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 Herbal Medicine: Inflammation and Arthritis 
The plant kingdom is abundant in species that act as anti-inflammatories to animal tissue. If the premise is accepted that through an ecological integration most of the biological needs of humanity and the other animalsare met by our evolutionary environment, the wealth of anti-inflammatory herbs comes as no surprise. Whilst they are rarely as immediately powerful as the steroid drugs, they are very rarely as dangerous and potentially life threatening.

It should be remembered that the steroidal anti-inflammatory drugs were developed from plant material and are still largely synthesized from saponins such as diosgenin from the Mexican Yam (Dioscorea floribunda).1

Inflammation, a process unpleasantly familiar to everyone, occurs in response to a range of traumas from sunburn and wounds, to infection and auto-immune conditions. Whatever the cause, this process is basically the same.

It is characterized by four physical signs; warmth, redness, swelling, and pain. Warmth and redness result from dilation of the small blood vessels in the injured area and increased local blood flow. Because blood vessels become more permeable during inflammation, protein rich exudate escapes from blood plasma to the damaged tissue and causes swelling. Pain is believed to result from such chemical substances as serotonin or from tension of tissue over the inflamed area. So inflammation in auto-immune conditions such as rheumatoid arthritis is fundamentally the same as that of simple infections or wounds, however the trigger of the reaction is very different.

The biochemistry and medical pathology of this complex process can often subtly imply that chemistry is the medical answer. Plants as whole medicines will reduce and soothe much inflammation wether we know the biochemistry or not. A review of recent studies show much confirmation about the efficacy of traditional remedies.

Perhaps the most important inflammatory conditions to affect humanity are the varieties of arthritis and rheumatism. Throughout the world herbal medicine is used in its treatment. Arthritis is a general term for approximately 100 named diseases that produce either inflammation of connective tissues, particularly in joints, or noninflammatory degeneration of these tissues. The word simply means joint inflammation, but because other structures are also affected, the diseases are often called connective tissue diseases. The terms rheumatism and rheumatic diseases are also used. Besides conditions so named, the diseases include gout, lupus erythematosus, ankylosing spondylitis, degenerative joint disease, and many others. Causes of these disorders include immune-system reactions and the wear and tear of aging, while research indicates that the nervous system may often be equally involved. About one out of seven Americans exhibit some form of arthritis. Many of these diseases are characterized by inflammation in the affected tissue. The usual signs of inflammation (warmth, redness, swelling, and pain) are often present.

In some conditions, the inflammation is an immune reaction. This may be the body's defense against invading microorganisms, but often the immune reaction against the body's own tissue is of unknown cause. The body seems to react against itself rather than against an invading microorganism. Anti-self antibodies react with intact connective tissue and synovial membranes and thus cause inflammation.

A common auto-immune form of arthritis is rheumatoid arthritis. Whilst the symptoms of rheumatoid arthritis are due to inflammation of the connective tissues, the cause is not at all clear. Characteristically the synovial membranes, or inner linings of the joint capsules, are chronically inflamed. The synovial mass proliferates and thereby destroys cartilage, bone and adjacent structures. Widespread inflammation may involve other tissue leading to painful joints, loss of mobility, and a generalized soreness and depression. Blood tests often reveal the presence of rheumatoid factors, proteins produced by the immune system in response to the rheumatic process.

Utilizing a broad holistic approach, herbal medicine works with the whole body promoting an amelioration of the condition whilst alleviating pain and discomfort. Simply using anti-inflammatory and anti-rheumatic remedies is not enough, therapy must focus on liver function, circulation, elimination as well as quality of life and experience. Such practical therapeutic considerations go beyond the range of this book in which research findings are the focus.

Herbs & inflammation
Herbalists around the world know of many plants with inflammation inhibiting and anti-arthritic properties. Whether it be Bogbean (Menyanthes trifoliata), Nettles (Urtica dioica) or the Kalahari desert herb Devil's Claw (Harpagophytum procumbens), they all work. Such remedies are under intense investigations as anti-inflammatory agents. In a well known study, 163 species of plants and fungi were tested to determine their anti-inflammatory activity. Of the species tested, 17 exhibited between 30/39% inhibition of inflammation, 21 between 40/49%, 15 between 50/59%, 4 between 60/69%, and 2 gave greater than 70 % inhibition.2

Unfortunately chemical identification of the anti-inflammatory components are usually given much more attention than therapeutic use of the herbs. This is because the plants are viewed as sources of potentially valuable drugs rather than having inherent value in themselves.

As examples of such chemical research, consider the aerial parts of Dianthus barbatus which has yielded two saponins (barbatosides A and B) having analgesic and anti-inflammatory activities.3 The aglycone of each saponin was identified as quillaic acid. The glycone of barbatoside A consisted of rhamnose, arabinose, fructose, xylose, galactose, glucose and one unidentified sugar; whereas the glycone of barbatoside B contained arabinose, fructose, xylose, mannose, galactose, glucose and three unidentified sugars. Astragalin, kaempferol-3-O-[[beta]]-D-sophoroside, D-pinitol and L-leucine were also isolated. Conyza canadensis is another herbal remedy found to exhibit a significant anti-inflammatory in the laboratory. Eight sesquiterpenes have the highest anti-inflammatory activity, including beta-santalene, beta-himachalene, cuparene, alpha-curcumene, gamma-cadinene.4

Whilst much of the anti-inflammatory research concerns herbs that do not come to mind immediately to the European or North American herbalist, some of our prized remedies have received attention. Meadowsweet, with its high levels of analgesic salicylates is described in the section on the digestive system. An excellent remedy introduced into British usage by the American Physio-medicalists is Prickly Ash (Zanthoxylum americanum), now under study as a source of effective anti-inflammatory chemicals such as piperonyl-4-acrylic isobutyl amide.5 The name Prickly Ash has much more of a ring to it!

Devil's Claw(Harpagophytum procumbens) is a remedy from the Kalahari desert in Namibia with a well deserved reputation as an effective rheumatic remedy. A group of glycosides called harpagosides found in the root show a marked antiinflammatory effect.6 Similarly Greater Celandine (Chelidonium majus) has revealed alkaloids that justify in chemical terms the ancient herbal wisdom about its use.7

Comparative studies
In many examinations, the herb or its components are compared to a commonly used anti-inflammatory drug such as aspirin or phenylbutazone. Results are compared to see if the effect of the herb is statistically significant. When Cucumis trigonus was studied for both analgesic and anti-inflammatory activity using a standard drug for comparison it showed statistically significant activity.8 Anti-inflammatory agents such as phenylbutazone, ibuprofen and Commiphora mukkul were compared. All three decreased the thickness of the joint swelling during the course of treatment, confirming the value of this Ayurvedic herb used in the treatment of Arthritis.9

A Chinese medicine known as Shosaikoto has been shown to have mild anti-inflammatory action but more importantly it significantly increased the anti-inflammatory effect of prednisolone in laboratory tests. This points to the possibility of using herbal remedies to potentiate drug treatments whilst using lower doses of the potentially dangerous chemicals involved.10

West African research
Most research is conducted in laboratories upon animals, with no reference to therapeutic practice with the remedies or possible future use. Much of the work coming from West Africa shows what can be done if real herbal usage is considered. Throughout the area herbal medicine is a thriving and respected part of the health care systems.

Investigation of Ficus elastica as an anti-inflammatory was prompted by the fact that practitioners of herbal medicine in West Africa use the plant for the treatment of muscle and joint pain. The results of the investigation confirm that the herb markedly inhibited experimentally induced inflammation. This effect of Ficus elastica was very similar to that of the commonly prescribed anti-arthritis drug indomethacin. Similarly, both Ficus elastica and indomethacin inhibited the primary as well as the secondary lesions of arthritis in the rat. The impressive anti-inflammatory activity of the herb may have been due to the presence of a flavonoid.11

Much of the observation of real herbal usage of these remedies is undertaken by ethnobotanists rather than overtly medical researchers. From a survey of anti-arthritic remedies used in Igbo tribal ethnomedicine in Nigeria, they selected three plants (Lonchocarpus cyanescens, Costus afar andTerminalia ivorensis) for closer study. Twenty-five volunteers were monitored while receiving treatment from two reputable herbalists, and the result of the clinical investigation were so impressive that they prompted pharmacological and phytochemical studies on the herbs. Extracts of the herbs reduced inflammation and the associated swelling, checked diarrhoea, and ameliorated all signs associated with polyarthritis in rats.12

Many cultures have received cursory examination by the ethnobotanists, but all too rarely by open minded clinicians. Whilst the surveys carried out are excellent, as in Panthong's review of Thai herbalism, this rarely comes to the attention of therapists considering possible techniques.13

Chinese research
A considerable number of Chinese medical herbs have been found to be anti-inflammatory upon screening for the inhibition of acute inflammation, allergic reaction, and for the alleviation of arthritis symptoms.14 This research has been published exclusively in Japanese or Chinese, making it little known in the west. Many popular Chinese medical prescriptions used in the treatment of arthritis base their anti-inflammatory action on synergistic interactions of the herbs present.15 This makes biochemical conclusions difficult to reach as research protocols for complex mixtures pose a formidable problem for the research pharmacologist.

Many examples can be given of the specific herbs shown to have value. A well known traditional remedy, Scutellaria baicalensis; a relative of Skullcap, has excellent properties partially attributable to the flavonoids present. It has an ancient history of use in, amongst other things, allergic conditions.16

Root and stem decoctions of Sinomenium acutum, one type of Fang-chi, have been used as a folk remedy for neuralgia and rheumatoid arthritis in many areas of the Far East. In Japan and China various plants have been identified as Fang-chi (Boi in Japanese) since antiquity. This uncertainty is a common example of the difficulty researchers have in evaluating the efficacy of herbs described in classical Chinese literature.

In investigation of the range of traditional Fang-chi plants only Sinomenium acutum has been demonstrated to contain the alkaloid sinomenine, which is now known to be effective in neuralgia and rheumatic diseases. Sinomenine is a unique plant alkaloid, as it potently releases histamine in association with degranulation of mast cells in connective tissue, preferentially in the skin and joint capsules. The released histamine is responsible for the pharmacological actions of sinomenine, such as vasodilation, increased vascular permeability, acceleration of the thoracic and peripheral lymph flow, contraction of smooth muscles, increased peristalsis of the intestines, and stimulation of gastric acid secretion.

This all provides a clear pharmacological basis for the anti-inflammatory action of this traditional herbal remedy.17

Ayurvedic studies
On pharmacological evaluation, the Ayurvedic anti-inflammatory remedy Salai guggal displayed marked activity in laboratory animals. No side effects were seen on cardiovascular, respiratory and central nervous system functions. Of great interest was the lack of ulceration in the rat stomach. Stomach ulcers are a common complication of drug treatment of arthritis.18

South American studies
South America is one of the richest botanical areas in the world. Under the tragic pressure of deforestation of the rain forest and resultant plant extinction much research is going into plant resources. It is a pity that economic value has to be cited as reason for preserving the forests or for considering the herbs, but we live in a crazy world. Croton lechleri, from the Upper Amazon Valley of Peru, has yielded a new anti-inflammatory alkaloid called taspine. The anti-inflammatory activity of taspine hydrochloride has been shown to have value in arthritis treatment.19

Italian studies
It is not just in Africa, Asia and South America that herbal remedies are used traditionally for the relief of rheumatism and arthritis. A recent paper reports on the use of more than 90 plant species as folk remedies to treat rheumatic and arthritic diseases in Northern Italy. The study focussed on the pharmacology of the mode of action of these remedies, not questioning that they have some empirical value. Rubefacient activity was shown to have its basis in moieties such as protoanemonin, isothiocyanate or allicine yielding plants and species containing capsaicin, oleoresins, volatile oils, resins and alkaloids. The effectiveness of other herbal remedies appeared to depend on their content of salicyl derivatives. A considerable number of the plant species contained chemicals for which anti-inflammatory properties have been demonstrated.20

1 Tyler (1981) PHARMACOGNOSY 8th Edn., Lea & Febiger
2 Benoit Biological and phytochemical evaluation of plants. XIV. Antiinflammatory evaluation of 163 species of plants. LLOYDIA 1976 Mar-Jun; 39(2-3):160-71
3 Cordell Biological and phytochemical investigations of Dianthus barbatus cv. China Doll (Caryophyllaceae). LLOYDIA 1977 Jul-Aug; 40(4):361-3
4 Lenfeld J Motl O Trka A Anti-inflammatory activity of extracts from Conyza ccanadensis. PHARMAZIE 1986 Apr; 41(4):268-9
5 Oriowo Anti-inflammatory activity of piperonyl-4-acrylic isobutyl amide, an extractive from Zanthoxylum zanthoxyloides. PLANTA MED (1982 Jan) 44(1):54-6
6 Eichler Antiphlogistic, analgesic and spasmolytic effect of harpagoside, a glycoside from the root of Harpagophytum procumbens.
ARZNEIM FORSCH (Jan 70) 20(1):107-9
7 Lenfeld Antiinflammatory activity of quaternary benzophenanthridine alkaloids from Chelidonium majus. PLANTA MED (1981 Oct) 43(2):161-5
8 Naik Analgesic and anti-inflammatory activity in alcoholic extracts of Cucumis trigonus Roxburghii. A preliminary communication. PHARMACOLOGY 1980; 20(1):52-6
9 Sharma JN Sharma JN Comparison of the anti-inflammatory activity of Commiphora mukul (an indigenous drug) with hose of phenylbutazone and ibuprofen in experimental arthritis induced by mycobacterial adjuvant. ARZNEIM FORSCH 1977 Jul; 27(7):1455-7
10 Shimizu Combination effects of Shosaikoto (Chinese traditional medicine) and prednisolone on the anti-inflammatory action.
J PHARMACOBIODYN 1984 Dec; 7(12):891-9
11 Sackeyfio AC Lugeleka OM: The anti-inflammatory effect of a crude aqueous extract of the root bark of Ficus elastica in the rat.
ARCH INT PHARMACODYN THER 1986 May; 281(1):169-76
12 Iwu MM Anyanwu BN: Phytotherapeutic profile of Nigerian herbs. I: Anti-inflammatory and anti-arthritic agents. J ETHNOPHARMACOL 1982 Nov; 6(3):263-74
13 Panthong: Ethnobotanical review of medicinal plants from Thai traditional books, Part I: Plants with anti-inflammatory, anti-asthmatic and antihypertensive properties.
J ETHNOPHARMACOL (1986 Dec) 18(3):213-28
14 Kosuge: Studies on bioactive substances in the Chinese material medicines used for arthritic diseases in traditional Chinese medicine.
I. Anti-inflammatory and analgesic effect of Chinese material medicines used for arthritic diseases.
YAKUGAKU ZASSHI (1985 Sep) 105(9):845-7
15 Cyong: A pharmacological study of the anti-inflammatory activity of Chinese herbs. A review. ACU ELECTROTHER RES (1982) 7(2-3):173-202
16 Kubo: Studies on Scutellariae radix. VII. Anti-arthritic and anti-inflammatory actions of methanolic extract and flavonoid components from Scutellariae radix.
CHEM PHARM BULL (TOKYO) (1984 Jul) 32(7):2724-9
17 Yamasaki H: Pharmacology of sinomenine, an anti-rheumatic alkaloid from Sinomenium acutum. ACTA MED OKAYAMA 1976 Feb; 30(1):1-20
18 Singh GB Atal CK: Pharmacology of an extract of Salai guggal ex-Boswellia serrata, a new non-steroidal anti-inflammatory agent.
AGENTS ACTIONS (1986 Jun) 18(3-4):407-12
19 Perdue GP Blomster RN Blake DA Farnsworth NR: South American plants II: taspine isolation and anti-inflammatory activity.
J PHARM SCI 1979 Jan; 68(1):124-6
20 Cappelletti External antirheumatic and antineuralgic herbal remedies in the traditional medicine of north-eastern Italy.
J ETHNOPHARMACOL 1982 Sep; 6(2):161-90
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 About The Author
David Hoffmann BSc (Hons), MNIMHWhilst working in conservation and lecturing in ecology and the eco-crisis for the University of Wales, David Hoffman became convinced that to heal the world, to embrace planetary wholeness and responsibility for it......more
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