermidis were most susceptible to the clary sage oil. Staphylococcus aureus strains including MRSA were simultaneously the most resistant to recommended antibiotics.

The essential oil of clary sage was analyzed as a potential antifungal agent. Food poisoning agents, spoilage fungi, and plant and animal pathogens were among the tested fungal species. The microdilution method was used to establish minimal inhibitory concentrations (MIC) and minimal fungicidal concentrations (MFC). The commercial antimycotic bifonazole was used as a control. A concentration of 25 μl/ml showed fungicidal activity against Aspergillus, Penicillium, and Fusarium species and Trichoderma viride.

The essential oil of S. sclarea and linalyl acetate combination (1:1) showed significant in situ protection of Picrorhiza kurroa rhizomes against Aspergillus flavus and other biodeteriorating fungal isolates, attributed to its high phenolic content and antioxidant nature. Hydrolates prepared from S. officinalis and S. sclarea also demonstrated inhibitory activity on tested Gram-positive and Gram-negative bacteria.

Limitations: All antimicrobial data are from in vitro laboratory studies. There are no published human clinical trials evaluating clary sage as an antimicrobial agent. In vitro findings do not reliably predict clinical efficacy.

5.5 Anticancer Properties

Evidence strength: Preclinical only (in vitro cell line studies); no human clinical trials.

The bioactive compounds of S. sclarea, particularly sclareol, exhibit promising anticancer properties, showing significant effectiveness against various cancer cell lines including leukemia, breast, colon, lung, cervical cancer, and osteosarcoma. Sclareol isolated from S. sclarea was found to inhibit proliferation and induce the apoptosis of several cancer cell lines. Sclareol also performed antiphotoaging efficacy in vitro and exhibited wrinkle improvement effects in a clinical test using 0.02% sclareol-containing cream.

Interestingly, sclareol has been recently considered as a potential candidate against COVID-19 and Parkinson's disease. These are investigational findings in early-stage research only.

Limitations: All anticancer data are derived from in vitro cell line studies. These findings are preliminary and exploratory. No human clinical trials have been conducted on sclareol's or clary sage's anticancer effects. Cell line efficacy does not predict clinical cancer treatment outcomes.

5.6 Antidiabetic Effects

Evidence strength: Preliminary preclinical evidence; limited clinical translation.

Research on S. sclarea essential oil for antidiabetic effects has focused particularly on chemotypes with high concentrations of linalool (averaging 40.2%) and linalyl acetate (averaging 50.4%). Chemotype 1, characterized by high linalool content and typically found in low-altitude regions of Poland and Lebanon, demonstrated significantly superior acute and subchronic antidiabetic properties compared to chemotype 5, distinguished by its high linalyl acetate content. Research confirmed the promising antidiabetic activity of clary sage essential oil, indicating its potential role as a complementary therapeutic option in diabetes management.

Sclareol has also been characterized with anti-diabetes and antihypertensive bioactivities. However, these findings remain largely preclinical.

5.7 Cardiovascular and Antihypertensive Effects

Evidence strength: Animal studies only.

Although Salvia sclarea is widely used in aromatherapy and has antioxidant and antimicrobial properties, its cardiovascular mechanisms of action were studied by assessing whether clary sage is effective in treating endothelial dysfunction induced by chronic immobilization stress in rats. Rats were intraperitoneally injected with almond oil, clary sage oil (5%, 10%, or 20%), or nifedipine once daily, followed by immobilization stress (2 h/day) for 14 days. Systolic blood pressure (SBP) and heart rate (HR) were measured, as were serum concentrations of corticosterone (CORT), a biomarker of chronic stress; malondialdehyde (MDA), a biomarker of oxidative stress; nitric oxide production; and eNOS level, a biomarker of endothelial dysfunction. These findings are confined to animal models.

5.8 Spasmolytic / Antispasmodic Activity

Evidence strength: In vitro; supported by traditional use and molecular docking.

A study aimed to evaluate the traditional use of Salvia sclarea L. by finding the possible mechanisms of its spasmolytic and bronchodilator actions in in vitro conditions supported by molecular docking analysis, along with antimicrobial effects. The study found that S. sclarea extracts inhibited spontaneous ileal contractions in isolated tissue preparations, supporting the traditional use of the plant for gastrointestinal spasm and respiratory conditions.

---

6. Body Systems Associated with Clary Sage

• Reproductive / Endocrine system: Clary sage has a particular affinity for the female reproductive system, having applications during menarche, labour, and menopause, working systemically and specifically, primarily on uterine muscle tissues, nervous system, and muscles.
• Central nervous system / Mood: The oil of clary sage is used to support the nervous system and is used widely in the treatment of stress, anxiety, depression, and tension.
• Musculoskeletal system: Its pain-relieving, antispasmodic effects make it helpful for relieving muscle cramps or sore muscles.
• Digestive system: Clary sage has a regulating effect on the digestive system, alleviating bloating and IBS.
• Respiratory system: It is antimicrobial and an expectorant, which makes it helpful in supporting and tonifying the lungs and supporting recovery from respiratory congestion or infection.
• Integumentary system (skin): Sclareol has been found to have antiphotoaging activity, and a 0.02% sclareol-containing cream demonstrated wrinkle-improvement effects in a clinical test setting.

---

7. Dosage Forms and Reported Dosages

Usage forms include primarily essential oil (inhalation, topical) and herbal tea. Specific dosage values reported in the cited human clinical studies are as follows:

• Topical aromatherapy massage (dysmenorrhea): Essential oils blended with lavender, clary sage, and marjoram in a 2:1:1 ratio were diluted in unscented cream at a 3% concentration for topical application.
• Inhalation (DFU/depression study): Patients were randomized to inhalation of 5% clary sage oil, 5% linalyl acetate, or almond oil (control) by natural breathing.
• Inhalation (dysmenorrhea in athletes): Each condition lasted for one menstrual cycle, with inhalation administered at bedtime for 60 minutes using a diffuser.
• Herbal tea / infusion: Fresh or dried leaves and flowers can be infused and drunk as a digestive tea to relieve bloating, flatulence, or IBS. No standardized dose for oral infusion has been established in the cited peer-reviewed literature.
• Animal study dosages (not applicable to humans): In the rat stress study, animals were intraperitoneally injected with clary sage oil at 5%, 10%, or 20% concentrations. These routes and concentrations are not clinically applicable to humans.

No standardized therapeutic dosage for oral or systemic administration of clary sage preparations has been established in the reviewed clinical literature. Doses used in the human studies cited above relate exclusively to aromatherapy (inhalation and topical) routes.

---

8. Safety Considerations and Interactions

8.1 Pregnancy

Clary sage is commonly touted as an essential oil to be avoided during pregnancy, owing to its actions as an emmenagogue. Despite this concern, there is no general consensus against its use nor clinical evidence finding that it is unsafe during pregnancy, with some authorities (Tisserand and Young) expressing no caution against its use. Similarly, there is no evidence confirming its safety during pregnancy, so its use during pregnancy is not recommended.

Clary sage should be avoided until term due to a possible effect on uterine action. Clary sage seems to be safe for pregnant and breastfeeding women in food amounts, but larger medicinal amounts should be avoided until more is known.

8.2 Hormone-Sensitive Conditions

Avoid use in cases of hormone-dependent cancers, since clary sage is a SERM and the interactions of SERMs with other cancer treatments are not well understood.

8.3 Alcohol Interaction

Alcohol may potentiate the narcotic effects of clary sage. Avoiding the use of this essential oil during or after alcohol use is advised. Reports indicate that this combination may lead to vivid dreams and trouble sleeping.

8.4 Drug Interactions

Chloral hydrate and hexobarbitone interact with clary sage oil. These drugs cause sleepiness and drowsiness, and clary sage appears to increase the effects of these hypnotic and sedative medications, enhancing their effects.

8.5 Skin Sensitization

Essential oils can be poisonous or cause skin irritation if used in their pure (undiluted) form. Standard aromatherapy practice calls for dilution in a carrier oil before topical application. Patch testing on a small area of skin is advised before widespread topical application.

8.6 General Tolerability

Clary sage is safe when used in amounts found in foods. There is not enough information to know if it is safe when used in medicinal amounts. Its broad-spectrum pharmacological activities, coupled with low toxicity and natural origin, make it a candidate for developing novel therapeutic agents and nutraceutical products — though human safety data at therapeutic doses remain limited.

8.7 Evidence Gaps and Overall Evidence Assessment

Clary sage is used for upset stomach and other digestive disorders, kidney diseases, menstrual cramps (dysmenorrhea), symptoms of menopause, anxiety, stress, and many other conditions, but there is no good scientific evidence to support these uses. The majority of pharmacological evidence remains preclinical (in vitro and animal-based). Human clinical trials are few in number, small in sample size, typically use essential oil blends rather than isolated clary sage, and are mostly limited to aromatherapy routes of administration. No randomized controlled trials examining clary sage's effects on progesterone exist in the peer-reviewed medical literature. Claims about progesterone-boosting effects are not supported by clinical research. This is a gap where marketing claims substantially exceed the available evidence.

---

References

• Salvia sclarea: A comprehensive review of its pharmacology, phytochemistry, ethnobotany and traditional uses — ScienceDirect (2026)
• Salvia sclarea Essential Oil Chemical Composition and Biological Activities — PMC (2023)
• The Bioactivities of Sclareol: A Mini Review — Frontiers in Pharmacology / PMC (2022)
• An In Vitro and In Silico Characterization of Salvia sclarea L. Methanolic Extracts as Spasmolytic Agents — PMC (2023)
• Natural Compounds of Salvia L. Genus and Molecular Mechanism of Their Biological Activity — PMC (2024)
• Differential Effects of Clary Sage Oil and Linalyl Acetate on Depression Levels in Diabetic Foot Ulcer Patients — Frontiers in Medicine / PMC (2025)
• Differential effects of clary sage (Salvia sclarea L.) oil and linalyl acetate on depression levels in diabetic foot ulcer patients — PubMed (2025)
• Pain relief assessment by aromatic essential oil massage on outpatients with primary dysmenorrhea: a randomized, double-blind clinical trial — PubMed (2012)
• Antidepressant-like effect of Salvia sclarea is explained by modulation of dopamine activities in rats — PubMed (2010)
• Effects of Salvia sclarea on chronic immobilization stress induced endothelial dysfunction in rats — PubMed (2014)
• Effects of clary sage oil and its main components, linalool and linalyl acetate, on the plasma membrane of Candida albicans: an in vivo EPR study — PubMed (2016)
• Changes in 5-hydroxytryptamine and Cortisol Plasma Levels in Menopausal Women After Inhalation of Clary Sage Oil — Phytotherapy Research (2014)
• The effect of clary sage oil on staphylococci responsible for wound infections — PMC (2015)
• Clary sage essential oil and its biological activities — Advances in Traditional Medicine, Springer (2020)
• Effects of Inhaling Clary Sage Essential Oil on Dysmenorrhea-Related Symptoms, Salivary Antioxidant Capacity, and Hormone Levels in Female Collegiate Athletes: A Randomized Crossover Trial — Applied Sciences / MDPI (2026)
• Salvia sclarea — Wikipedia
• Clary Sage (Salvia sclarea): Benefits, Side Effects, Safety — Herbal Reality
• Clary Sage — WebMD Vitamins & Supplements
• Can Clary Sage Really Help Your Hormones? What the Research Actually Shows — Klarity Health Library
• Chemical composition and antifungal activity of Salvia sclarea (Lamiaceae) essential oil — ResearchGate
• Bioactive chemical composition and pharmacological insights into Salvia species — PMC (2025)