Chinese herbal remedies
Kangfuxin
Kang fu xin is a pure Chinese herbal medicine extracted from Periplaneta Americana (the American cockroach) and is used in the treatment of several ulcerative conditions. The key components of Kangfuxin are polyhydric alcohols, peptides, mucin, amino acids and other active substances. Kangfuxin improves the gastrointestinal mucosa microcirculation, promotes the growth of granulation tissue and angiogenesis, it accelerates shedding of necrotic tissue, therefore expediting the wound or ulcer healing process. This accelerated wound healing process and gastro- protective properties play an important part in the treatment of oral, gastric and duodenal ulcers.28Kangfuxin has also been noted to significantly increase the production of superoxide dismutase which has anti-oxidant and anti-inflammatory properties. 28In addition, its anti-inflammatory properties not only reduce associated inflammatory edema but also aid in pain reduction. Kangfuxin solution can also be used in the formation of compounded mouth washes, this formulation aids in the management of oral erosions and ulcers caused by paraquat ingestion. 29We recognized two clinical trials that used Kangfuxin in the management of paraquat induced oral mucositis. Both studies used Kangfuxin for oral care prior to the application of the other intervention. 18 28 All two trials reported positive outcomes in terms of reduction in oral mucositis severity and improvement of healing time.
Tea oil (Camellia oil)
Tea oil also known as camellia oil or camellia seed oil is natural herbal oil extracted from Camellia oleifera Abel. It has been used through history mainly because of its anti-inflammatory and anti-oxidant properties. Squalene, polyphenols and flavonoids present in camellia oil have good bactericidal and anti-inflammatory effects, these effects ward of secondary infections and also aid in the reduction of associated pain. 30 31 32The protective properties of camellia oil in relation to its antioxidant activity help neutralize the excessive production of Reactive Oxygen Species and ulcerative destruction of the already compromised mucosa after the ingestion of paraquat. One clinical trial was recognized. The clinical trial used tea oil as one of the ingredients in a compounded paste preparation. 20 mls of tea oil was used in the preparation and the paste was used 3-5 times a day. The control group only received oral care using qingkou gargle. The results of this randomized study showed significant difference for average number of days to mucositis resolution or pain scores. 25
MEBO (moist exposed burn ointment)
MEBO is an herbal formulation containing b-sitosterol, baicalin, and berberine as active ingredients in a base of beeswax and sesame oil.33 MEBO not only has analgesic and antimicrobial effects but also has been noted to promote the formation of granulation tissue and therefore shorten the healing duration of ulcers and wounds. It increases gene expression of vascular endothelial growth factor and basic fibroblast growth factor (bFGF), which help in the regulation of angiogenesis and tissue repair. 2834 35 It can be directly applied on the surfaces of the oral ulcers induced by paraquat or prepared into a compounded formulation. One clinical trial used kangfuxin and MEBO for the management of oral mucositis. The treatment group used Kangfuxin for oral care prior to the application of MEBO that was used to adequately cover the oral mucosa 3 times/day. The control group only used Kangfuxin for oral care. MEBO proved to be effective alternative in the treatment of paraquat induced oral mucositis.28
Colloidal silver (yin er tong/ activated ionized silver)
Silver and is a non-antibiotic antibacterial agent that has been used through history for its antimicrobial effects. 36Through time, its use diminished after the discovery of penicillin and other antibiotics. With the rising cases of antibiotic resistance, the use of silver and other non-antibiotic antibacterial treatments have been on the rise as an alternative for antimicrobial coverage.37Colloidal silver, silver nanoparticles and ionized silver, exhibit a broad-spectrum antimicrobial capability against many micro-organisms (gram-positive bacteria, gram-negative bacteria, fungi and rhinovirus). 38 39 The effectiveness of silver’s broad-spectrum antimicrobial capability is attributed to ability of the silver ions in binding non-specifically to many different targets, thus affecting bacteria in many components of their metabolism and structure.94 One clinical trial used yin er tong in conjunction with other interventions in the management of oral mucositis. The treatment group received yin er tong, recombinant human epidermal growth factor, Kangfuxin and Vit C, while the control group received conservative management for their symptoms. The patients were asked to gargle with 10 mls of yin er tong for 3-5 minutes for approximately 3 times a day. The treatment group was more effective in terms of pain reduction and severity of oral mucositis.18