The word inflammation originates from the Latin ‘inflammare’ or ‘to set on fire’ (Scott et al., 2004). The Roman, Cornelius Celsus, around 2000 years ago, defined the four characteristic signs of inflammation: ‘rubor et tumor cum calore et dolore’, meaning ‘redness and swelling with heat and pain’. Inflammation can be acute or chronic, this article discusses dealing with the chronic form of inflammation which can be very destructive. A modern definition is, ‘chronic inflammation involves the proliferation, migration, and recruitment of tissue and inflammatory cells, which can be extremely damaging to normal tissue’ (Jackson et al., 1997). It also characteristically involves the elevation of inflammatory mediators which communicate between the different kinds of immune cell, called cytokines. Chronic inflammation, which is closely related to chronic pain, is present in difficult to treat conditions such as rheumatoid arthritis, osteoarthritis, and psoriasis. Chronic pain is very common and chronic pain of moderate to severe intensity occurs in 19% of adult Europeans (Breivik et al., 2006).

One approach to chronic inflammation is supressing it with pharmaceutical drugs like NSAIDs or biologic DMARD drugs. This can be very effective, but another approach is to use radical diet changes (e.g. a no red meat Paleo diet) and certain herbal medicines. There is now an increasing body of evidence that implies certain herbs reduce inflammatory pain and they typically involve fewer side effects. I now list some of the most powerful herbs for chronic inflammation that have at least one placebo or alterate medication controlled human study supporting their use against chronic inflammation. I also include some studies that support a herbs dual application for pain and the psychological side of the pain, like anxiety and depression.

  1. Boswellia. Boswellia serrata is a tree which grows throughout the dry hilly regions of northwest India (Kimmatkar et al., 2003). Boswellia is related to biblical frankincense and it has been known to Ayurvedic doctors of India for thousands of years (Castleman, 2001). It is used to treat chronic inflammation amongst other disorders. Its use is well supported by a few scientific papers from around 10-15 years ago, one double-blind placebo controlled study demonstrated a significant reduction of osteoarthritis pain compared with the placebo (Kimmatkar et al., 2003). Another well controlled study found boswellia was effective as sulfasalazine in treating ulcerative colitis (Gupta et al., 1997). A final human study found it was effective against asthma (Gupta et al., 1998). Although these studies were quite small, around 30-40 individuals, they show very promising results and I expect future larger studies will reinforce their discoveries and confirm the traditional knowledge of boswellia.
  2. Curcumin (from turmeric). Turmeric is a perennial herb that produces branched oblong shaped roots (Chattopadhyay et al., 2004). The roots have medicinal properties because of the yellow pigment that gives the root a distinctive yellow colour, called curcumin. A double blind randomised placebo control trial of 40 people demonstrated curcumin could reduce pain in osteoarthritis patients (Panahi et al., 2014). Another well controlled study found it effective against depression (Lopresti et al., 2014), since depression is related to severity of chronic pain, this supports its role as an important option in the treatment of chronic inflammation.
  3. Ashwagandha. Ashwagandha is a small herb native to India, parts of the Middle East and East Africa (Castleman, 2001). It holds a central position in Ayurveda and is mentioned in the ancient text, the Charak, as a whole body tonic. A double-blind placebo controlled study found it was effective against osteoarthritis together with curcumin, ginger, and boswellia (Kulkarni et al., 1991). However, ashwagandha is not a simple anti-inflammatory agent, it also can reduce anxiety and this has been demonstrated in a large well controlled trial (Auddy et al., 2008). Therefore, ashwagandha is a sensible option to include in a formula for chronic pain as it can help both the physical and psychological side of the disorder. It is quite similar to holy basil (tulsi) in this respect, which I haven’t included in this list because the lack of scientific studies in humans, although it is a valuable medicine.
  4. Cordyceps. Cordyceps is a medicinal mushroom that grows at very high altitude on the Qinghai-Tibetan plateau (Zhu et al., 1998). It is one of the Chinese superior tonic herbs and is used traditionally for diverse diseases including allergies and asthma (Winston, 2007). Cordyceps has been found to reduce the occurrence of lupus nephritis, which is inflammation of the kidney (related to the disease lupus), in a randomised alternate medication controlled study of 61 people (Lu et al., 2002).
  5. Nettles. Stinging nettles are a common perennial plant that grow throughout Europe, the U.S.A., and other temperate climates (Winston, 2007). David Hoffman, in his book, ‘holistic herbal’, states, ‘Nettles are one of the most widely applicable plants we have. They strengthen and support the whole body’ (Hoffman, 1988). Nettles have been shown to reduce the expression of inflammatory markers in patients with type II diabetes in a double-blind placebo controlled human study (Namazi et al., 2011). This may be related to why nettles are indicated traditionally for gout, arthritis, and allergies.
  6. Chinese skullcap. Chinese skullcap is a member of the mint family, it is found growing in China alongside roads, in fields, and in high dry sandy soils (Kovács et al., 2004). One study, randomised placebo controlled, found it was effective in reducing osteoarthritis of the knee in combination with another herb (Arjmandi et al., 2014). In this study, they found these herbs performed as well as the NSAID, naproxen.
  7. Asian ginseng. Asian ginseng is a small herb with red berries and a fleshy, multibranched root which is the source of its medicinal powers (Castleman, 2001). Early traditional Chinese medical texts suggest it increases lifespan and is given the name, ‘the root of immortality’. A large double-blind placebo controlled study found that Korean red ginseng significantly reduced the symptoms of allergic rhinitis or common allergy (Jung et al., 2011). Herbalists use it commonly in cases of autoimmunity due to its immune balancing properties (Winston, 2007).
  8. Ginger. Ginger is a flowering plant which originated in Southern Asia whose roots are used for medicinal purposes, it is in the same family as turmeric. In TCM and Ayurveda it was applied in stomach-aches, diarrhoea, nausea, asthma, respiratory disorders, and arthritis (Grzanna et al., 2005). A very large well controlled study found it significantly improved osteoarthritis knee pain (Altman et al., 2001), although the magnitude of the change was a little low which is why it is probably best applied in a formula (Kulkarni et al., 1991).
  9. Reishi. Reishi is a revered medicinal mushroom also known as the lingzhi mushroom, that translates to the ‘herb of spiritual potency’ (Benzie, 2011). Additionally, it is known as the mushroom of immortality and was thought by Chinese doctors to increase human lifespan. Similar to other adaptogenic herbs like Asian ginseng it is known by herbalists for its immune balancing properties (Groves, 2016). There has been a recent study that found an extract of reishi reduced inflammatory cytokine expression in the blood and colon mucosa of individuals with Crohn’s disease (Liu et al., 2015). While this study was small it indicates that future studies may well confirm the medicinal potency of this highly valued Chinese mushroom in reducing chronic inflammation.

Summary

There is an exciting trend towards increasing scientific support and interest in medicinal herbs. It is more than likely that future scientific studies will confirm and expand upon the medicinal properties of the same herbs discussed in this article. I believe there are five main things to remember in relation to what has been discussed today; 1. Substantial diet changes (and lifestyle changes) must accompany herbal therapy for increased success, imparticular, a plant based no red meat Paleo diet should help reduce inflammation (if only done 90%), 2. Herbs work better in teams, for example one study showed that curcumin, boswellia, ashwagandha, and ginger in formula reduced osteoarthritis pain (Kulkarni et al., 1991), this is a classic formula for chronic inflammation, 3. We need more larger studies before herbs can be trusted as a first line therapy for chronic inflammatory disorders, 4. Treating chronic pain is often about treating the whole person including mental problems like depression that may be aggravating the problem, herbs excel in this area. 5. My view is for people who have found no or inadequate relief with conventional approaches, having trouble with side effects, or are living in countries where they cannot afford conventional medicine, this approach is certainly worth a try. Especially if it is done is a careful and well informed manner.

References:

Altman, Roy D., and K. C. Marcussen. “Effects of a ginger extract on knee pain in patients with osteoarthritis.” Arthritis & Rheumatism 44.11 (2001): 2531-2538.

Arjmandi, Bahram H., et al. “A combination of Scutellaria baicalensis and Acacia catechu extracts for short-term symptomatic relief of joint discomfort associated with osteoarthritis of the knee.” Journal of medicinal food 17.6 (2014): 707-713.

Auddy B, Hazra J, Mitra A, Abedon B, Ghosal S. A standardized Withania somnifera extract significantly reduces stress-related parameters in chronically stressed humans: A double-blind, randomized, placebo-controlled study. J Am Nutraceutical Assoc. 2008;11:50–6.

Breivik, Harald, et al. “Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment.” European journal of pain 10.4 (2006): 287-287.

Castleman, Michael. “The new healing herbs.” Bantam Book, New York (2001): 465-471.

Chattopadhyay, Ishita, et al. “Turmeric and curcumin: Biological actions and medicinal applications.” CURRENT SCIENCE-BANGALORE- 87 (2004): 44-53.

Grzanna, Reinhard, Lars Lindmark, and Carmelita G. Frondoza. “Ginger—an herbal medicinal product with broad anti-inflammatory actions.” Journal of medicinal food 8.2 (2005): 125-132.

Groves, Maria. Body into Balance. Storey Publishing, 2016.

Gupta, I., et al. “Effects of Boswellia serrata gum resin in patients with ulcerative colitis.” European journal of medical research 2.1 (1997): 37-43.

Gupta, I., et al. “Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study.” European journal of medical research 3.11 (1998): 511-514.

Hoffman, David. Holistic herbal. Element Books, 1988.

Jackson, Jeffrey R., et al. “The codependence of angiogenesis and chronic inflammation.” The FASEB Journal 11.6 (1997): 457-465.

Jung, Jae-Woo, et al. “Therapeutic effects of fermented red ginseng in allergic rhinitis: a randomized, double-blind, placebo-controlled study.” Allergy, asthma & immunology research 3.2 (2011): 103-110.

Kimmatkar, N., et al. “Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee–a randomized double blind placebo controlled trial.” Phytomedicine 10.1 (2003): 3-7.

Kovács, Gy, et al. “HPLC determination of flavonoids in hairy-root cultures of Scutellaria baicalensis Georgi.” Chromatographia 60 (2004): S81-S85.

Kulkarni, R. R., et al. “Treatment of osteoarthritis with a herbomineral formulation: a double-blind, placebo-controlled, cross-over study.” Journal of ethnopharmacology 33.1-2 (1991): 91-95.

Liu, Changda, et al. “Anti-inflammatory Effects of Ganoderma Lucidum Triterpenoid in Human Crohn’s Disease Associated with Down-Regulation of NF-κB Signaling.” Inflammatory bowel diseases 21.8 (2015): 1918.

Lopresti, Adrian L., et al. “Curcumin for the treatment of major depression: a randomised, double-blind, placebo controlled study.” Journal of affective disorders 167 (2014): 368-375.

Scott, A., et al. “What is “inflammation”? Are we ready to move beyond Celsus?.” British journal of sports medicine 38.3 (2004): 248-249.

Lu, Lan. “Study on effect of Cordyceps sinensis and artemisinin in preventing recurrence of lupus nephritis.” Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi= Chinese journal of integrated traditional and Western medicine/Zhongguo Zhong xi yi jie he xue hui, Zhongguo Zhong yi yan jiu yuan zhu ban 22.3 (2002): 169-171.

Namazi, N., et al. “The effect of hydro alcoholic Nettle (Urtica dioica) extracts on insulin sensitivity and some inflammatory indicators in patients with type 2 diabetes: a randomized double-blind control trial.” Pakistan journal of biological sciences: PJBS 14.15 (2011): 775-779.

Panahi, Yunes, et al. “Curcuminoid Treatment for Knee Osteoarthritis: A Randomized Double‐Blind Placebo‐Controlled Trial.” Phytotherapy Research 28.11 (2014): 1625-1631.

Winston, David, and Steven Maimes. Adaptogens: herbs for strength, stamina, and stress relief. Inner Traditions/Bear & Co, 2007.

Zhu, Jia-Shi, Georges M. Halpern, and Kenneth Jones. “The scientific rediscovery of an ancient Chinese herbal medicine: Cordyceps sinensis Part I.” The Journal of alternative and complementary medicine 4.3 (1998): 289-303.