Cinnamon aromaticum

MEDICINAL

PLANTS

Cinnamomum aromaticum Nees +++ (Lauraceae)

by 

RETTODWIKART THENU, S.Pd

CINNAMON

Cinnamon

(si’nuh-muhn)

Cinnamomum aromaticum Nees +++ (Lauraceae)

SUMMARY AND PHARMACEUTICAL COMMENT

The reputed antimicrobial, antiseptic, anthelmintic, carminative and antispasmodic properties of cinnamon are probably attributable to the volatile oil. The astringent properties of tannins may account for the claimed antidiarrhoeal action. However, rigorous clinical research assessing the efficacy and safety of cinnamon preparations is required. Cinnamon should not be used in amounts greatly exceeding those used in foods.

HISTORICAL NOTE (Braun, L and Cohen, M. 2010)

 Cinnamon has been used since ancient times for a variety of uses and was considered a precious commodity. In ancient Egypt, it was used as a flavouring for beverages, in combination with other spices for embalming, and as a medicinal agent. Ancient Chinese herbals mention it as a medicinal treatment as early as 2700 BC (Castleman 1991) and it has long been used as a remedy for diabetes in China, Korea, Russia and India. In medieval Europe, cinnamon was a common ingredient in cooking, often used together with ginger. Due to the high demand for cinnamon, discovering lands where it grew was a primary motive for a number of explorers’ enterprises in the 15th and 16th centuries. Today, two main types of cinnamon are cultivated, Cinnamomum verum, also known as Ceylon cinnamon, and Cinnamomum cassia, also known as Chinese cinnamon.

DESCRIPTION  (Medical Economics Company, Inc. 2000)

Medicinal Parts: The medicinal parts are the flowers collected and dried after they have finished blossoming, and the whole or partly peeled, dried bark of thin and young branches, as well the oil extracted from them.

Flower and Fruit: The flowers are small on short, slender, silky pedicles. They are arranged in threes in cymous panicles in the leaf axils and in larger panicles at the end of the branches. The perianth is slightly silky, about 3 mm long, with oblong-lanceolate petals. The fruit is a juicy, pea-sized, elliptoid, smooth drupe.

Leaves, Stem and Root: This evergreen tree grows up to 7 m tall with aromatic bark and angular branches. The bark is brown, in quilled pieces, sometimes with the remains of the outer layer present. The 7.5 to 10 cm long leaves are oblanceolate and pubescent on 6 to 8 cm long petioles, more or less tapered toward the base. They are coriaceous, alternate and brown underneath.

Habitat: Indigenous and cultivated in southern China, Vietnam, Laos and Burma.

Production: Chinese Cinnamon consists of the completely or partly peeled, dried stem bark from the aboveground or thinbranched axis of Cinnamomum aromaticum. The drug, from branches 2 to 3 cm thick, is peeled with horn knives, freed from cork and outer rind, and dried in the sun for 24 hours.

Not to be Confused With: Chinese Cinnamon should not be confused with waste products from the production process or other barks and materials, nor with the skins of horse chestnut seeds.

SPECIES (FAMILY) (Barnes, J et al., 2007)

*Cinnamomum zeylanicum Bl. (Lauraceae)

†Cinnamomum loureirii Nees

‡Cinnamomum burmanii (Nees) Bl.

BOTANICAL NAME/FAMILY (Braun, L and Cohen, M. 2010)

Cinnamomum verum J.S. Presl (also known as C. zeylanicum Nees) and C. cassia Blume (family Lauraceae)

SYNONYM(S) (Barnes, J et al., 2007)

*Ceylon Cinnamon, Cinnamomum verum J.S. Presl., True Cinnamon

†Cinnamomum obtusifolium Nees var. loureirii Perr. & Eb., Saigon Cassia, Saigon Cinnamon

‡Batavia Cassia, Batavia Cinnamon, Padang-Cassia, Panang Cinnamon

OTHER NAMES (Braun, L and Cohen, M. 2010)

Cinnamomum verum: cannelle de ceylan, Ceylon celonzimi cinnamon, Ceylon cinnamon, cinnamon bark, cortex cinnamomi ceylanici, dalchini, ecorce de cannelier de Ceylan, echter, gujerati-dalchini, kannel, kuei-pi, kurundu, kulit kayumanis, ob choei, tamalpatra, wild cinnamon

Cinnamomum cassia Blume: cassia, Chinese cinnamon, dalchini, guipi, kannan keihi, keishi, lavanga-pattai, lurundu, macrophyllos cassia bark tree, rou gui, Saigon cinnamon, saleekha, taj, toko keihi, Viet Nam cinnamon

NOTES (CASSIA):

Take thou also unto thee principal spices, of pure myrrh five hundred shekels, and of sweet cinnamon half so much, even two hundred and fifty shekels, and of sweet calamus two hundred and fifty shekels.

Exodus 30:23 (KJV)

And of cassia five hundred shekels, after the shekel of the sanctuary, and of oil olive an hin.

Exodus 30:24 (KJV)

and of cassia five hundred, according to the shekel of the sanctuary, and of olive oil a hin.

Exodus 30:24 (RSV)

and cassia five hundred units, by the shekel of the holy place, and olive oil a hin.

Exodus 30:24 (NWT)

It is nice to see that all versions cite the cassia, and most scholars agree that it is the cassia of today’s spice trade. Although the spice trade tends to lump cassia and cinnamon in the same spice jar, Israeli botanist Michael Zohary and the Bible itself treat them as separate items. Although both are mentioned many times in the Bible, nowhere are they both mentioned in the same verse; but it is very close in the case quoted above, where cinnamon was mentioned in verse 23 and cassia in verse 24. Of the cassia, citing Exodus 30:24, Job 42:14, and Psalms 45:7–8, Zohary says, “In the quoted passages, the Hebrew ketziah and kiddah are translated as ‘cassia’; the former is also applied as a personal name. The question as to whether ketziah and kiddah are synonymous or refer to different plants or drugs will never be resolved” (ZOH). Moses and Solomon probably obtained cassia, via trade, from Sri Lanka, where it is only cultivated or more possibly from China, where it is native (BIB; USN).

COMMON NAMES (CASSIA) (Duke, J. A et al., 2003)

Bastard Cinnamon (Eng.; EFS); Bunga Lawang (Java; IHB); Caneficier (Fr.; EFS); Canela de China (Cuba; RyM); Canela de la China (Sp.; USN); Canelero Chino (Sp.; USN); Canella de Coromandel (It.; HH2); Canella di China (It.; KAB); Canelle de Chine (Fr.; EFS); Canelle de Cochinchine (Fr.; USN); Cannelier Casse (Fr.; USN); Casia (Sp.; EFS); Casse Ligneux (Fr.; EFS); Cassia (Eng.; It.; Scn.; AH2; CR2; EFS); Cassia (Por.; USN); Cassia Lignea (It.; HH2); Cassis (Fr.; EFS); Chinazimpt (Ger.; USN); Chinese Cassia (Eng.; BIB); Chinese Cassiaboom (Dutch; EFS); Chinese Cinnamon (Eng.; Ocn.; AH2; BIB); Chinese Kaneelboom (Dutch; EFS); Chinesischer Kassia (Ger.; EFS); Chinesischer Zimptbaum (Ger.; EFS; HH2); Chinesischer Zimtstrauch (Ger.; HH2); Ch’un Kuei (China; EFS; KAB); Cin Tarcini (Tur.; EFS); Dalchini (India; EFS); Darasini (Arab.; EGS); Fahej (Hun.; KAB); Gudatvak (Sanskrit; EFS); Gui Zhi (Pin.; AH2); Holzkassia (Ger.; EFS); Holzzimpt (Ger.; EFS); Hout Cassia (Dutch; EFS); Kanel Kassia (Den.; EFS); Kashia Keihi (Japan; USN); Kassienzimpt (Ger.; EFS); Kayu Manis China (Malaya; EFS; IHB); Ketziah (Heb.; ZOH); Kiddah (Heb.; ZOH); Kitaiskaya Koritsa (Rus.; KAB); Koritsa (Rus.; KAB); Koui Chou (China; KAB); Kuei (China; EFS); Kulit Manis (Malaya; EFS); Kwa P’i (China; EFS); Kwai Phee (China; EFS); Laurier Casse (Fr.; EFS); Lauro Cassia (It.; EFS); Malabar Leaf (Eng.; JLH); Malabathron (Greek; JLH); Mou Kuei (China; EFS); Rou Gui (Pin.; AH2; DAA); Saila Myah (Iran; EFS); Salikha (Arab.; KAB); Taj (Iran; Urdu; KAB); Zimtbaum (Ger.; HH2); Zimtkassie (Ger.; EFS; HH2); Zimtstrauch (Ger.; HH2).

ORIGIN (Linda, S-R. 2010)

 Cinnamon is found in India, South America, Sri Lanka, and the West Indies.

PART(S) USED (Barnes, J et al., 2007)

Inner bark

PHARMACOPOEIAL AND OTHER MONOGRAPHS (Barnes, J et al., 2007)

BHP 1996(G9)

BP 2007(G84)

Complete German Commission E(G3)

Martindale 35th edition(G85)

Ph Eur 2007(G81)

WHO volume 1 1999(G63)

LEGAL CATEGORY (LICENSED PRODUCTS) (Barnes, J et al., 2007)

GSL(G37)

CONSTITUENTS  

CONSTITUENTS (Barnes, J et al., 2007)

The following is compiled from several sources, including General References G2, G58, G59 and G62.

Tannins Condensed.

Volatile oils Up to 4%. Cinnamaldehyde (60–75%), benzaldehyde and cuminaldehyde; phenols (4–10%) including eugenol, and methyleugenol, pinene, phellandrene, cymeme and caryophyllene (hydrocarbons), eugenol acetate, cinnamyl acetate and benzyl benzoate (esters), linalool (an alcohol). Of the various types of cinnamon bark the oil of C. Zeylanicum is stated to contain the highest amount of eugenol. Cinnamon oil differs from the closely related cassia oil in that the latter is reported to be devoid of eugenol, monoterpenoids and sesquiterpenoids (see Cassia).

Other constituents Calcium oxalate, cinnzeylanin, cinnzeylanol, coumarin, gum, mucilage, resins and sugars.

Other plant parts Cinnamon leaf oil contains much higher concentrations of eugenol, from 80 to 96% depending on the species. A cinnamon leaf oil of Chinese origin, Cinnamomum japonicum Sieb., contains a high concentration of safrole (60%) and only about 3% eugenol.

CHEMICAL COMPONENTS (Braun, L and Cohen, M. 2010)

Both forms of cinnamon contain an essential oil that consists primarily of cinnamaldehyde (up to 80% in C. verum and 90% in C. cassia) and differ primarily in their eugenol and coumarin content. The volatile oil from C. verum contains 10% eugenol whereas the oil from C. cassia contains only trace amounts. Also, C. cassia contains coumarin, which is not found substantially in C. verum. The bark of C. verum contains caryophyllene, cinnamyl acetate and linalool whereas the bark of C. cassia contains catechin and 1,8 cineole.

USED

MEDICINAL USES  (Duke, J. A et al., 2002)

 Regarded as alexeteric, aperient, balsamic, lactafuge, stimulant, tonic, and vermicidal, cassia is a folk remedy for arthritis, chills, dizziness, dysmenorrhea, goiter, headache, jaundice, lumbago, menorrhagia, nausea, phymata, postpartum, rheumatism, and snakebite. Prolonged use of Cassia is thought to improve the complexion, giving one a more youthful aspect. Constant use is said (I’m not convinced) to prevent gray hair. The bark is prepared as a tea for excessive salivation. The leaves are taken internally for rheumatism. Unani consider the bark carminative, emmenagogue, and tonic, using it for headache, inflammation, piles, and pregnancy. The bark is antiseptic, astringent, and carminative, and the EO has demonstrated cardiovascular, hypotensive, and antiviral activities. Extracts are antibacterial and fungicidal. The bark extracts have shown anesthetic (2% bark solution anesthetizing nerve fiber) and antiallergic activity. Bark is a component of a Chinese proprietary drug used in epilepsy and where sedative or tranquilizing activities are needed in neurological disorders (WO2).

The aqueous extracts prevent increases in urinary protein levels when given orally to nephritic rats (WO2). Its antiulcer activity has been compared to Cimetidine. Sharma et al. (2001) proved that cassia has antimutagenic activity against two mutagens, viz. benzo[a]pyrene (B[a]P) and cyclophosphamide (CP). The antimutagenic potential was probably due to its effects on xenobiotic bioactivation and detoxification processes (X11506812). Trans-cinnamaldehyde is antimutagenic in Escherichia coli.

Two glucosides, 2 epicatechin derivatives, 2 cinnamic aldehyde, 1,3-acerals, and (dl)-syrigaresinol in the bark extract exhibited antiallergic activity. Cinncassiol D4 and cinncassiol D4 glucoside from a bark fraction also exhibited antiallergic activity. The aqueous extract slightly inhibits the production of hemolytic plaque-forming cells, evidently with an anticomplement action, inhibiting complement-dependent allergic reactions. The major component, cinnamaldehyde, is sedative and antipyretic. The eugenol found in the oil from the bark (12.5%) has an antiseptic, irritant, and local anesthetic properties, as well as weak tumor-promoting activity on mouse skin. It enhances trypsin activity in vitro. Cassia contains the antitumor (and probably oncogenic) agents benzaldehyde, coumarins, and tannins. The bark EO contained 70.5% cinnamaldehyde and 12.5% eugenol but the leaf EO contained 92.2% benzyl benzoate and only 4.2% cinnamaldehyde.

PLANT PARTS USED (Braun, L and Cohen, M. 2010)

Dried inner bark of the shoots grown on cut stock of C. verum or of the trunk bark, freed from the underlying parenchyma; outer cork of C. cassia Blume.

FOOD USE (Barnes, J et al., 2007)

Cinnamon is listed by the Council of Europe as a natural source of food flavouring (category N2). This category indicates that cinnamon can be added to foodstuffs in small quantities, with a possible limitation of an active principle (as yet unspecified) in the final product.(G16) It is commonly used as a spice in cooking, although at levels much less than the stated therapeutic doses. The acceptable daily intake of cinnamaldehyde has been temporarily estimated as 700 mg/kg body weight.(G45) Previously, cinnamon has been listed as GRAS (Generally Recognised As Safe).(G41)

HERBAL USE (Barnes, J et al., 2007)

Cinnamon is stated to possess antispasmodic, carminative, orexigenic, antidiarrhoeal, antimicrobial, refrigerant and anthelminti properties. It has been used for anorexia, intestinal colic, infantile diarrhoea, common cold, influenza, and specifically for flatulent colic, and dyspepsia with nausea.(G7) Cinnamon bark is also stated to be astringent, and cinnamon oil is reported to possess carminative and antiseptic properties.(G2, G41, G64)

INDICATIONS AND USAGE (Medical Economics Company, Inc. 2000)

Approved by Commission E:

• Loss of appetite

• Dyspeptic complaints

Unproven Uses: Folk medicine uses include symptomatic treatment of gastrointestinal disorders (mild, colicky upsets of the gastrointestinal tract, bloating, flatulence and diarrhea), as well as for temporary states of exhaustion and to increase weight. Efficacy has been sufficiently proven for gastric complaints and it is plausible for diarrhea, but the evidence is not sufficient for the other indications.

Chinese Medicine: Among uses in Chinese medicine are impotence, diarrhea, enuresis, rheumatic conditions, testicle , hernia, menopause syndrome, amenorrhea, abortion and to stabilize immunity.

Indian Medicine: Digestive complaints, vomiting and diarrhea are the most common uses in Indian medicine.

PRODUCT AVAILABILITY (Linda, S-R. 2010)

Dried bark, essential oil, leaves, fl uid extract, powder, tincture

Plant Parts Used: Bark, leaves

DOSAGE

DOSAGE (Barnes, J et al., 2007)

Dosages for oral administration (adults) for traditional uses recommended in older standard herbal and pharmaceutical reference texts are given below.

Dried bark 0.5–1.0 g as an infusion three times daily.(G7)

Liquid extract 0.5–1.0 mL (1 : 1 in 70% alcohol) three times daily.(G7)

Tincture of Cinnamon (BPC 1949) 2–4 mL.

DOSAGES (Linda, S-R. 2010)

Dosages vary widely

Passive Bleeding

·       Adult PO essential oil: used in combination with Erigeron essential oil, diluted in a carrier oil such as vegetable oil; 10-30 drops (Smith, 1999)

Other

·       Adult PO bark: 2-4 g daily (Blumenthal, 1998)

·       Adult PO essential oil: 0.05-0.2 ml diluted in a carrier oil daily

·       Adult PO infusion: 1 cup bid-tid at meals

·       Adult PO fl uid extract: 0.5-1 ml tid

·       Adult PO tincture: 1-3 ml tid

DOSAGE RANGE

General guide

• Dried bark (crushed cinnamon): 1.5–4 g taken up to four times daily.

• Fluid extract 1:1: 0.5–1.0 mL taken up to three times daily.

• Tea: half to three-quarters teaspoon of powdered cinnamon in a cup of boiling water taken 2–3 times daily with meals.

• Essential oil: 0.05–0.2 mL diluted in carrier oil.

According to clinical studies

Diabetes

• 3–6 g daily of powdered cinnamon (C. cassia) administered in capsules. Loss of appetite or digestive complaints

• Essential oil: 0.05–0.2 g daily.

• Fluid extract (1:1 g/mL): 0.7–1.3 mL three times daily.

• Infusion or decoction: 0.7–1.3 g in 150 mL water three times daily.

• Tea: 1–4.5 g daily using C. cassia bark.

DOSAGES (CASSIA): (Duke, J. A et al., 2003)

FNFF = !!!

Dried green fruits are the cassia buds of commerce, which resemble cloves. Cassia bark is also an important spice. All parts of the plant possess an essence, cinnamic aldehyde, which may be distilled for export. Buds of the tree are used in place of cloves to season dishes (BIB; FAC; TAN). 2–4 g ground bark/day (BGB; PH2); 0.7–1.3 g bark in 150 ml water 3 x/day (BGB); 0.5–1 g bark, as tea, 3 x/day (CAN); 0.05–0.2 ml cassia oil 3 x/day (CAN); 0.3–1.2 ml flower tincture (1:5 in 90% ethanol) 3 x/day (CAN).

·         Chinese suggest that prolonged use improves the complexion, making it more youthful (DAA).

·         Chinese use the plant for amenorrhea, arthritis, cancer, chills, cold, colic, cough, diabetes, diarrhea, dizziness, dysmenorrhea, dyspepsia, dysuria, fever, goiter, headache, jaundice, lumbago, rheumatism, and stomachache (DAA).

·         Egyptians use the leaves for cancer of the womb, the “grains” for condylomata, vaginosis, and warts (JLH).

·         Indonesians use the plant for tumors (JLH).

·         Iranians use bark tea for excessive salivation (BIB).

·         Javan brides must drink a potion containing two Bunga Lawang (cassia buds) (IHB).

·         Malayans use the imported bark in decoction with other herbs for chest complaints and cough (IHB).

·         Unani, considering the bark carminative, emmenagogue, hematotonic, and tonic, use it for headache, inflammation, piles, and pregnancy (KAB).

DOSAGE

Mode of Administration: Comminuted bark for infusions, essential oil, as well as other galenic preparations for internal use.

Preparation: To prepare a tincture of Chinese Cinnamon, moisten 200 parts cinnamon bark evenly with ethanol and percolate to produce 1000 parts tincture.

Daily Dosage: 2 to 4 g drug; 0.05 to 0.2 g essential oil. The average single dose is 1 g.

Storage: Chinese Cinnamon should be stored in a cool, dry environment in tightly sealed containers.

PHARMACOLOGICAL ACTIONS (Barnes, J et al., 2007)

IN VITRO AND ANIMAL STUDIES

Cinnamon oil has antifungal, antiviral, bactericidal and larvicidal properties.(G41) A carbon dioxide extract of cinnamon bark (0.1%) has been documented to suppress completely the growth of numerous microorganisms including Escherichia coli, Staphylococcus aureus and Candida albicans.(G41) (See Cassia for details of the many pharmacological actions documented for cinnamaldehyde and cinnamomi cortex (cinnamon bark).)  Antiseptic and anaesthetic properties have been documented for eugenol(1) and two insecticidal compounds, cinnzeylanin and cinnzeylanol, have been isolated.(G41) Tannins are known to possess astringent properties.

Figure 2. Cinnamon (Cinnamomum zeylanicum)

Figure 3.  Cinnamon – dried drug substance (inner bark).

Weak tumour-promoting activity on the mouse skin and weak cytotoxic activity against HeLa cells has been documented for eugenol.(G41)

CLINICAL STUDIES

There is a lack of clinical research assessing the effects of cinnamon and rigorous randomised controlled clinical trials are

required.

ACTIVITIES (Duke, J. A et al., 2003)

Aldose-Reductase Inhibitor (1; X12553890); Analgesic (f; WO2); Anesthetic (f1; DAA; WO2); Antiaging (f; DAA); Antiaggregant (1; CAN); Antiallergic (1; WO2); Anticomplement (1; CAN); Antidiarrheic (f1; CAN); Antidote (f; WO2); Antiemetic (f1; CAN); Antifertility (f1; DAA); Antiinflammatory (f1; X15710356); Antimutagenic (1; X11506812); Antioxidant (1; X12916067); Antiproteinuric (1; WO2); Antipyretic (f; WO2); Antiseptic (f1; CAN; DAA; WO2); Antispasmodic (f1; CAN); Antitumor (f1; CAN); Antiulcer (1; BGB; CAN; PH2; WO2); Antiviral (1; BGB; DAA; LAF); Apoptotic (1; X14587878); Astringent (f1; AHP; WO2); Bactericide (1; BGB; LAF; PH2; X12423924); Cardiotonic (f1; DAA; WO2); Carminative (f1; BGB; CAN; DAA; WO2); COX-2 Inhibitor (1; X12413723); Diaphoretic (f; AHP); Digestive (f; BGB); Diuretic (f; WO2); Expectorant (f; WO2); Febrifuge (f1; DAA); Fungicide (1; BGB; HH2; LAF; PH2); Hepatotonic (f; WO2); Hypotensive (1; DAA; WO2); Immunostimulant (1; PH2); Insectifuge (1; X15264623); Larvicide (1; BGB; LAF; X15796573); Metalloproteinase-9 Inhibitor (1; X15652283); Mosquitofuge (1; X15264623); NF-kappa B Inhibitor (1; X15710356); NO Inhibitor (1; X15710356); iNOS Inhibitor (1; X12475291); Parasiticide (1; X12847923); Purgative (f; WO2); Sedative (f1; DAA; WO2); Stomachic (f; AHP; BGB); Tranquilizer (f; WO2); Vasodilator (1; KC2); Xanthine-Oxidase Inhibitor (1; X11025157).

INDICATIONS  (Duke, J. A et al., 2002)

Allergy (1; WO2); Amenorrhea (1; PH2; WO2); Anesthetic (1; WO2); Anorexia (2; BGB; KOM; PH2); Ascites (f; WO2); Asthenia (f; BGB); Asthma (1; BGB; WO2); Bacteria (1; BGB; LAF; PH2); Bloating (2; BGB; KOM); Bronchosis (1; BGB); Cancer (1; CAN; JLH); Cancer, bladder (f; JLH); Cancer, diaphragm (f; JLH); Cancer, kidney (f; JLH); Cancer, liver (f; JLH); Cancer, rectum (f; JLH); Cancer, spleen (f; JLH); Cancer, stomach (f; JLH); Cancer, uterus (f; JLH); Cancer, vagina (f; JLH); Cold (f; BGB; CAN); Colic (1; BGB; CAN; PH2); Condyloma (f; JLH); Cough (f; BGB); Cramp (1; BGB; CAN); Cystosis (f; JLH); Diaphragmosis (f; JLH); Diarrhea (1; BGB; CAN; PH2); Dyspepsia (2; BGB; CAN; KOM; PH2); Dysuria (f; WO2); Edema (f; WO2); Enterosis (f; BGB; PH2; WO2); Enuresis (f; PH2); Epilepsy (f; WO2); Fatigue (f; PH2); Fever (f; AHP; BGB; WO2); Fungus (1; BGB; LAF; PH2); Gas (1; BGB; CAN; PH2; WO2); Gastrosis (f; BGB; PH2; WO2); Gray Hair (f; WO2); Hepatosis (f; JLH); Hernia (f; PH2); High Blood Pressure (1; WO2); Immunodepression (1; PH2); Impotence (f; PH2); Induration (f; JLH); Infection (1; BGB; LAF; PH2); Insomnia (f; WO2); Menopause (f; PH2); Mycosis (1; BGB; LAF; PH2); Nephrosis (1; BGB; WO2); Nervousness (f; WO2); Neuralgia (1; WO2); Neurasthenia (f; PH2); Ophthalmia (1; WO2); Orchosis (f; PH2); Pain (1; WO2); Pharyngosis (f; WO2); Sore (f; JLH); Splenosis (f; JLH); Tracheosis (1; WO2); Tumor (1; CAN); Ulcer (1; BGB; CAN; PH2; WO2); Urethrosis (f; WO2); Uterosis (f; WO2); Vaginosis (f; JLH); Virus (1; BGB; LAF); Vomiting (1; CAN; PH2); Wart (f; JLH); Water Retention (f; WO2).

MAIN ACTIONS (Braun, L and Cohen, M. 2010)

The cinnamaldehyde constituent in cinnamon is attributed with producing most of the herb’s biological effects. This component is found in large amounts in both forms of cinnamon. More recently, several other constituents have also been tested in isolation and found to exert significant pharmacological effects.

Antibacterial and fungicidal effects

Several in vitro studies have identified broad-spectrum antibacterial and fungicidal effects for both forms of cinnamon. This has been chiefly attributed to cinnamaldehyde although other constituents such as eugenol, carophyllene and 1,8 cineole also exhibit antimicrobial properties. C. verum demonstrated activity against a wide range of bacteria and fungi including Bacillus subtilis, Escherichia coli, Saccharomyces cerevisiae, Candida albicans, Listeria monocytogenes and Salmonella enterica (De et al 1999, Friedman et al 2002, Matan et al 2006, Simic et al 2004, Tampieri et al 2005). C. cassia extracts significantly inhibited Helicobacter pylori in vitro and produced zones of inhibition greater than or equal to commonly used antibiotics (Tabak et al 1999). The essential oil of C. cassia also exhibited strong antifungal properties in vitro (Giordani et al 2006). When tested required for adequate antifungal effects. Antibacterial activity for the oil has also been demonstrated against antibiotic-resistant E. coli and Staphylococcus aureus (Friedman et al 2004).

Fungi in bakery products Antifungal activity against the more common fungi causing spoilage of bakery products, Eurotium amstelodami, E. herbariorum, E. repens, E. rubrum, Aspergillus flavus, A. niger and Penicillium corylophilum, was demonstrated for cinnamon oil in vitro (Guynot et al 2003).

Respiratory tract pathogens An in vitro study of the antibacterial activity of essential oils and their major components against the major bacteria causing respiratory tract infection indicated that cinnamon bark oil was effective against Haemophilus influenzae, Streptococcus pneumoniae and S. pyogenes (Inouye et al 2001).

Oral pathogens According to in vitro research, cinnamon bark oil is an effective inhibitor of bacteria causing dental caries and periodontal disease (Saeki et al 1989).

Carminative The essential oil exhibits carminative activity and decreases smooth muscle contractions in guinea-pig trachea and ileum, and in dog ileum, colon and stomach (WHO 2004). The oil has also demonstrated antifoaming activity in a foam generator model for flatulence (ESCOP 2003). The active antispasmodic constituent is considered to be cinnamaldehyde.

Hypoglycaemic activity Using an experimental model of diabetes, Kim et al observed that cinnamon extract significantly reduced blood glucose levels after two weeks of treatment (Kim et al 2006). A significant decrease in total cholesterol levels and triglycerides and increase in HDL-cholesterol was also found for cinnamontreated mice.

Enhanced insulin sensitivity Water soluble compounds extracted from C. Cassia potentiate insulin activity, as measured by glucose oxidation in the rat epididymal fat-cell assay. The most active compound, methylhydroxy chalcone polymer (MHCP), increased glucose metabolism approximately 20-fold and was an effective mimetic of insulin according to an in vitro study. When combined with insulin, the responses were greater than additive, indicating synergism between the two compounds (Jarvill-Taylor et al 2001). According to Anderson et al (2004), MHCP is actually a water-soluble polyphenolic type-A polymer that increases insulin sensitivity by activating the key enzymes that stimulate insulin receptors, while inhibiting the enzymes that deactivate them. More specifically, extracts of cinnamon activate insulin receptor kinase and inhibit dephosphorylation of the insulin receptor, leading to maximal phosphorylation of the insulin receptor. The United States Agricultural Research Service has filed a patent application on the active substances.

Antitumour activity Cinnamon extract displayed anti-tumour activity when administered orally or by intra-tumour injection (Kwon et al 2009). It strongly inhibited the expression of pro-angiogenic factors and master regulators of tumour progression. The effects were seen not only in melanoma cell lines but also in an experimental melanoma model. In addition, cinnamon extract treatment increased the anti-tumour activities of CD8+ T cells by increasing the levels of cytolytic molecules and their cytotoxic activity. These findings are important as tumour cells recruit new blood vessels by excessive production of proangiogenic factors that play a pivotal role in tumour progression and tumour survival.

Anti-inflammatory and antioxidant Potent antioxidant and anti-inflammatory activity for cinnamon bark oil has been demonstrated in vitro and for the dry ethanolic extract in vivo (ESCOP 2003, Jarvill-Taylor et al 2001, Lee et al 2003, Mathew & Abraham 2006).

OTHER ACTIONS (Braun, L and Cohen, M. 2010)

A dose-dependent antinociceptive activity has been demonstrated for Cinnamomum zeylanicum when administered orally to mice in the hot plate and acetic acid writhing induced tests (Atta and Alkofahi 1998). C. cassia also possesses antipyretic activity (Kurokawa et al 1998) and reduced the occurrence of ulcers in rats in a dose-dependent manner in a study that administered an aqueous extract (Tanaka et al 1989). Besides antispasmodic and broad-spectrum antibacterial and fungicidal activities, cinnamaldehyde exhibits antitumour effects (Kwon et al 1998) and cytotoxicity (Moon & Pack 1983).

CLINICAL USE (Braun, L and Cohen, M. 2010)

Cinnamon has been used as a medicinal agent in several traditional healing systems. In the last two decades, scientific investigation has been undertaken to investigate its clinical effects. Evidence to support its clinical use is still mainly derived from in vitro and in vivo research, and from traditional usage, however an increasing number of clinical trials are now being published.

Dyspepsia and related symptoms Cinnamon bark oil and crushed cinnamon bark is used in the treatment of dyspeptic conditions, such as mild spastic conditions of the gastrointestinal tract, fullness and flatulence, loss of appetite and diarrhoea. Although controlled studies are unavailable, evidence of antispasmodic and antifoaming activity in animal models and a long tradition of use provide some support for its use in these indications. Cinnamon bark and Chinese cinnamon are approved by the German Commission E for the treatment of loss of appetite and dyspeptic complaints such as mild gastrointestinal spasms, bloating and flatulence (Blumenthal et al 1998).

Helicobacter pylori infection According to a placebo-controlled study of 15 volunteers with documented H. pylori infection, an ethanolic extract of cinnamon was ineffective at eradicating the infection when used at a dose of 40 mg twice daily for 4 weeks (Nir et al 2000). Considering this is an extremely low dose, further investigation is required using therapeutic doses in order to adequately test its effectiveness for this indication.

Diabetes Cinnamon has a long history of use for diabetes in China, India, Korea and Russia. To date, four clinical studies have investigated its effects in this population, producing mixed results. In 2003, a randomised, placebo-controlled study of type 2 diabetes demonstrated that cinnamon exerts clinically significant glucose- and lipid-lowering effects (Khan et al 2003). The study involved 60 people who were divided into six groups. Groups 1–3 consumed 1, 3 or 6 g of cinnamon daily whereas groups 4–6 were given the equivalent number of placebo capsules and acted as controls. The volunteers were not using insulin therapy and had a fasting blood glucose reading between 140 and 400 mg/dL. After 40 days of treatment, all three doses of cinnamon reduced mean fasting serum glucose by 18 to 29%, triglycerides by 23 to 30%, LDL-cholesterol by 7 to 27%, and total cholesterol by 12 to 26%. No significant changes were observed in the placebo groups. The effect on glucose and lipid levels was sustained 20 days after treatment had ceased, suggesting that cinnamon would not need to be consumed every day. The cinnamon used was C. cassia, which was finely ground and put into capsules. More recently, a 6-week placebo-controlled study was conducted in 25 postmenopausal women with type 2 diabetes and produced different results (Vanschoonbeek et al 2006). Researchers assessed the effects of cinnamon supplementation (C. cassia, 1.5 g/day) on fasting blood glucose, insulin and glycosylated haemoglobin concentrations, indices of oral glucose tolerance and whole-body insulin sensitivity, and fasting blood lipid profiles. During the trial, volunteers maintained their normal dietary and physical activities and continued all medication. After 6 weeks, cinnamon supplementation had no significant effect on fasting plasma glucose or insulin concentrations, whole-body oral glucose tolerance, or blood lipid profiles in this sample. It is not clear why positive results should be observed in the first study and not in the second. The dose of cinnamon used was within the range expected to be active and the same form was used. Vanschoonbeek et al report that baseline values of fasting glucose and triglycerides were different for subjects participating in the two studies and discrepant results may be accounted for by this difference and by a lack of nutritional standardisation in the study by Khan et al. Most recently, a crossover study of 15 healthy volunteers reported that ingestion of 3 g cinnamon significantly reduced postprandial serum insulin and increased glucagon-like peptide-1 concentrations without significantly affecting blood glucose, glucose-dependent insulinotropic polypeptide, the ghrelin concentration, satiety, or gastric emptying rate. A lower dose of cinnamon (1 g) was also tested and found to have no effects on any measurements (Hlebowicz et al 2009).

Gestational diabetes A randomised, double-blind placebo controlled study of 51 women with gestational diabetes found that 6 weeks of treatment with 1 g of cinnamon daily produced a trend towards decreased insulin requirements (53.85% cinnamon vs 44% placebo, P = 0.58); however, this did not reach significance (Graham et al 2005). The cinnamon used was C. cassia. The researchers suggested that a longer duration of treatment may be required to produce better results.

Metabolic syndrome A water-soluble extract of cinnamon (Cinnulin PF(R) 500 mg/day) significantly reduced fasting blood glucose, systolic blood pressure and increased lean body mass according to a placebo controlled trial of 22 subjects with prediabetes and metabolic syndrome (Ziegenfuss et al 2006). The study was conducted over 12 weeks and also detected small but statistically significant decreases in body fat in the cinnamon treated group when within-group analyses were performed.

Polycystic ovarian syndrome A pilot study involving 15 non-diabetic women with oligomenorrhoea or amenorrhoea and polycystic ovaries which compared cinnamon (333 mg cinnamon extract taken three times a day) to placebo (Wang et al 2007). The randomised study found oral cinnamon extract resulted in a significant reduction in fasting glucose as well as insulin resistance, as measured by various indices of insulin sensitivity from fasting and oral glucose tolerance test (OGTT) values. Specifically, fasting glucose was reduced by 17% during the 8-week treatment period. The reduction in insulin resistance appears to be mediated through an increase in glucose utilisation, as there were no significant alterations in hyperinsulinaemia measured by fasting insulin or mean insulin levels during OGTT. These preliminary findings are consistent with prior in vivo animal and human studies.

OTHER USES (Braun, L and Cohen, M. 2010)

Traditional uses  Cinnamon has been used traditionally by ancient healers from many backgrounds for stomach cramps, flatulence, nausea, vomiting, diarrhoea, infant colic, common infections and also female reproductive problems such as dysmenorrhoea, menorrhagia, lactation and pain in childbirth. It has also been used as an ingredient in topical preparations for pain and inflammation. Cinnamon is often used in combination with other herbs and spices for most of these indications. In TCM it is considered to warm the kidneys and fortify yang, so is used for impotence among other indications. In Ayurvedic medicine and in China, Korea and Russia it has long been used as a treatment for diabetes.

Natural food preservative  Spices such as cinnamon have been used traditionally for the preservation of food products. The considerable antimicrobial, fungicidal and antioxidant properties of cinnamon provide a theoretical basis for its use.

EXTRACTS (Duke, J. A et al., 2003)

He et al. (2005) note that cinnamaldehyde (83% or bark essential oil, 65% or twig essential oil) has antifungal, antioxidant, antipyretic, antiseptic, cytotoxic, and larvicidal activities, inhibiting the production of lymphocytes and modulating T-cell differentiation. In TCM, cassia is used for circulatory disorders, dyspepsia, gastritis, and inflammation (X15796573). EO LD50 = 320 mg/kg dermal (CAN) (should not be used on skin at levels >0.2%); Aqueous extracts of cassia deemed as effective as cimetidine in preventing ulcers (BGB; WO2). Trans-cinnamaldehyde (IC50 = 3 μg/ml) and weakly cinnamyl alcohol, trans-cinnamic acid, and eugenol inhibited aldose reductase (but quercitrin was 6 times more potent than cinnamaldehyde) (X12553890). Cinnamomum cassia inhibited epimastigote forms of Trypanosoma cruzi, (IC50 = 3.9 μg/ml) (X15567249). Butanol extracts inhibit metalloproteinase-9 (IC > 90 = 100 μg/ml) (X15652283); LD50 (cinnamaldehyde) = 2200–3350 mg/kg orl rat HH2; LD50 (cinnamaldehyde) = 200 mg/kg ipr mus HH2; LD50 (cinnamaldehyde) = 132 mg/kg ivn mus HH2; LD50 (cinnamaldehyde) = 2225 mg/kg orl mus HH2; LD50 (EO) = 5200 mg/kg orl rat HH2.

SIDE-EFFECTS, TOXICITY (Barnes, J et al., 2007)

None documented for cinnamon bark. However, clinical safety data and toxicity data for cinnamom are limited and further investigation of these aspects is required. Cinnamon oil contains cinnamaldehyde, an irritant and sensitising principle.(G58) The dermal LD50 of the oil is reported to be 690 mg/kg body weight (see Cassia). The accepted daily intake of eugenol is up to 2.5 mg/ kg.(G45)

CONTRA-INDICATIONS, WARNINGS (Barnes, J et al., 2007)

Contact with cinnamon bark or oil may cause an allergic reaction.(G51) Cinnamon oil is stated to be a dermal and mucous

membrane irritant, and a dermal sensitiser.(G58) It is a hazardous oil and should not be used on the skin.(G58) The oil should not be taken internally.

Drug interactions None documented.

Pregnancy and lactation There are no known problems with the use of cinnamon during pregnancy and lactation, provided that doses do not greatly exceed the amounts used in foods.

CONTRAINDICATIONS (Linda, S-R. 2010)

Class 2B/2D Herb.

Until more research is available, except as a spice or for fl avoring, cinnamon should not be used during pregnancy and breastfeeding. It should not be given to children. Persons with hypersensitivity to cinnamon or balsam of Peru should not

use cinnamon. Prolonged use is not recommended in persons with intestinal or gastric ulcers.

SIDE EFFECTS/ADVERSE REACTIONS (Linda, S-R. 2010)

CNS: Flushing

CV: Increased heart rate

EENT: Stomatitis, glossitis, gingivitis

GI: Increased motility, anorexia, irritant (full doses)

INTEG: Allergic dermatitis (topical) (Jellin et al, 2008).

RESP: Shortness of breath

SYST: Hypersensitivity

CLIENT CONSIDERATIONS (Linda, S-R. 2010)

Assess

·         Assess the reason the client is using cinnamon medicinally.

·         Assess for hypersensitivity (rash, wheezing); if present, discontinue use of cinnamon and administer an antihistamine or other appropriate therapy.

Administer

·         Instruct the client to store cinnamon in a cool, dry place, away from heat and moisture.

·         Instruct the client to dilute cinnamon oil in a carrier oil.

Teach Client/Family

·         Caution the client not to use cinnamon bark therapeutically in children or those who are pregnant or breastfeeding until more research is available.

TOXICITY (Braun, L and Cohen, M. 2010)

The oral LD50 for cinnamon bark oil in rats is 4.16 g/kg and 3.4 mL/kg body weight.

ADVERSE REACTIONS

When the powdered herb is ingested orally, it is generally well tolerated; however, when cinnamon oil is applied topically, allergic reactions are possible as cinnamaldehyde may cause allergic contact dermatitis (Cheung et al 2003).

SIGNIFICANT INTERACTIONS (Braun, L and Cohen, M. 2010)

Controlled studies are not available, therefore interactions are based on pharmacological activity and are largely theoretical and speculative.

Hypoglycaemic agents Oral ingestion of cinnamon capsules may reduce blood glucose levels, therefore theoretically, an additive effect is possible with concurrent use —observe; potential beneficial interaction under professional supervision.

CONTRAINDICATIONS AND PRECAUTIONS (Braun, L and Cohen, M. 2010)

Cinnamon is contraindicated in people with an allergy to cinnamon or Peru balsam, in cases of fever of unknown origin, active stomach or duodenalulcers (WHO 2004).

PREGNANCY USE

C. cassia or C. zeylanicum/verum should not be used in pregnancy; however, usual dietary intakes are likely to be safe. Currently, evidence of teratogenicity from animal studies is contradictory.

PATIENTS’ FAQs (Braun, L and Cohen, M. 2010)

What will this herb do for me? Cinnamon is a natural food preservative with wide ranging antimicrobial and antifungal properties. It may improve digestion and ease symptoms of dyspepsia, flatulence and nausea. It may also lower blood glucose, total cholesterol and triglyceride levels, however more research is required to confirm these effects.

When will it start to work? The effects on digestion should start rapidly; however, effects on blood glucose and lipid levels may take 1 month or more.

Are there any safety issues? Cinnamon oil can cause allergic contact dermatitis when used topically and should be avoided by people with allergies to cinnamon or Peru balsam, pregnant women or those with active gastrointestinal ulcers.

PRACTICE POINTS/PATIENT COUNSELLING (Braun, L and Cohen, M. 2010)

·         Cinnamon has been used since ancient times as a flavouring and medicinal agent.

·         It is a natural food preservative with antioxidant and wide ranging antimicrobial and antifungal properties.

·         It has been used traditionally to treat dyspepsia, nausea, flatulence, poor appetite, stomach cramps and diarrhoea. Some evidence suggests it may be effective for some of these indications.

·         Whether ground cinnamon (C. cassia) reduces blood glucose and lipid levels and can be useful for people with type 2 diabetes is uncertain as clinical studies have produced mixed results

·         Cinnamon oil can cause allergic contact dermatitis when used topically and should be avoided by people with allergies to cinnamon  or Peru balsam, pregnant women or those with active gastrointestinal ulcers.

PREPARATIONS (Barnes, J et al., 2007)

Proprietary single-ingredient preparations

USA: Cinnamon Extract.

Proprietary multi-ingredient preparations

Austria: Brady's-Magentropfen; China-Eisenwein; Mariazeller; Montana; Montana N; Passedan. Brazil: Balsamo Branco;

Paratonico. Czech Republic: Blahungstee N; Dr Theiss Rheuma Creme; Dr Theiss Schwedenbitter; Magen- und Darmtee N. France: Elixir Grez; Quintonine. Germany: Amara-Pascoe; Gastrosecur; Klosterfrau Melisana; Melissengeist; Schwedentrunk Elixier; Sedovent. India: Carmicide. Israel: Davilla. Italy: Biophase Shampoo; Dam. Russia: Doppelherz Melissa (Доппельгерц Мелисса); Himcolin (Химколин). South Africa: Melissengeist; Rooilavental; Spiritus Contra Tussim Drops. Spain: Agua del Carmen; Vigortonic. Switzerland: Odontal; Tisane pour les problemes de prostate. Thailand: Meloids. UK: Melissa Comp.. Venezuela: Aftil.

REFERENCE

Barnes, J., Anderson, L. A., and Phillipson, J. D. 2007. Herbal Medicines Third Edition. Pharmaceutical Press. Auckland and London.

Braun, L and Cohen, M. 2010. Hebs and Natural Supplements An Evidence Based Guide 3R D Edition. Elsevier Australia. Australia.

Duke, J. A. with Mary Jo Bogenschutz-Godwin, Judi duCellier, Peggy-Ann K. Duke. 2002. Handbook of Medicinal Herbs 2nd Ed. CRC Press LLC. USA.

Duke, J. A. with Peggy-Ann K and Judi duCellier,. Duke. 2003. Duke’s Handbook Of Medicinal Plants Of The Bible. CRC Press LLC. USA.

Duke, J. A. with Mary Jo Bogenschutz-Godwin, Judi duCellier, Peggy-Ann K. Duke. 2003. CRC Handbook of Medicinal Spices. CRC Press LLC. USA.

Kraft, K and Hobbs, C. 2004 . Pocket Guide to Herbal Medicine. Thieme. Stuttgart New York.

Linda S-Roth. 2010. Mosby’s Handbook Of Herbs & Natural Supplements, Fourth Edition. Mosby Elsevier. USA.