Canker sores and sore throat

Although not necessarily related in origin, the same botanicals are used to treat both disorders, so it is convenient to consider them together here. Related ailments, such as cough, were discussed in Chapter 5 . Many of these conditions are self-limiting; consequently, herbal treatments are, in general, palliative in character. Some of the commonly used herbs do pos- sess modest antiseptic properties.

Goldenseal Consisting of the dried rhizome and roots of Hydrastis canadensis L., family Ranunculaceae, this native American plant was introduced to the early settlers by the Cherokee Indians. It was long listed in the official compen- dia (USP and NF) and in relatively recent times was employed in medi- cine as a bitter. Previously, it had been thought to have value in treating urinary tract infections and in checking internal hemorrhage. However, there is no substantial clinical evidence that goldenseal or its constituents are effective in such conditions. 50

Goldenseal contains a number of isoquinoline alkaloids, including hydrastine (4 percent), berberine (up to 6 percent), berberastine (3 percent), and canadine (1 percent). Of these, berberine is particularly active, hav-

ing antibacterial and amoebicidal properties. 51 It probably accounts for the

Chapter ten: Problems of the skin, mucous membranes, and gingiva 189 widespread use of goldenseal in the treatment of canker sores and other

conditions causing sore mouth. A strong tea prepared from 2 teaspoon- fuls of the herb and 1 cup of water has a considerable folkloric reputation as a mouthwash to alleviate pain and facilitate healing. The process may

be repeated three or four times daily. Lacking any modern clinical studies dealing with the safety and efficacy of goldenseal when used internally, it is necessary to agree with Sollmann that ingestion of the herb “has few, if any, rational indications.” 50

In recent years, goldenseal has become very popular as a purported immunostimulant. For this purpose, it is commonly combined with echi- nacea. However, the alkaloids of goldenseal are very poorly absorbed from the gastrointestinal tract, so any significant systemic effects are pre- cluded. In addition, the wild plant has been so intensively collected that the survival of the species is now in doubt. For these reasons, the contin- ued use of this botanical is not rational.

Rhatany Containing up to 15 percent condensed tannins, the dried root of Krameria triandra Ruiz & Pav., family Krameriaceae, is frequently used in the form of

a hydroalcoholic solution (tincture) as a treatment for various oral lesions, including inflammation of the gums and of the mucous membranes of the mouth (gingivitis and stomatitis). Used as such or combined with equal parts of myrrh tincture, it is applied locally to noninfectious canker sores with good results. Treatment is carried out two or three times daily. The tincture is also effective when used as a mouthwash, five to ten drops being added to a glass of water for that purpose. 52

A decoction can also be prepared using 1 level teaspoonful (1.5–2 g) of coarsely powdered root and 5 oz (150 mL) boiling water, covered and kept on the boil for ten to fifteen minutes before being strained. This can

be used as a rinse or gargle two to three times daily. Myrrh

Myrrh is neither plant nor plant part; technically, it is an exudate, an oleo- gum-resin, which exudes from incisions in the bark of Commiphora mol- mol Engl., C. abyssinica Engl., C. myrrha (Nees) Engl., or other species of the same genus (family Burseraceae). The plants yielding myrrh are small trees native to Ethiopia, Somalia, and the Arabian Peninsula.

Consisting of a mixture of about 2.5–10 percent volatile oil, 50–60 percent gum, and 25–40 percent resin composed of resin acids ( α-, β-, and γ-commiphoric acids), resenes, and phenolic compounds, 53 the chemical constituents of myrrh are very complex. Presumably, its therapeutic utility may be attributed to the sesquiterpenes that dominate in the essential oil and to the resin acids in the resin. Many of the carbohydrate constituents

190 Tyler's herbs of choice: The therapeutic use of phytomedicinals constituting the gum are insoluble in alcohol and not found in the usual

myrrh preparations. 54 Utilized for many centuries for its astringent and protective properties, myrrh was first listed in the USP in 1820 and enjoyed official status there, and subsequently in the NF, until 1965. It is currently approved by the German Commission E for the local treatment of mild inflamma- tions of the mucous membranes of the mouth and throat. Myrrh is almost always employed in the form of a tincture containing 20 percent of the drug in 85 percent alcohol. The tincture is applied locally to canker sores two or three times daily; a gargle for sore throat consists of five to ten drops of the tincture in a glass of water. 55

A growing body of evidence suggests that gugulipid, an active com- ponent of the guggul or guggulu plant, Commiphora mukul Hook., may be effective in lowering serum cholesterol and triglyceride levels. In addition, no significant adverse effects have been reported in clinical studies. Although guggul-based products containing gugulipid are already mar- keted as drugs in India and France and the powdered resin is available in the form of capsules in the United States, there is insufficient evidence available at this time to render a definitive judgment as to their safety and

efficacy. 56 Although preliminary indications are promising, much addi- tional research is required to substantiate the value of the herb. Guggul is therefore not discussed in Chapter 6 , “Cardiovascular System Problems.” It is mentioned here merely to avoid confusing it with myrrh because both are derived from plants of the same genus.

Canker sores and sore throat