Can Traditional Herbal Medicine Help Heal Chronic Diabetic Foot Ulcers?

Alexander M. Reyzelman, DPM, and Irina Bazarov, MS

A Closer Look At A Novel Healing Ointment

One recent addition to the arsenal of traditional Chinese herbal medicine-based therapies available to Western physicians is a topical ointment, WinVivo Healing Balm (WinVivo Corp.), which we have used successfully to treat difficult-to-heal lower extremity ulcers.9 WinVivo has 11 ingredients, which include camellia oil and extracts of tree peony bark, coptis root, rhubarb root, fritillaria bulb, lithospermum root, chicken gizzard, and corydalis rhizome, as well as dragon’s blood resin, borneol powder and bone ash. The ointment has been in use to treat acute and chronic wounds. Randomized clinical studies in China have shown it to be effective in the healing of second- and third-degree burns.10

   A number of ingredients included in WinVivo ointment exhibit properties that could be beneficial in wound healing.

   Tree peony bark (Paeonia suffruticosa) has been part of traditional Chinese medicine since the 1st century AD. It contains several compounds with analgesic, antioxidant and antipyretic properties.11 The anti-inflammatory effects of tree peony are theoretically due to the suppression of the pro-inflammatory cytokines TNF-a and IL-6, and modulation of the phosphorylation of mitogen-activated protein kinase (MAPK) cascade.12 Since prolonged, out of control inflammatory response is believed to be one of the major mechanisms responsible for the failure of chronic wounds to heal, the plant’s anti-inflammatory properties could potentially facilitate the progression of wounds to faster healing.13

   Coptis root (Coptis chinensis) is a rich source of berberine alkaloids, which are well known for their anti-cancer, antimicrobial and anti-inflammatory effects. In vitro and in vivo studies have shown that the plant possesses a broad spectrum of antibacterial, antifungal and antiviral activity.14-16 A recent study in mice with irritable bowel syndrome has demonstrated that coptis root has potent analgesic properties that are likely due to an inhibitory effect on serotonin release and pain transmission.17

   Rhubarb root (Rheum palmatum) has been recognized as a medicinal plant for thousands of years and now grows around the world. Its main active compound, emodin, is well known for its antimicrobial and anti-inflammatory properties. A recent in vitro study has demonstrated that emodin inhibits proliferation of pro-inflammatory cytokines TNF-a, IL-1b, IL-6 and IL-8, as well as prostaglandin E2 and matrix-metalloproteinases (MMP) 1 and MMP-13.18 In addition, in vivo investigation has revealed that topical application of emodin promotes healing of excisional wounds in rats by regulating the SMAD-mediated TGF-β1 signaling pathway.19

   Research has shown that lithospermum root (Lithospermum erythrorhizon) and its major component shikonin reduce inflammation by inhibiting signaling pathways leading to activation of AP-1 and NF-kB transcription factors in macrophages.20 Shikonin derivatives from lithospermum root possess antifungal, antiviral and antibacterial properties.21,22 In addition, lithospermum root may act as an antioxidant.23 Fujita and colleagues have demonstrated that an extract of lithospermum root accelerates wound healing in diabetic mice by shortening of the inflammatory phase and advancement of proliferative and maturation phases.24

   Corydalis tuber (Corydalis turtschaninovii) has been in use in traditional Chinese medicine since the 8th century AD. One of its components, dehydrocorydaline, possesses potent anti-inflammatory properties due to its role in inhibiting antigen-induced histamine release.25,26 One study demonstrated that pseudocoptisine, another compound obtained from corydalis, reduces levels of pro-inflammatory mediators iNOS, COX-2 and TNF-a through inhibition of NF-kB and suppression of ERK and p38 phosphorylation.27

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