MYRRH (Commiphora myrrha (Nees) Engl. (Burseraceae) )

HERBAL

MEDICINAL

PLANT

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MYRRH

Commiphora myrrha (Nees) Engl. (Burseraceae)

BY

RETTODWIKART THENU

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MYRRH

Commiphora myrrha (Nees) Engl. (Burseraceae)

SUMMARY AND PHARMACEUTICAL COMMENT

The volatile oil, gum and resin components of myrrh are well documented. The anti-inflammatory and antipyretic activities documented in animals support some of the traditional uses. Phenol components of the volatile oil may account for the antimicrobial properties of myrrh, although no documented studies were located. Lipid-lowering properties via a stimulant action on the thyroid gland have been documented for C. mukul both in animals and, to a limited extent, in humans. However, robust clinical research assessing the efficacy and safety of myrrh is lacking. In view of the lack of toxicity data, excessive use of myrrh and use during pregnancy and lactation should be avoided.

SPECIES (FAMILY)

Commiphora myrrha (Nees) Engl. and other spp.) ++ (Burseraceae)

SYNONYM(S)

African Myrrh, Arabian Myrrh, Balsamodendron Myrrha, Balsamodendron myrrha (Nees), Bitter Myrrh, Commiphora, Commiphora molmol (Engl.) Engl., C. coriacea Engl., C. cuspidata Chiov., C. habessinica (O. Berg) Engl. var. Grossedentata Chiov., C. myrrha (Nees) Engl. var. molmol Engl., C. Playfairii (Oliv.) Engl. var. benadirensis Chiov., C. rivae Engl., Diddin, Didin, Male Myrrh, Malmal, Mohmol, Molmol, Murr, Myrrh, Somali Myrrh, Yemen Myrrh

I doubt that the Herbal PDR editors and Commission E writers are any wiser than the wise men or me, or Madaus in 1938, or Felter in 1898, at knowing which species of Commiphora is myrrh. They call it C. molmol, but also resin, and Myrrh Commiphora. All PH2 entries below were

ORIGIN

Myrrh is a shrub found in various regions of Africa.

PHARMACOPODIAL AND OTHER MONOGRAPHS

BHC 1992(G6)

BHP 1996(G9)

BP 2007(G84)

Complete German Commission E(G3)

ESCOP 2006(G76)

Martindale 35th edition(G85)

Ph Eur 2007(G81)

USP29/NF24(G86)

LEGAL CATEGORY (LICENSED PRODUCTS)

GSL(G37)

CONSTITUENTS

The following is compiled from several sources, including General References G2, G6 and G52.

Carbohydrates Up to 60% gum yielding arabinose, galactose, xylose, and 4-O-methylglucuronic acid following hydrolysis.

Resins Up to 40% (average 20%) consisting of a-, b- and gcommiphoric acids, commiphorinic acid, a- and b-heerabomyrrhols, heeraboresene and commiferin.

Steroids Campesterol, cholesterol and b-sitosterol.

Terpenoids a-Amyrin. Furanosesquiterpenes, including furaneudesma- 1,3-diene (major), furaneudesma-1,4-diene-6-one, lindestrine, curzerenone, furanodiene, 2-methoxyfuranodiene and 4,5- dihydrofuranodiene-6-one.(1, G52)

Volatile oils 1.5–17%. Main constituents are furanosesquiterpenes. Dipentene, cadinene, heerabolene, limonene, pinene, eugenol, m-cresol, cinnamaldehyde, cuminaldehyde, cumic alcohol and others.

USES

USES

Myrrh traditionally has been used internally to treat upper respiratory congestion, pharyngitis, gingivitis, mouth ulcers, stomatitis, leprosy, syphilis, and legulcers. Topically, it is used to treat wounds, decubitus ulcers, and hemorrhoids. Contemporary use is mostly limited to fl avoring in foods and fragrance in cosmetic products.

INVESTIGATIONAL USES

Researchers are experimenting with the use of myrrh in combination with other products to treat colds and infections.

FOOD USE

Myrrh is listed by the Council of Europe as a natural source of food flavouring (category N2). This category indicates that myrrh can be added to foodstuffs in small quantities, with a possible limitation of an active principle (as yet unspecified) in the final product.(G16) Previously, in the USA, myrrh has been permitted for use in alcoholic beverages.(G65)

HERBAL USE

Myrrh is stated to possess antimicrobial, astringent, carminative, expectorant, anticatarrhal, antiseptic and vulnerary properties. Traditionally, it has been used for aphthous ulcers, pharyngitis, respiratory catarrh, common cold, furunculosis, wounds and abrasions, and specifically for mouth ulcers, gingivitis and pharyngitis.(G2, G4, G6–G8, G43, G52, G64) The German Commission E approved topical use for mild inflammation of the oral and pharyngeal mucosa.(G3)

  

Figure 1. (a) Myrrh Oil and (b) Myrrh Gum (c) Resin

ACTIONS

ACTIONS

Several studies have focused on the actions of myrrh. Myrrh has been found to decrease cholesterol levels, decrease infl ammation, provide analgesia, act as an antiulcer and antitumor agent, and stimulate triiodothyronine production.

Antilipidemic Action

When myrrh was studied along with garlic for reduction of cholesterol, triglycerides, and phospholipids, garlic was found to be far superior to myrrh (Dixit et al, 1980). However, when myrrh was studied with Allium sativum and Allium cepa, all three agents were found to prevent a rise in these three indicators (Lata et al, 1991).

Antiinfl ammatory and Antipyretic Actions

Three studies have identifi ed the antiinfl ammatory action of myrrh. One study used laboratory animals that had been injected with liquid paraffin containing killed mycobacterial adjuvant. In this study, phenylbutazone, ibuprofen, and a fraction of myrrh all were shown to provide signifi cant relief of arthritis symptoms (Sharma et al, 1977). The other studies identifi ed a triterpene with antiinfl ammatory and analgesic properties (Dolara et al, 2000; Fourie et al, 1989). In this study, a signifi cant antiinfl ammatory effect occurred when myrrh was administered to mice. In another study, an antipyretic action was observed (Tariq et al, 1986).

Anticancer Action

Myrrh’s anticancer action has been demonstrated in a study using mice. The study evaluated results at 25 to 50 days. Anticarcinogenic results were less pronounced after 50 days. The effect was comparable to that of cyclophosphamide (Al-Harbi et al, 1994). Another study showed similar results, leading researchers to conclude that the use of myrrh for the treatment of cancer is appropriate (Qureshi et al, 1993).

PHARMACOLOGICAL ACTIONS

IN VITRO AND ANIMAL STUDIES

Anti-inflammatory activity Anti-inflammatory (carrageenaninduced inflammation and cotton pellet granuloma)(2) and antipyretic activities in mice(2, 3) have been documented for C. molmol.

Hypoglycaemic activity Hypoglycaemic activity in both normal and diabetic rats has been reported for a myrrh extract.(4, 5) Together with an aloe gum extract, myrrh was found to be an active component of a multi-plant extract that exhibited antidiabetic activity. The mode of action was thought to involve a decrease in gluconeogenesis and an increase in peripheral utilisation of glucose in diabetic rats. Myrrh is stated to have astringent properties on mucous membranes(G45) and to have antimicrobial activities in vitro.(G41)

Anti-inflammatory activity Anti-inflammatory activities have been reported for an Indian plant, Commiphora mukul, commonly known as guggulipid. Anti-inflammatory activity was described for a crystalline steroidal fraction of guggulipid in both acute (carrageenan-induced rat paw oedema test) and chronic (adjuvant arthritis) models of inflammation.(6)

Lipid-lowering effects A ketosteroid has been identified as the active hypocholesterolaemic principle in guggulipid.(7) In some animal species, thyroid suppression is required as well as cholesterol administration in order to achieve experimental hypercholesterolaemia. Results of studies in chicks administered a thyroid suppressant and cholesterol indicated that guggulipid prevents endogenous hypercholesterolaemia via stimulation of the thyroid gland.(7) When fed to rabbits, guggulipid has been found to reverse the decrease in catecholamine concentrations and dopamine-b-decarboxylase activity that are associated with hyperlipidaemia.(8)

Stimulation of phagocytosis Stimulation of phagocytosis has been documented in mice innoculated with Escherichia coli and given with extracts of myrrh by intraperitoneal injecton.(G52)

Cytoprotective activity An aqueous suspension of myrrh administered to rats at oral doses of 250–1000 mg/kg gave significant and dose-dependent protection to gastric mucosa against various ulcerogenic agents.(G52)

Analgesic activity In mice, powdered myrrh (1 mg/kg, orally) had significant analgesic activity in the hotplate test.(G52) Isolated furanoeudesma-1,3-dione (50 mg/kg, orally) was significantly more effective than control (p < 0.01) in the mouse writhing test, and the effective dose was reversed by naloxone (1 mg/ kg).(G52)

Anti-tumour and cytotoxic activities In mice with Ehrlich solid tumours, an aqueous suspension of myrrh (250 or 500 mg/kg, orally) produced significant decreases in tumour weight (p < 0.05) after 25 days.(G52) Aqueous suspension of myrrh increased survival time in mice with Ehrlich ascite tumours.

CLINICAL STUDIES

There is a lack of clinical research assessing the effects of myrrh and rigorous randomised controlled clinical trials are required. Guggulipid has been reported to lower the concentration of total serum lipids, serum cholesterol, serum triglycerides, serum phospholipids and b-lipoproteins in 20 patients.(9) This effect was reported to be comparable to that of two other known lipidlowering drugs also used in the study.

ACTIVITIES

Analgesic (1; APA; BGB); Antiedemic (1; CAN); Antiinflammatory (1; APA; BGB; PNC); Antipyretic (1; APA; CAN); Antirheumatic (1; BGB); Antiseptic (1; APA; BGB; FEL; PH2; PNC; SKY); Antispasmodic (1; APA; PNC); Aperitif (f; PH2); Astringent (2; APA; KOM; PH2; SKY); Carminative (f; BGB; PHR; PNC); Decongestant (1; APA); Deodorant (1; BGB; HHB); Digestive (f; PH2); Emmenagogue (f; APA; FEL); Expectorant (f; FEL; PHR; PH2; PNC); Hypocholesterolemic (1; CAN); Hypoglycemic (1; APA; CAN); Hypotriglyceridemic (1; CAN); Immunostimulant (1; APA; PNC); Lipolytic (1; CAN); Stimulant (f; APA; FEL); Vulnerary (f; PNC).

INDICATIONS

Abrasion (1; CAN); Adnexosis (f; MAD); Alopecia (f; MAD); Amenorrhea (f; BGB; FEL; MAD; PH2); Anorexia (f; PH2); Aphtha (1; CAN); Asthma (1; APA; FEL); Atherosclerosis (f; MAD); Athlete’s Foot (1; SKY); Bedsore (f; APA); Bladder Stone (f; BIB); Boil (f; PNC); Bronchosis (1; APA; BGB; FEL); Cancer (f; APA; PH2); Cancer, abdomen (f; PH2); Cancer, colon (f; PH2); Candida (1; BGB); Canker Sore (1; APA; SKY); Carbuncle (f; PH2); Caries (f; FEL); Catarrh (f; BGB; CAN; FEL); Chilblain (f; BIB); Chlorosis (f; BIB); Cold (1; BGB; CAN; SKY); Congestion (1; APA; BGB); Cough (f; PH2); Cramp (1; APA; PNC); Decubitis (f; BGB); Dermatosis (1; APA; MAD; PH2); Diarrhea (f; MAD); Dropsy (f; BIB); Dysentery (f; MAD); Dysmenorrhea (1; BGB; PH2); Dyspepsia (f; APA; FEL); Dysuria (f; MAD); Earache (f; BIB); Enterosis (f; PH2); Erysipelas (f; MAD); Fever (1; APA; BIB; CAN; MAD); Freckle (f; MAD); Furunculosis (1; CAN; PH2); Gangrene (f; FEL); Gas (f; APA; BGB; MAD; PHR; PNC); Gastrosis (f; FEL; PH2; PNC); Gingivosis (1; APA; FEL; PNC; SKY); Gleet (f; FEL); Gonorrhea (f; FEL); Halitosis (f; FEL); Hemorrhoid (f; APA; BGB; BIB); Hepatosis (f; MAD); High Cholesterol (1; CAN); Hoarseness (f; APA); Hyperglycemia (1; APA; CAN); Immunodepression (1; APA; PNC); Infection (f; PH2); Infertility (f; MAD); Inflammation (1; APA; BGB; PH2; PNC); Laryngosis (f; FEL); Leprosy (f; APA); Leukorrhea (f; FEL; MAD); Menopause (1; BGB); Menorrhagia (f; MAD); Mucososis (1; APA; FEL; PH2); Odontosis (f; MAD); Ophthalmia (f; BIB); Osteosis (f; BGB); Pain (1; APA; BGB); Pharyngosis (2; APA; FEL; KOM; MAD; PH2; PNC); Pulmonosis (f; MAD); Respirosis (f; BGB); Rheumatism (1; BGB); Rhinosis (f; APA; BIB); Salpingosis (f; MAD); Side Ache (f; MAD); Sinusosis (1; APA); Sore (1; APA; FEL; PNC); Sore Throat (2; BGB; FEL; KOM; MAD; SKY); Stomatosis (2; APA; KOM; MAD; PH2; PIP); Swelling (1; APA; CAN); Tonsilosis (1; APA; BGB; FEL; PNC); Tuberculosis (f; MAD); Ulcer (f; APA; PH2; X11113992); Uterosis (f; MAD); Uvulosis (f; FEL); VD (f; FEL); Water Retention (f; MAD); Worm (f; FEL; MAD); Wound (f; APA; BGB); Wrinkle (f; MAD); Yeast (1; BGB).

INDICATIONS AND USAGE

Approved by Commission E:

Liver and gallbladder complaints Spastic discomfort in the area of the gallbladder and bile ducts, as well as the gastrointestinal tract.

Unproven Uses: In folk medicine, the herb has been used for skin diseases, constipation, cystitis, arteriosclerosis, rheuma tism, arthritis, as a blood purifier, hypoglycemia and for infections.

Homeopathic Uses: for chronic, itching eczema resulting from liver disease.

PRODUCT AVAILABILITY

Capsules, fl uid extract, mouthwash, resin, tincture

PLANT PARTS USED: Gum, oil, resin

DOSAGES

DOSAGES

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

·         Myrrh Tincture (BPC 1973) 2.5–5.0 mL; in a glass of water several times daily as a gargle or a mouthwash. For skin, undiluted or diluted.(G52)

·         Tincture Myrrh Co (Thompsons) (1 part Capsicum Tincture BPC 1973 to 4 parts Myrrh Tincture BPC 1973) 1.0– 2.5 mL.

DOSAGES

Isolated Mouth and Throat Ulcers (Aphthae) 

·         Myrrh Tincture   Apply a few drops of myrrh tincture 1 : 5 to the affected sites, 2 to 3 times a day.

DOSAGES

·         Adult PO mouthwash: mix 5-10 drops in glass of water (Blumenthal, 1998)

·         Adult PO tea: place 2 tsp 10% powdered resin in 8 oz boiling water, steep 15 min; may be taken tid

DOSAGES

·         1 tsp powdered myrrh/cup water 1–2 ×/day (APA); 5–10 drops tincture/glass water for mouthwash or gargle (APA); 6–10 drops tincture several ×/day (MAD); 1–2 ml tincture 3 ×/day (SKY);

·         2.5–5.0 ml myrrh tincture (CAN; PNC); 8–10 drops myrrh extract to 4 ×/day (APA); 0.3–1.2 g resin/day (HHB); 1 g resin 3 ×/day (SKY); 0.3–1.5 g (MAD).

CONTRAINDICATIONS, INTERACTIONS, AND SIDE EFFECTS

Class 2b. None known (KOM; PHR). “No adverse effects from myrrh have been reported” (SKY). Emmenagogue and uterotonic. Contraindicated in uterorrhagia. Doses >2–4 g may cause diarrhea and nephrosis. French permit only external application (AHP). Undiluted tincture may produce burning and local irritation (AEH). CAN cautions that because it is reputed to affect the menstrual cycle, its use in pregnancy and lactation is to be avoided. May interfere with diabetic therapies. In view of the lack of toxicological data, excessive use should be avoided (CAN). Apprehension, diarrhea, hiccups, and restlessness have been reported as side effects of gugulipid administration (CAN).

CONTRAINDICATIONS

Pregnancy category is 2; breastfeeding category is 3A.

Myrrh should not be given to children. It should not be used by persons with hypersensitivity to it or by those with fever, severe uterine bleeding, or tachycardia.

SIDE EFFECTS/ADVERSE REACTIONS

CNS: Anxiety, restlessness

GI: Nausea, vomiting, anorexia, diarrhea

INTEG: Hypersensitivity reactions, dermatitis

INTERACTIONS

Drug

Antidiabetics: Use of myrrh with antidiabetics may cause increased hypoglycemic effects; avoid concurrent use.

Lab Test

Blood glucose: Myrrh may decrease blood glucose levels (theoretical) (Jellin et al, 2008).

SIDE-EFFECTS, TOXICITY

There is a lack of clinical safety and toxicity data for myrrh and further investigation of these aspects is required. No reported side-effects were located for C. molmol or C. abyssinica. Hiccup,(9) diarrhoea,(7) restlessness and apprehension,( 9) were documented as side-effects for guggulipid when administered to 20 patients.(9) Myrrh has been reported to be nonirritating, non-sensitising and non-phototoxic to human and animal skins.(G41)

CONTRA-INDICATIONS, WARNINGS

Drug interactions None documented. However, the potential for preparations of myrrh to interact with other medicines administered concurrently, particularly those with similar or opposing effects, should be considered. There is limited evidence from preclinical studies that myrrh has hypoglycaemic activity. Pregnancy and lactation In view of the lack of safety information, use of myrrh during pregnancy and lactation should be avoided.

EXTRACTS 

The resin kills germs and stimulates macrophages (SKY). Extracts of C. abyssinica stimulate phagocytosis in mice inoculated with Escherichia coli. Other species of Commiphora have demonstrated antiaggregant, antioxidant, cardioprotective, hypocholesterolemic, and hypotriglyceridemic activities suggesting the utility of these gums, like many other gums, in preventing and moderating heart disease. And I kinda like the idea of a gum for a gum disease.

CLIENT CONSIDERATIONS

ASSESS

·         Assess for hypersensitivity reactions. If present, discontinue the use of myrrh and administer an antihistamine or other appropriate therapy.

·         Assess the client’s use of antidiabetics such as insulin. Monitor blood glucose if the client is taking concurrently with myrrh (see Interactions).

ADMINISTER

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

TEACH CLIENT/FAMILY

·         Inform the client that pregnancy category is 2 and breastfeeding category is 3A.

·         Caution the client not to give myrrh to children.

PREPARATIONS

Proprietary single-ingredient preparations

Germany: Inspirol P.

Proprietary multi-ingredient preparations

Argentina: Parodontax Fluor. Australia: Eczema Relief. Austria: Brady's-Magentropfen; Dentinox; Original Schwedenbitter; Paradenton; Parodontax; Parodontax. Brazil: Paratonico; Parodontax. Canada: Chase Coldsorex; Cold Sore Lotion. Chile: Astrijesan. Czech Republic: Dr Theiss Rheuma Creme; Dr Theiss Schweden Krauter; Dr Theiss Schwedenbitter. Denmark: Dolodent. Germany: Ad-Muc; Mint-Lysoform; Myrrhinil-Intest; Repha-Os. Hong Kong: Ad-Muc. Italy: Gengivario. Russia: Original Grosser Bittner Balsam (Ориги-нальный Большой Бальзам Биттнера). South Africa: Helmontskruie; Lewensessens. Spain: Buco Regis. Switzerland: Pommade au Baume; Sanogencive. UK: Golden Seal Indigestion Tablets; Herbal Indigestion Naturtabs; HRI Golden Seal Digestive; Indigestion and Flatulence; Napiers Digestion Tablets; Nervous Dyspepsia Tablets; Vocalzone; Wind & Dyspepsia Relief. Venezuela: One Drop Spray.

REFERENCE

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

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.

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