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Anti-inflammatory Herbs

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					Anti-inflammatory Herbs Please note that this is merely text taken from a published article. Dr. Sands recommends that you check with your primary care doctor before instituting ANY change in your medication/vitamin regimen. Dr. Sands takes no responsibility for any adverse affects caused by taking any of the herbs reported in this article. As with any medication, you should always check with your doctor and/or pharmacist to make sure there are no adverse drug to herb interactions.

Inflammation can occur in almost any tissues of the body. Skin inflammations are the most visible and usually manifest as itching, redness, swelling, and local discomfort. Most of these conditions are mild and do not require a physician's visit. They can be treated with oral and topical OTC antiinflammatory agents, such as aspirin and ibuprofen. Inflammations are commonly associated with injuries and thus managing the injured site can relieve inflammation. Although inflammation normally occurs in response to a local disruption to the tissues after injury, 1 2 this process is also seen in conditions such as Alzheimer's disease, cancer, and irritable bowel 3 syndrome. Whether inflammation contributes to the cause of these conditions or is a response to them is not fully understood. However, it is believed that controlling inflammation may help alleviate these conditions or even prevent them. The inflammatory process is considered to be one of the elements by which the body repairs injury. Inflammation can be acute or chronic. Acute inflammations usually last from hours to several days; they are self-limiting and rarely result in permanent tissue damage. On the other hand, chronic inflammations progress slowly and can last for many months. Many herbs possess anti-inflammatory properties.

Anti-inflammatory Herbs
Among the best-known herbs with anti-inflammatory properties are Matricaria recutita, Curcuma longa, Zingiber officinale, Glycyrrhiza glabra, Salix alba, and Arnica montana. Some commercially available formulas and their suppliers are listed in TABLE 1.

Matricaria recutita (German Chamomile): The dried flowers of this plant are commonly used for 7 their sedative and spasmolytic properties. In addition, chamomile possesses anti-inflammatory 8 9 activities. Matricaria contains several flavones (ie, polyphenolic pigments of some plants), 7,10 8 namely, apigenin, luteolin, and matricine. When applied topically, the flavonoids were found to 10 penetrate intact skin deeply to exert an anti-inflammatory effect. Evidence suggests that 11 apigenin may generally inhibit cytokine-induced gene expression. Matricine does not have antiinflammatory activity. However, chamazulene, a transformation product of matricine, was found to 8 possess anti-inflammatory properties. Compared to a hydrocortisone 1% cream, the anti12 inflammatory effect of a chamomile cream was weaker. The recommended dose of Matricaria recutita flowers is 3 g three times daily; Matricaria is available as an infusion, a fluid extract, and a 13 tincture (1:5). Allergic hypersensitivity to this herb may occur in rare cases, and the herb can 14 irritate the eyes if applied near them. Curcuma longa (Turmeric): This Indian spice comes from the roots of Curcuma longa and contains diferuloyl methane (curcumin), demethoxycurcumin, and bisdemethoxycurcumin--all of 15 16 which are known as curcuminoids. Curcumin (the lipid-soluble component in turmeric) has been shown to exert an anti-inflammatory activity in several clinical studies, due in part to the 15,17-20 20 inhibition of COX-2 enzyme and iNOS. In particular, the inhibition of COX-2 was significant in colon cancer cells, which makes curcumin important as a colon cancer preventive 17,19 21,22 agent, since the COX-2 enzyme plays a key function in the progression of this disease. The inhibition of the COX-2 enzyme is achieved by suppressing the activation of NF-kB, a 18 eukaryotic transcription factor. Curcumin has also been shown to have an effect on the release of inflammatory mediators (eg, eicosanoids), which may further explain its role as an anti 23 inflammatory agent. However, the water-soluble portion of turmeric that contains turmerin does 16 not have an anti-inflammatory effect, although it has been shown to have antidepressant effects 24 that may be due to monoamine oxidase inhibition in the brain. According to Commission E in Germany (the German authority on evaluating herbal preparations), the recommended dose is 1.5 to 3 g of cut root daily; preparations of Curcuma longa are infusion powders, tinctures (1:5), 13 and fluid extracts. The use of curcumin is contraindicated in bile duct obstruction because it

enhances the secretion of bile.

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Zingiber officinale (Ginger): Ginger is commonly used in the diet, especially in India. The main ingredients in ginger that have an anti-inflammatory effect as well as antitumor and antiproliferative pro perties against tumor cells are 6-gingerol and 6-paradol, which are found in 25,26 the oleoresin fraction in ginger. Other constituents of ginger, 8-paradol and 8-shogaol, 27 demonstrate a significant inhibitory effect on the COX-2 enzyme system. Three important features of the molecules are necessary for this inhibition: (1) the degree of lipophilicity of the alkyl side chain, (2) hydroxy and carbonyl groups substitution pattern on the side chain, and (3) 27 the methoxy and hydroxy groups substitution arrangement on the aromatic moiety. Ginger oil 28 obtained from the plant's roots was found to have a profound anti-inflammatory effect. The German Commission E recommends a dose of 2 to 4 g of cut rhizome or dried extract daily or its 13 equivalent. Because ginger can enhance bile secretion, it is contraindicated in patients with 14 gallstones. Glycyrrhiza glabra (Licorice): The roots of Glycyrrhiza glabra contain glycyrrhizin, a compound 29 with anti-inflammatory activity. The aglycone, b-glycyrrhetinic acid, may cause this action of 29 glycyrrhizin. Glycyrrhizic acid, another major constituent in licorice, also has anti-inflammatory 30 activity. Glycyrrhizin, in addition to having anti-inflammatory actions, may act also as a 31 chemoprotective agent against tumors. The dose of licorice is 5 to 15 g daily of cut or powdered 13 roots and should contain 200 to 600 mg of glycyrrhizin. Licorice use is contraindicated in 14 patients with high blood pressure, cardiac diseases, or liver cirrhosis. Salix alba (White Willow): The role of salicylates in inflammation and pain management is well 2 32 documented in medicine. The bark of this plant contains salicin. Following oral administration 33 of salicin, it was found in serum mainly in the form of salicylic acid. After an oral dose (240 mg) was given to healthy volunteers, the Tmax was less than two hours and Cmax was 1.2 mg/L, 33 33 respectively. Salicylic acid is eliminated in urine as salicyluric acid. A daily dose equivalent to 13 60 to 120 mg of salicin is recommended by the German Commission E. Willow use can trigger 14 an allergic response in individuals sensitive to willow or to aspirin. Arnica montana (Arnica): This herb is commonly used for treating bruises and swelling, 34-36 although several clinical trials cast doubt on its efficacy. The presence of sesquiterpene lactones, such as helenalin and dihydrohelenalin, in arnica provides this herb with anti37 inflammatory properties. This is attributed to inhibition of the activation of transcription factors 38 NF-kB and NF-AT. Helenalin, the most active lactone, exerts its anti-inflammatory effect by inhibiting the activation of transcription factor NF-kB, which is responsible for the transcription of 37,39 genes involved in encoding mediators for the inflammatory process. Helenalin was also found to possess some cytotoxic effects against small cell carcinoma of the lung and colorectal cancer 40 cells in cell culture studies. The recommended doses are 2 g of herb/100 mL for the aqueous infusion, one part herb and five parts fatty oil for the oil, and for the ointment, not more than 15% 13 of oil. Sesquiterpene lactones may cause contact or allergic dermatitis when applied 14 externally. The internal use of arnica is not recommended due to its toxicity on major organs 14 such as the kidneys and the liver. Other Herbs: A host of other herbs have been shown to have anti-inflammatory activities. The distillate of Hamamelis virginiana (witch hazel) has been known to possess anti-inflammatory 41 properties. Echinacoside in Echinacea species (echinacea), a caffeoyl derivative, is thought to 42,43 be responsible for the anti-inflammatory activity in these species. Ananas comosus 44 (pineapple) contains bromelain, which has anti-inflammatory effects.

Conclusion
Numerous herbs possess anti-inflammatory effects. Some of this action may be due to the inhibition of the COX-2 enzyme or inhibition of the activation of transcription factors. As a general

rule, herbal preparations are not recommended during pregnancy or in children unless a physician prescribes them. The pharmacist should be aware of their contraindications when recommending these herbs to patients.