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 effective, but another approach is to use anti-inflammatory diet changes (e.g. a modified Paleo diet) and certain herbal medicines. There is now an increasing body of evidence that implies certain herbs reduce inflammatory pain, they typically involve fewer or no side effects and in fact added health benefits. I now list some of the best herbs for chronic inflammation using a combination of traditional and scientific knowledge. I also include some studies that support a herbs dual application for pain and the psychological side of the pain, like anxiety and depression.
- 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. Boswellia is one of the most potent specific herbs for inflammation in our materia medica.
- Curcumin (from turmeric). Curcuma longa 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), although the effect was quite mild, since depression is related to severity of chronic pain, this supports its role as an important option in the treatment of chronic inflammation.
- Ashwagandha. Withania somnifera 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 Charaka Samhita, 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 a more relaxing adaptogenic tonic herb, although not as so as tulsi, it may improve sleep in some people. It’s broad applicability means it is one of the most widely appropiate herbs in our materia medica.
- Cordyceps. Cordyceps sinensis 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). It is an important and highly regarded herb, but is more stimulating than some other adaptogens.
- 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 are also classified as an ‘alterative’ in Western herbalism, which means they are thought to treat the underlying cause of the disease. 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.
- 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.
- 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). The disadvantages of this historically important herb are it is very hard to get good quality Asian ginseng, and it can be over stimulating in certain people.
- 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 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).
- 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 holy basil and ashwagandha 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 confirm the medicinal potency of this highly valued Chinese mushroom in reducing chronic inflammation. Reishi is a little more stimulating than ashwagandha and tulsi, but less so than cordyceps, and may help sleep while balancing the immune system.
- Holy basil. Tulsi is a small fragrant plant often with purple-green leaves it grows wild and is grown domestically in parts of south East Asia and throughout India (Kuhn and Winston, 2000). Maria Groves in her text, ‘Body Into Balance’, states tulsi may have a role to play in chronic infections and inflammatory problems. David Winston applies it alongside reishi in allergies (Winston, 2007). In a double blind placebo controlled trial it was found to be effective against stress which can be related to pain (Saxena et al., 2011). The traditional knowledge points to a great importance of tulsi alongside other calmer adaptogens such as ashwagandha and reishi in treating cases of chronic inflammation. As one of the calmest adaptogens, tulsi is more suitable to people prone to insomnia.
There is a 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. Out of the herbs discussed here there are 2 main types; more specific herbs for inflammation (turmeric, boswellia, ginger), and the adaptogenic tonic herbs which are specific for inflammation and many other disorders such as anxiety (ashwagandha, holy basil, reishi). For chronic inflammation, it may be that a combination formula is best that includes one or two tonic herbs (ashwagandha, reishi, and holy basil) and specifics for inflammation like turmeric and boswellia.
It may be that other conditions underlie the persistent inflammation like poor bowel health. So it is possible some manner of cleansing with diet and herbs should be done. In Western herbalism, this is where the alteratives come into play (e.g. nettles, dandelion, burdock, yellow dock, red clover), these are thought to gently cleanse the system and help remove the cause of the disease (Hoffman, 1988).
To summarise; 1) Substantial diet changes (and lifestyle changes) must accompany herbal therapy for increased success, imparticular, a plant based modified Paleo diet should help reduce inflammation (it requires modification in order to be more practical/ better suit the person) (Cordain, 2012), 2) Herbs work well in teams, for example one study showed that curcumin, boswellia, ashwagandha, and ginger in formula reduced osteoarthritis pain (Kulkarni et al., 1991), 3) Treating chronic pain is often about treating the whole person including mental problems like depression or physicial problems like constipation that may be aggravating the problem, 4) My view is for people who have found no or inadequate relief with conventional approaches or they cannot afford conventional medicine, this approach is certainly worth a try, especially if it is done is a careful and educated way.
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