A Review of Anti-Inflammatory Herbs for Wound Healing: Traditional Knowledge and Insights Applications

Inflammation: Inflammation is a normal, protective response to tissue injury caused by physical trauma, noxious chemicals or microbiological agents^1.Living tissue’s extreme reaction to any type of damage is inflammation. Pain, redness, heat or warmth, and swelling are the four main signs of inflammation. The arterioles in the surrounding tissue widen when any portion of the human body is injured. This results in increased blood flow to the region (redness)^2. In order to repair tissue damage, wound healing involves a complex web of overlapping biological processes.  Haemostasis, inflammation, tissue proliferation, and maturation are the main stages, and they involve a wide variety of cell types, some of which are local and others that are drawn in after an injury^3.Herbal medicine is one of the most important medicines for treating all kinds of diseases. It is best therapy having least side effects and best Curative effects. In this review some plants which their anti-inflammatory effect has been thoroughly evaluated in many research articles and review articles which are of experimental based. Curcuma long, Zingiber officinale, Rosa Canina, cassia fistula, salvia officinale, Borago Officinale, Rosmarinus officinale, evening Primrose, Ribesnigrum, Oleaeuropea Herpagophytum, Elaeagnusangustifolia these are  the plants which have strong anti-inflammatory activity and have been used for the  of many inflammatory disorders such as in the treatment of rheumatoid arthritis, uveitis, Inflammatory bowel disease, ulcerative colitis, dermatitis, bronchitis, meningitis, sinusitis, periodontitis etc. In inflammatory process various mechanisms are involved^4.

Symptoms:

?It is pain in muscles and joints.

?The person has fatigue.

?It was difficult to sleep.

?Depression and anxiety.

?There are Digestive problems.

?There are frequent infections.

Causes:

Typical causes include:

• Insufficient physical activity.

• Prolonged tension.

• Obesity is defined as having a BMI of 30 or higher, particularly if the additional weight includes visceral fat, which is found deep within the abdomen.

• Dysbiosis, or an imbalance between beneficial and detrimental microbes in your gut.  

• Consistently consuming inflammatory foods, such as those high in trans-fat or salt

• Sleep and circadian rhythm disturbances.

• Toxin exposure, such as exposure to industrial chemicals, hazardous waste, and air pollution.

• Making use of tobacco products.

• Consistently consuming excessive amounts of alcohol.

Risk Factors of Inflammation:

Types of Inflammation

Fig. 1: Types of Inflammation

Would Healing:

Wound healing is an important but complicated process in Human or animal, containing a multifaceted process governed By sequential yet overlapping phases, including hemostasis/Inflammation phase, proliferation phase, and remodeling Phas^[6. After an injury to skin, the exposed sub-endothelium, Collagen and tissue factor will activate platelet aggregation, which results in degranulation and releasing chemotactic Factors (chemokines) and growth factors (GFs) to form the Clot, and all above-mentioned procedures will achieve successful hemostasis^7. Neutrophils, the first cells to appear at the Injury site, cleanse debris and bacteria to provide a good Environment for wound healing. In the following, macrophages accumulate and facilitate phagocytosis of bacteria and Damage tissue^8. Acute and Chronic Wound Healing Acute wounds (such as traumatic and surgical wounds) pass through the normal wound healing stages, resulting in an expectable and organized tissue repair arrangement ^9. On the contrary, chronic wounds involve a disordered repair process and they can be mainly classified into vascular ulcers (such as venous and arterial ulcers), diabetic ulcers and pressure ulcers ^10. Chronic wounds exhibit a persistent inflammation phase, resulting in microorganism recruitment, biofilm development ¹¹ and the release of platelet-derived factors, such as transforming growth factor-beta (TGF-β), or Emergent molecules. The pro-inflammatory cytokine cascade, including interleukin-1β (IL-1β) and tumor necrosis factor α (TNFα), continues for a prolonged period, leading to important levels ofprotease in the wound bed. In chronic wounds, protease levels go above those of inhibitors, triggering ECM destruction, and boosting proliferative and inflammatory phases ^11. Inflammatory cellscollected in the chronic wound bed rise to levels of reactive oxygen species (ROS), resulting in EC protein injuries and premature cellular senescence ¹³ Chronic injuries are also characterized by phenotypic defects in the cells and dermis, such as reduced growth factor receptor density and mitogen potential, inhibiting resident cells from responding adequately to wound healing signals On thecontrary, proteases are tightly regulated by their inhibitors in acute injuries, avoiding ECM destruction and supporting the proliferation phase.¹⁴

Table 1: Anti-inflammatory agents

1) Turmeric (Curcuma longa):

Turmeric is a widely used Indian rhizomatous therapeutic plant. Turmeric has received a great deal of attention from both the culinary and medical industries. Turmeric is a rhizomatous herbaceous plant (Curcuma longa) belonging to the ginger family (Zingiberaceae). The therapeutic advantages of turmeric are due to the presence of active phytoconstituents known as curcuminoids (curcumin, demethoxycurcumin (DMC) and bisdemethoxycurcumin (BDMC)). 

Fig. 2: Turmeric

It displays range of biological functions, including; antibacterial, anticancer, antidiabetic, antivenom, antiobesity, anti-inflammatory, antiviral, antioxidant, anti-asthmatic, antiarthritis and wound-healing effects in anxiety, depression, and other conditions. 

• 2. Ginger (Zingiber officinalis): 

The rhizome of Zingiber officinale is widely used around the world for medicinal purposes because of its ethno-medicinal and nutritional value. Because of its antioxidant and anti-inflammatory properties ^15,16,17,18 turmeric has been commonly utilized as a medical herb. The Ayurveda literature emphasizes the use of ginger in the treatment of both infectious and non-infectious illnesses.

Fig 3: Ginger

The pharmacological activity of Zingiber officinale includes antiviral, anticancer, antioxidant, and anti-inflammatory properties. It is also employed for loss of appetite. Additionally, Ginger is helpful for Digestive disorders and malabsorption disorders. According to both Ayurvedic and contemporary theories, ginger can also help revitalize the body during disease conditions by improving appetite, immunity, and re-boosting impaired physiological functions of the human body. The active phytoconstituents found in ginger, such as Zingerole, Zerumbone, 6-shogaol and 6-Gingerol, are responsible for enhancing enzyme actions and balancing circulation by regenerating the body with physical restrengthening. 19,20

3. Rosemary (Rosmerinus officinalis):

Salvia rosmarinus often known as rosemary, is a shrub with aromatic, evergreen, needle-like leaves and blooms that come in white, pink, purple, or blue. Rosemary, which is also known as R. officinalis L., is a widely used herb in Brazil. It belongs to the sage family, Lamiaceae ^21. Because of its antioxidants, its leaves are employed as a natural preservative and to flavor food. Rosemary is a flexible herb with a wide range of applications, from traditional medicine to cuisine. It is employed in Brazilian traditional medicine to:

 - Treat menstrual issues

- Reduce stress and anxiety

- Alleviate muscle spasms

 - Treat respiratory problems, such as asthma

- Support heart health - Relieve coughs, colds, and flu

 - Soothe digestive issues, such as stomach pain and bloating ²²

Rosemary leaves, which have a pine-like scent that enhances many cooked dishes, are used in Mediterranean cuisine, whether fresh or dried. The leaves can also be used to produce herbal tea23.The woody stem, with its leaves removed, is occasionally used as a skewer in cooking. Rosmarinus officinalis is one of the most well-liked perennial herbs. Rosemary is its popular name24

Fig 4: Rosemary

Due to its anti-inflammatory properties, it has been used therapeutically in a number of nations. Additionally, it exhibits antibacterial, antidiabetic, and anti-ulcerogenic properties. Diterpenes, carsonic acid, and essential oil all have anti-inflammatory properties. The anti-inflammatory activity of Rosmarinus officinalis essential oil is mediated by blocking the intracellular adhesion molecule (ICM-1) at the transcriptional level 25. In the inflammatory process, carnosic acid also plays an inhibitory role by suppressing the expression of cytokines. Rosemary diterpenes are highly effective at blocking the activation of glial cells, which are key inflammatory cells that release pro-inflammatory cytokines like tumor necrosis factor alpha, interleukin 1beta, and interleukin-6 26^.

4. Licorice (Glycyrrhiza Glabra): 

Fig 5: Liquorice

As seen in Figure 5, Mulethi is the name of the licorice found all over India. Yashtimadhu is another name for it in ayurvedic remedies. Since ancient times, liquorice root has been utilized as an adaptogenic plant because of its anti-inflammatory effects. Its coumarins and stilbenoids give it anti-inflammatory properties, and it is frequently used to treat gastrointestinal problems, coughs, and colds. 27Glycyrrhizin, a compound found in licorice root, has anti-inflammatory, antibacterial, and antioxidant effects. Licorice extract has traditionally been consumed by adults at dosages of 100–990 mg orally every day for two to twenty-four weeks.

5. Gingseng (Panax gingseng):

The therapeutic benefits of ginseng were first recorded in Asia about 2,000 years ago. The Chinese name for ginseng, which alludes to the root's "man-like" shape, was formerly believed to be beneficial for human health. With the help of Native Americans, Lafitau J.F. discovered the first American ginseng species in North America in 1761 ²⁹ The Russian botanist Carl A. Meyer gave ginseng the botanical name Panax in 1843, which means "allhealing" in Greek ³⁰. The two main classes of the well-known ginseng, according to the cultivation distribution, are Asian ginseng (Panax ginseng C.A. Meyer) and American ginseng (Panax quinquefolius)^31.

Fig 6: Gingseng

They display a variety of antibacterial, antiviral, antifungal, antioxidant, and anti-inflammatory characteristics. Furthermore, they have demonstrated potential in the treatment of stress, high blood pressure, and several neurological disorders, such as Alzheimer's, Parkinson's, and Huntington's disease. 

6. Ashwagandha (Withania somnifera):

This known to help lower cortisol levels in the body and counteract its negative effects ^32,33] Ashwagandha (Withania somnifera) : Ashwagandha has been shown to help reduce cortisol in the body and fight the negative effects. Ashwagandha lowers inflammation, which helps to balance blood sugar, calm anxiety, calm the adrenal glands, and strengthen the immune system. Research suggests that the herb may help prevent skin inflammation. Ashwagandha is a common ingredient in sleep aids and is well-known for its ability to alleviate stress and anxiety. Withaferin A is in charge of preventing pro-inflammatory and oxidative substances. Adults have most frequently taken up to 1000 mg of ashwagandha daily for up to 12 weeks³⁴

Fig 7:  Ashwagandha

7. Garlic (Allium Sativum

Fig 8:  Garlic

Poor Man’s Treacle is another name for garlic (Allium Sativum), which is a member of the Liliaceae family. Garlic is a traditionally cultivated plant that has been used in folklore medicine and in everyday life for centuries for food preparation. Garlic is an herb that has long been used for culinary flavor enhancement and therapeutic purposes. One of the therapeutic herbs that has anti-cancer properties is garlic. Its effects have been demonstrated in numerous studies on carcinomas as well as on the cardiovascular and immune systems. To determine which component of garlic has a positive impact, the role of each one was examined. Garlic contains a number of active phytoconstituents, including volatile oil with sulfur-containing compounds like ajoene, alliin, and allicin, as well as enzymes like peroxidase, myrosinase, and allinase, in addition to other substances like vgeraniol, α-phellandrene, β-phellandrene, linalool, and citral. In addition to minerals like calcium, magnesium, germanium, copper, iron, potassium, selenium, zinc, and vitamins A, B1, and C^35,36 it also has at least 33 sulfur compounds. Garlic has a very strong flavor and scent. Garlic has an extremely strong flavor and aroma. For centuries, it has been used as a traditional remedy by many individuals to treat a wide range of ailments. Studies have demonstrated that garlic’s anti-inflammatory effects can alleviate the symptoms of arthritis. One of the advantages of the Spice is that it gives food flavor ³⁷ Diallyl disulfide, an anti-inflammatory ingredient found in garlic, inhibits the effects of pro-inflammatory cytokines. The dosage of garlic powder varied between 300 and 2,400 mg daily for two to twenty-four weeks³⁸

8. peppermint (Mentha Piperita):

Fig 9:  peppermint

Aloe vera is widely recognized for its antioxidant, anti-inflammatory, antidiabetic, sunburn relief, immune boost, anti-ageing, and anticancer capabilities (Langmead et al., 2004). Because of its distinctive makeup, aloe vera has found use in a number of commercial sectors. Aloe vera is used in several applications as aloe vera juice, concentrate, and powder. Due to its reliable therapeutic qualities, aloe vera has grown in significance as a result of aloe vera investigations, and it has been used to make pharmaceutical items like ointments, tablets, and capsules (Eshun and He, 2004; He et al., 2005

Fig 10: Aloevera

Aloe vera gel is widely used in the cosmetic industry, where it has established itself as a key selling component, and it has been discovered that a variety of its constituents are effective against a number of illnesses. It serves as a base ingredient in a variety of preparations, such as moisturizers and suntan lotions, which are used as humectants in skin treatments (Iwu, 2014). Due to its beneficial moisturizing and relaxing properties in goods like shampoos, soaps, cleansers, and moisturizing lotions, aloe vera gel and powder have several additional uses in the cosmetics business. Aloe vera possesses anti-ulcer, anti-inflammatory, anti-cancer, anti-diabetic, antioxidant, wound healing, and laxative qualities [40].

10. Cinnamon (Cinnamomum Zeylanicum):

Many members of the Lauraceae family, to which cinnamomum (cinnamon) belongs, are used as spices. The two major varieties of cinnamon are Ceylon or true cinnamon (Cinnamon zeylanicum Blume), which is cultivated in Sri Lanka and Southern India, and cassia (Cinnamom aromaticumn Ness), which is grown in China, Indonesia and Vietnam. When dried, cassia turns into a tubular form known as a quill or cinnamon stick. ^{41,42 Since} antiquity, Egyptians and Chinese have utilized cinnamon in traditional medicine and food preparation. In addition to its potent antioxidant, antibacterial, antipyretic and anti-inflammatory effects, which are essential for tissue healing, this spice has been discovered to have these properties

Fig 11: Cinnamon

The bark of cinnamon has been used in traditional oriental herbal medicine as a spice, to make tea, and as an herbal treatment for coughs, cardiovascular illnesses, and persistent gynecological and gastrointestinal problems. Cinnamon has also been used to treat sore throats, coughs, indigestion, abdominal cramps, intestinal spasms, nausea, flatulence, and diarrhea.Furthermore, it has been discovered that cinnamon has antifungal qualities and slows down food spoilage ⁴³

11. Boswellia (Boswellia Serrata):