Analgesic Herbal Medicines in the Treatment of Knee Osteoarthritis: A Systematic Review

Author(s): Soudeh Teymouri, Hasan Rakhshandeh, Hamideh Naghedi Baghdar, Mahdi Yousefi, Roshanak Salari*.

Journal Name: Current Rheumatology Reviews

Volume 15 , Issue 4 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Background: Osteoarthritis (OA) is a type of progressive rheumatoid disease, which leads to the degeneration of the articular cartilage, synovium, subchondral bone, tendons, and the surrounding ligaments.There are various treatments for knee OA, including pharmaceutical, nonpharmaceutical, and surgical treatments. Considering the chronic nature of the disease as well as the necessity for the long-term use of chemical medications, various side effects could occur that include gastrointestinal bleeding, hypertension, congestive heart failure, hyperkalemia, and kidney failure. Therefore, suitable treatments with fewer side effects should be recommended. Recent investigations suggest increased tendency in people to use Complementary and Alternative Medicine (CAM) for knee OA treatment.

Objective: This systematic review aimed to assess the effectiveness and safety of herbal preparations for the treatment of OA.

Methods: The searched databases were Cochrane, Scopus, and PubMed. All the selected papers pertained to randomized controlled trials until August 8, 2017 in English in which one or several specific herbs had been used in knee OA treatment.

Results: We included 24 randomized trials (involving 2399 women and men). There were several different herbal medicines used within the included trials.

Conclusion: The results show that the methods used in these trials may reduce symptoms and the extent of NSAID consumption and enhance the quality of life. Additional trials are suggested to investigate the safety and efficacy of herbs for the treatment of patients with OA.

Keywords: Knee osteoarthritis, herbal medicines, randomized controlled trials, systematic review, osteoarthritis, medicine, symptoms.

[1]
Cooper C, Inskip H, Croft P, et al. Individual risk factors for hip osteoarthritis: obesity, hip injury, and physical activity. Am J Epidemiol 1998; 147(6): 516-22.
[http://dx.doi.org/10.1093/oxfordjournals.aje.a009482] [PMID: 9521177]
[2]
Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis 2001; 60(2): 91-7.
[http://dx.doi.org/10.1136/ard.60.2.91] [PMID: 11156538]
[3]
Felson DT. Clinical practice. Osteoarthritis of the knee. N Engl J Med 2006; 354(8): 841-8.
[http://dx.doi.org/10.1056/NEJMcp051726] [PMID: 16495396]
[4]
Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991-94. J Rheumatol 2006; 33(11): 2271-9.
[PMID: 17013996]
[5]
Drury P, Shipley M. Rheumatology and bone disease. Clin Med (Northfield Ill) 1998; 4.
[6]
D’Ambrosia RD. Epidemiology of osteoarthritis. Orthopedics 2005; 28(2)(Suppl.): s201-5.
[PMID: 15747607]
[7]
Hochberg MC, Altman RD, Brandt KD, et al. Guidelines for the medical management of osteoarthritis. Part I. Osteoarthritis of the hip. Arthritis Rheum 1995; 38(11): 1535-40.
[http://dx.doi.org/10.1002/art.1780381103] [PMID: 7488272]
[8]
Buffum M, Buffum JC. Nonsteroidal anti-inflammatory drugs in the elderly. Pain Manag Nurs 2000; 1(2): 40-50.
[http://dx.doi.org/10.1053/jpmn.2000.7779] [PMID: 11706458]
[9]
Izzo AA, Hoon-Kim S, Radhakrishnan R, Williamson EM. A critical approach to evaluating clinical efficacy, adverse events and drug interactions of herbal remedies. Phytother Res 2016; 30(5): 691-700.
[http://dx.doi.org/10.1002/ptr.5591] [PMID: 26887532]
[10]
Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. John Wiley & Sons 2011.
[11]
Piscoya J, Rodriguez Z, Bustamante SA, Okuhama NN, Miller MJ, Sandoval M. Efficacy and safety of freeze-dried cat’s claw in osteoarthritis of the knee: mechanisms of action of the species Uncaria guianensis. Inflamm Res 2001; 50(9): 442-8.
[http://dx.doi.org/10.1007/PL00000268] [PMID: 11603848]
[12]
Appelboom T, Schuermans J, Verbruggen G, Henrotin Y, Reginster J-Y. Symptoms modifying effect of avocado/soybean unsaponifiables (ASU) in knee osteoarthritis. A double blind, prospective, placebo-controlled study. Scand J Rheumatol 2001; 30(4): 242-7.
[http://dx.doi.org/10.1080/030097401316909602] [PMID: 11578021]
[13]
Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee--a randomized double blind placebo controlled trial. Phytomedicine 2003; 10(1): 3-7.
[http://dx.doi.org/10.1078/094471103321648593] [PMID: 12622457]
[14]
Grube B, Grünwald J, Krug L, Staiger C. Efficacy of a comfrey root (Symphyti offic. radix) extract ointment in the treatment of patients with painful osteoarthritis of the knee: results of a double-blind, randomised, bicenter, placebo-controlled trial. Phytomedicine 2007; 14(1): 2-10.
[http://dx.doi.org/10.1016/j.phymed.2006.11.006] [PMID: 17169543]
[15]
Oben J, Enonchong E, Kothari S, Chambliss W, Garrison R, Dolnick D. Phellodendron and Citrus extracts benefit joint health in osteoarthritis patients: a pilot, double-blind, placebo-controlled study. Nutr J 2009; 8(1): 38.
[http://dx.doi.org/10.1186/1475-2891-8-38] [PMID: 19682376]
[16]
Myers SP, O’Connor J, Fitton JH, et al. A combined phase I and II open label study on the effects of a seaweed extract nutrient complex on osteoarthritis. Biologics 2010; 4: 33-44.
[http://dx.doi.org/10.2147/BTT.S8354] [PMID: 20376172]
[17]
Kuptniratsaikul V, Pinthong T, Bunjob M, Thanakhumtorn S, Chinswangwatanakul P, Thamlikitkul V. Efficacy and safety of Derris scandens Benth extracts in patients with knee osteoarthritis. J Altern Complement Med 2011; 17(2): 147-53.
[http://dx.doi.org/10.1089/acm.2010.0213] [PMID: 21309709]
[18]
Farid R, Rezaieyazdi Z, Mirfeizi Z, et al. Oral intake of purple passion fruit peel extract reduces pain and stiffness and improves physical function in adult patients with knee osteoarthritis. Nutr Res 2010; 30(9): 601-6.
[http://dx.doi.org/10.1016/j.nutres.2010.08.010] [PMID: 20934601]
[19]
Pinsornsak P, Niempoog S. The efficacy of Curcuma Longa L. extract as an adjuvant therapy in primary knee osteoarthritis: a randomized control trial. J Med Assoc Thai 2012; 95(Suppl. 1): S51-8.
[PMID: 23964444]
[20]
Madhu K, Chanda K, Saji MJ. Safety and efficacy of Curcuma longa extract in the treatment of painful knee osteoarthritis: a randomized placebo-controlled trial. Inflammopharmacology 2013; 21(2): 129-36.
[http://dx.doi.org/10.1007/s10787-012-0163-3] [PMID: 23242572]
[21]
Panahi Y, Rahimnia AR, Sharafi M, Alishiri G, Saburi A, Sahebkar A. Curcuminoid treatment for knee osteoarthritis: a randomized double-blind placebo-controlled trial. Phytother Res 2014; 28(11): 1625-31.
[http://dx.doi.org/10.1002/ptr.5174] [PMID: 24853120]
[22]
Srivastava S, Saksena AK, Khattri S, Kumar S, Dagur RS. Curcuma longa extract reduces inflammatory and oxidative stress biomarkers in osteoarthritis of knee: a four-month, double-blind, randomized, placebo-controlled trial. Inflammopharmacology 2016; 24(6): 377-88.
[http://dx.doi.org/10.1007/s10787-016-0289-9] [PMID: 27761693]
[23]
Kuptniratsaikul V, Dajpratham P, Taechaarpornkul W, et al. Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study. Clin Interv Aging 2014; 9: 451-8.
[http://dx.doi.org/10.2147/CIA.S58535] [PMID: 24672232]
[24]
Niempoog S, Pawa KK, Amatyakul C. The efficacy of powdered ginger in osteoarthritis of the knee. J Med Assoc Thai 2012; 95(Suppl. 1): S59-64.
[PMID: 23964445]
[25]
Eftekhar Sadat B, Khadem Haghighian M, Alipoor B, Malek Mahdavi A, Asghari Jafarabadi M, Moghaddam A. Effects of sesame seed supplementation on clinical signs and symptoms in patients with knee osteoarthritis. Int J Rheum Dis 2013; 16(5): 578-82.
[http://dx.doi.org/10.1111/1756-185X.12133] [PMID: 24164846]
[26]
Christensen R, Tarp S, Altman RD, Henriksen M, Bartels EM, Klokker L, et al. Comparing different preparations and doses of rosehip powder in patients with osteoarthritis of the knee: an exploratory randomized active-controlled trial. Int J Clin Rheumatol 2014; 9(3): 267.
[http://dx.doi.org/10.2217/ijr.14.13]
[27]
Nikniaz Z, Ostadrahimi A, Mahdavi R, Ebrahimi AA, Nikniaz L. Effects of Elaeagnus angustifolia L. supplementation on serum levels of inflammatory cytokines and matrix metalloproteinases in females with knee osteoarthritis. Complement Ther Med 2014; 22(5): 864-9.
[http://dx.doi.org/10.1016/j.ctim.2014.07.004] [PMID: 25440377]
[28]
Panahi Y, Alishiri GH, Bayat N, Hosseini SM, Sahebkar A. Efficacy of Elaeagnus Angustifolia extract in the treatment of knee osteoarthritis: a randomized controlled trial. EXCLI J 2016; 15: 203-10.
[PMID: 27330526]
[29]
Connelly AE, Tucker AJ, Tulk H, et al. High-rosmarinic acid spearmint tea in the management of knee osteoarthritis symptoms. J Med Food 2014; 17(12): 1361-7.
[http://dx.doi.org/10.1089/jmf.2013.0189] [PMID: 25058311]
[30]
Abolhassanzadeh Z, Aflaki E, Yousefi G, Mohagheghzadeh A. Randomized clinical trial of peganum oil for knee osteoarthritis. J Evid Based Complementary Altern Med 2015; 20(2): 126-31.
[http://dx.doi.org/10.1177/2156587214566867] [PMID: 25654976]
[31]
Kooshki A, Forouzan R, Rakhshani MH, Mohammadi M. Effect of Topical Application of Nigella Sativa Oil and Oral Acetaminophen on Pain in Elderly with Knee Osteoarthritis: A Crossover Clinical Trial. Electron Physician 2016; 8(11): 3193-7.
[http://dx.doi.org/10.19082/3193] [PMID: 28344755]
[32]
Salimzadeh A, Ghourchian A, Choopani R, Hajimehdipoor H, Kamalinejad M, Abolhasani M. Effect of an orally formulated processed black cumin, from Iranian traditional medicine pharmacopoeia, in relieving symptoms of knee osteoarthritis: A prospective, randomized, double-blind and placebo-controlled clinical trial. Int J Rheum Dis 2017; 20(6): 691-701.
[http://dx.doi.org/10.1111/1756-185X.13066] [PMID: 28378356]
[33]
Maghsoumi-Norouzabad L, Alipoor B, Abed R, Eftekhar Sadat B, Mesgari-Abbasi M, Asghari Jafarabadi M. Effects of Arctium lappa L. (Burdock) root tea on inflammatory status and oxidative stress in patients with knee osteoarthritis. Int J Rheum Dis 2016; 19(3): 255-61.
[http://dx.doi.org/10.1111/1756-185X.12477] [PMID: 25350500]
[34]
Obregon L. Cat’s claw, Uncaria genus Botanical, chemical and pharmacological studies of Uncaria tomentosa (Willd) DC (Rubiaceae) and Uncaria guianensis (Aubl). Lima: Gmel. Instituto de Fitoterapia Americano 1995.
[35]
Hardin SR. Cat’s claw: an Amazonian vine decreases inflammation in osteoarthritis. Complement Ther Clin Pract 2007; 13(1): 25-8.
[http://dx.doi.org/10.1016/j.ctcp.2006.10.003] [PMID: 17210508]
[36]
Beg AA, Baltimore D. An essential role for NF-kappaB in preventing TNF-α-induced cell death. Science 1996; 274(5288): 782-4.
[http://dx.doi.org/10.1126/science.274.5288.782] [PMID: 8864118]
[37]
Au RY, Al-Talib TK, Au AY, Phan PV, Frondoza CG. Avocado soybean unsaponifiables (ASU) suppress TNF-α, IL-1β, COX-2, iNOS gene expression, and prostaglandin E2 and nitric oxide production in articular chondrocytes and monocyte/macrophages. Osteoarthritis Cartilage 2007; 15(11): 1249-55.
[http://dx.doi.org/10.1016/j.joca.2007.07.009] [PMID: 17845860]
[38]
Maheu E, Mazières B, Valat JP, et al. Symptomatic efficacy of avocado/soybean unsaponifiables in the treatment of osteoarthritis of the knee and hip: a prospective, randomized, double-blind, placebo-controlled, multicenter clinical trial with a six-month treatment period and a two-month followup demonstrating a persistent effect. Arthritis Rheum 1998; 41(1): 81-91.
[http://dx.doi.org/10.1002/1529-0131(199801)41:1<81:AID-ART11>3.0.CO;2-9] [PMID: 9433873]
[39]
Sengupta K, Kolla JN, Krishnaraju AV, et al. Cellular and molecular mechanisms of anti-inflammatory effect of Aflapin: a novel Boswellia serrata extract. Mol Cell Biochem 2011; 354(1-2): 189-97.
[http://dx.doi.org/10.1007/s11010-011-0818-1] [PMID: 21479939]
[40]
Gokaraju GR, Gokaraju RR, Gottumukkala VS, Golakoti T, Pratha S. Process for producing a fraction enriched up to 100% of 3-Oacetyl- 11-keto-beta-boswellic acid from an extract containing a mixture of boswellic acids. Google Patents 2013.
[41]
Predel H-G, Giannetti B, Koll R, Bulitta M, Staiger C. Efficacy of a comfrey root extract ointment in comparison to a diclofenac gel in the treatment of ankle distortions: results of an observer-blind, randomized, multicenter study. Phytomedicine 2005; 12(10): 707-14.
[http://dx.doi.org/10.1016/j.phymed.2005.06.001] [PMID: 16323288]
[42]
Koll R, Buhr M, Dieter R, et al. Efficacy and tolerance of a comfrey root extract (Extr. Rad. Symphyti) in the treatment of ankle distorsions: results of a multicenter, randomized, placebo-controlled, double-blind study. Phytomedicine 2004; 11(6): 470-7.
[http://dx.doi.org/10.1016/j.phymed.2004.02.001] [PMID: 15500257]
[43]
Giannetti BM, Staiger C, Bulitta M, Predel H-G. Efficacy and safety of comfrey root extract ointment in the treatment of acute upper or lower back pain: results of a double-blind, randomised, placebo controlled, multicentre trial. Br J Sports Med 2010; 44(9): 637-41.
[http://dx.doi.org/10.1136/bjsm.2009.058677] [PMID: 19460762]
[44]
Lee D-U, Kang YJ, Park MK, et al. Effects of 13-alkyl-substituted berberine alkaloids on the expression of COX-II, TNF-α, iNOS, and IL-12 production in LPS-stimulated macrophages. Life Sci 2003; 73(11): 1401-12.
[http://dx.doi.org/10.1016/S0024-3205(03)00435-1] [PMID: 12850501]
[45]
Lee YS, Kim WS, Kim KH, et al. Berberine, a natural plant product, activates AMP-activated protein kinase with beneficial metabolic effects in diabetic and insulin-resistant states. Diabetes 2006; 55(8): 2256-64.
[http://dx.doi.org/10.2337/db06-0006] [PMID: 16873688]
[46]
Li RW, Theriault AG, Au K, et al. Citrus polymethoxylated flavones improve lipid and glucose homeostasis and modulate adipocytokines in fructose-induced insulin resistant hamsters. Life Sci 2006; 79(4): 365-73.
[http://dx.doi.org/10.1016/j.lfs.2006.01.023] [PMID: 16497336]
[47]
Ritter LS, Copeland JG, McDonagh PF. Fucoidin reduces coronary microvascular leukocyte accumulation early in reperfusion. Ann Thorac Surg 1998; 66(6): 2063-71.
[http://dx.doi.org/10.1016/S0003-4975(98)00823-6] [PMID: 9930494]
[48]
Veena CK, Josephine A, Preetha SP, Varalakshmi P. Physico-chemical alterations of urine in experimental hyperoxaluria: a biochemical approach with fucoidan. J Pharm Pharmacol 2007; 59(3): 419-27.
[http://dx.doi.org/10.1211/jpp.59.3.0012] [PMID: 17331346]
[49]
Machelska H, Cabot PJ, Mousa SA, Zhang Q, Stein C. Pain control in inflammation governed by selectins. Nat Med 1998; 4(12): 1425-8.
[http://dx.doi.org/10.1038/4017] [PMID: 9846582]
[50]
Muanwongyathi P, Supatwanich P. Pharmacognostic study of Derris scandens Benth. Mahidol University J Pharmaceutical Science 1981; pp. 57-64.
[51]
Laupattarakasem P, Houghton PJ, Hoult JRS. Anti-inflammatory isoflavonoids from the stems of Derris scandens. Planta Med 2004; 70(6): 496-501.
[http://dx.doi.org/10.1055/s-2004-827147] [PMID: 15229800]
[52]
Srimongkol Y, Warachit P, Chavalittumrong P, Sriwanthana B, Pairour R, Inthep C, et al. A study of the efficacy of Derris scandens (Roxb.) Benth. extract compared with diclofenac for the alleviation of low back pain. Journal of Thai Traditional & Alternative Medicine 2007; 5(1): 17-23.
[53]
Watson RR, Zibadi S, Rafatpanah H, et al. Oral administration of the purple passion fruit peel extract reduces wheeze and cough and improves shortness of breath in adults with asthma. Nutr Res 2008; 28(3): 166-71.
[http://dx.doi.org/10.1016/j.nutres.2008.01.003] [PMID: 19083404]
[54]
Arjmandi BH, Khalil DA, Lucas EA, et al. Soy protein may alleviate osteoarthritis symptoms. Phytomedicine 2004; 11(7-8): 567-75.
[http://dx.doi.org/10.1016/j.phymed.2003.11.001] [PMID: 15636169]
[55]
Zibadi S, Farid R, Moriguchi S, Lu Y, Foo LY, Tehrani PM, et al. Oral administration of purple passion fruit peel extract attenuates blood pressure in female spontaneously hypertensive rats and humans. Nutr Res 2007; 27(7): 408-16.
[http://dx.doi.org/10.1016/j.nutres.2007.05.004]
[56]
Ruby AJ, Kuttan G, Babu KD, Rajasekharan KN, Kuttan R. Anti-tumour and antioxidant activity of natural curcuminoids. Cancer Lett 1995; 94(1): 79-83.
[http://dx.doi.org/10.1016/0304-3835(95)03827-J] [PMID: 7621448]
[57]
Aggarwal S, Ichikawa H, Takada Y, Sandur SK, Shishodia S, Aggarwal BB. Curcumin (diferuloylmethane) down-regulates expression of cell proliferation and antiapoptotic and metastatic gene products through suppression of IkappaBalpha kinase and Akt activation. Mol Pharmacol 2006; 69(1): 195-206.
[http://dx.doi.org/10.1124/mol.105.017400] [PMID: 16219905]
[58]
Ali BH, Marrif H, Noureldayem SA, Bakheit AO, Blundene G. Some biological properties of curcumin: A review. Nat Prod Commun 2006; 1(6): 509-21.
[http://dx.doi.org/10.1177/1934578X0600100613]
[59]
Sutipornpalangkul W, Morales NP, Charoencholvanich K, Harnroongroj T. Lipid peroxidation, glutathione, vitamin E, and antioxidant enzymes in synovial fluid from patients with osteoarthritis. Int J Rheum Dis 2009; 12(4): 324-8.
[http://dx.doi.org/10.1111/j.1756-185X.2009.01430.x] [PMID: 20374370]
[60]
Grant KL, Lutz RB. Ginger. Am J Health Syst Pharm 2000; 57(10): 945-7.
[http://dx.doi.org/10.1093/ajhp/57.10.945] [PMID: 10832493]
[61]
Connell D, Sutherland M. A re-examination of gingerol, shogaol, and zingerone, the pungent principles of ginger (Zingiber officinale Roscoe). Aust J Chem 1969; 22(5): 1033-43.
[http://dx.doi.org/10.1071/CH9691033]
[62]
Nurtjahja-Tjendraputra E, Ammit AJ, Roufogalis BD, Tran VH, Duke CC. Effective anti-platelet and COX-1 enzyme inhibitors from pungent constituents of ginger. Thromb Res 2003; 111(4-5): 259-65.
[http://dx.doi.org/10.1016/j.thromres.2003.09.009] [PMID: 14693173]
[63]
Rondanelli M, Riva A, Morazzoni P, et al. The effect and safety of highly standardized Ginger (Zingiber officinale) and Echinacea (Echinacea angustifolia) extract supplementation on inflammation and chronic pain in NSAIDs poor responders. A pilot study in subjects with knee arthrosis. Nat Prod Res 2017; 31(11): 1309-13.
[http://dx.doi.org/10.1080/14786419.2016.1236097] [PMID: 27737573]
[64]
Christensen R, Bartels EM, Altman RD, Astrup A, Bliddal H. Does the hip powder of Rosa canina (rosehip) reduce pain in osteoarthritis patients?--a meta-analysis of randomized controlled trials. Osteoarthritis Cartilage 2008; 16(9): 965-72.
[http://dx.doi.org/10.1016/j.joca.2008.03.001] [PMID: 18407528]
[65]
Larsen E, Kharazmi A, Christensen LP, Christensen SB. An antiinflammatory galactolipid from rose hip (Rosa canina) that inhibits chemotaxis of human peripheral blood neutrophils in vitro. J Nat Prod 2003; 66(7): 994-5.
[http://dx.doi.org/10.1021/np0300636] [PMID: 12880322]
[66]
Ahmadiani A, Hosseiny J, Semnanian S, et al. Antinociceptive and anti-inflammatory effects of Elaeagnus angustifolia fruit extract. J Ethnopharmacol 2000; 72(1-2): 287-92.
[http://dx.doi.org/10.1016/S0378-8741(00)00222-1] [PMID: 10967484]
[67]
Farahbakhsh S, Arbabian S, Emami F, et al. Inhibition of cyclooxygenase type 1 and 2 enzyme by aqueous extract of Elaeagnus angustifolia in mice. Basic Clin Neurosci 2011; 2(2): 31-7.
[68]
Petersen M, Simmonds MS. Rosmarinic acid. Phytochemistry 2003; 62(2): 121-5.
[http://dx.doi.org/10.1016/S0031-9422(02)00513-7] [PMID: 12482446]
[69]
Pearson W, Fletcher RS, Kott LS. Oral rosmarinic acid-enhanced Mentha spicata modulates synovial fluid biomarkers of inflammation in horses challenged with intra-articular LPS. J Vet Pharmacol Ther 2012; 35(5): 495-502.
[http://dx.doi.org/10.1111/j.1365-2885.2011.01343.x] [PMID: 22070392]
[70]
Farouk L, Laroubi A, Aboufatima R, Benharref A, Chait A. Evaluation of the analgesic effect of alkaloid extract of Peganum harmala L.: possible mechanisms involved. J Ethnopharmacol 2008; 115(3): 449-54.
[http://dx.doi.org/10.1016/j.jep.2007.10.014] [PMID: 18054186]
[71]
Adams M, Berset C, Kessler M, Hamburger M. Medicinal herbs for the treatment of rheumatic disorders--a survey of European herbals from the 16th and 17th century. J Ethnopharmacol 2009; 121(3): 343-59.
[http://dx.doi.org/10.1016/j.jep.2008.11.010] [PMID: 19063957]
[72]
Ali BH, Blunden G. Pharmacological and toxicological properties of Nigella sativa. Phytother Res 2003; 17(4): 299-305.
[http://dx.doi.org/10.1002/ptr.1309] [PMID: 12722128]
[73]
Ramadan MF. Nutritional value, functional properties and nutraceutical applications of black cumin (Nigella sativa L.): an overview. Int J Food Sci Technol 2007; 42(10): 1208-18.
[http://dx.doi.org/10.1111/j.1365-2621.2006.01417.x]
[74]
Wu J-G, Wu J-Z, Sun L-N, et al. Ameliorative effects of arctiin from Arctium lappa on experimental glomerulonephritis in rats. Phytomedicine 2009; 16(11): 1033-41.
[http://dx.doi.org/10.1016/j.phymed.2009.04.005] [PMID: 19524415]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 15
ISSUE: 4
Year: 2019
Page: [290 - 303]
Pages: 14
DOI: 10.2174/1573397115666190328150203
Price: $58

Article Metrics

PDF: 24
HTML: 3
EPUB: 1
PRC: 2

Special-new-year-discount