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.


Arthritis

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 et.al.: (1981) PHARMACOGNOSY 8th Edn., Lea
& Febiger

2 Benoit et.al. 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 et.al. 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 et.al.: Anti-inflammatory activity of piperonyl-4-acrylic
isobutyl amide, an extractive from Zanthoxylum zanthoxyloides. PLANTA
MED (1982 Jan) 44(1):54-6

6 Eichler et.al.: 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 et.al.: Antiinflammatory activity of quaternary benzophenanthridine
alkaloids from Chelidonium majus. PLANTA MED (1981 Oct) 43(2):161-5

8 Naik et.al. 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 et.al.: 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 et.al.: 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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David L. Hoffmann BSc Hons MNIMH Written by David L. Hoffmann BSc Hons MNIMH

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