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Curcuma: Turmeric

by Jill Hoppe, Clinical Herbalist

Medical Herbalism 11(4):1,3-5

Curcuma longa (turmeric) is a perennial herb of the Zingiberaceae (ginger) family that has been revered as a food and medicine for thousands of years. Having a long history of use for its anti-inflammatory effects, turmeric is an herb of major importance in the East and has been used extensively in the Indian (both Ayurveda and Unani Tibb) and Chinese systems of medicine. Turmeric is cultivated in many parts of the world, but India produces most of the world’s supply. Curcuma longa is the most popular species of turmeric grown in India. Turmeric is widely used as a condiment in Indian curries and prepared mustard and its powerful antioxidant actions assist in preserving the freshness of food by preventing oxidation. The part used in commerce is the cured (boiled, cleaned, sun dried and polished) rhizome.

Indian Materia Medica

Part Used: Tubers and rhizomes

Preparations: Powder, paste, ointment, oil, lotion, inhalant, confection

Actions: Aromatic, stimulant, tonic, carminative, anthelmintic

Uses:

Internally used as an antiparasitic.

Used for jaundice and other liver afflictions.

Root used for intermittent fevers.

1000-1300 mg. twice daily for flatulence, dyspepsia and weak state of the stomach.

Internally and externally for skin diseases due to blood impurity.

A paste applied hot to sprains, bruises, wounds and inflammatory troubles of the joints.

Juice of the fresh rhizome applied to wounds, bruises and leech-bites.

A thin paste applied to facilitate the scabbing process in chickenpox.

A decoction (1 ounce of the bruised root to 20 ounces of water) applied as a lotion to relieve burning in catarrhal and purulent opthalmia conjunctivitis and other eye inflammations. A piece of cloth soaked in the decoction, and placed over the afflicted eye, relieves the symptoms.

Sprinkled on ulcers to stimulate them to healthy action.

Mixed with ghee to relieve cough.

A paste, alone or in combination with the pulp of neem leaves, used in ringworm, obstinate itching, eczema and parasitic skin diseases.

An ointment of turmeric, hemp leaves, onions and warm mustard or linseed oil for painful and protruding hemorrhoids, and for eczema and other itchy conditions.

A thick coating of mustard oil, dusted with turmeric, is applied for shingles.

Sprinkled over burning charcoal for scorpion stings, with the smoke applied to the affected part for a few minutes.

With alum powder in proportion of 1 part turmeric to 20 parts alum, blown into the ear for inflammation of the ear with discharge.

Internally for urinary tract diseases.

A good digestive compound powder: equal parts turmeric, long pepper, ginger, cardamom, with ½ part black pepper.

(Nadkarni)

Chinese Medicine

In Chinese Medicine, turmeric is considered an herb that invigorates the Blood. This class of herbs may be used to treat pain, abscesses and ulcers, and abdominal masses. In Chinese Medicine, the rhizome and tuber are distinguished as decribed in the box on page three..

Clinical Trials

Most research has taken place in India and has focused upon turmeric’s active curcuminoids (the most well known being curcumin) and volatile oil. The curcuminoids are an important class of antioxidant and anti-inflammatory constituents and are responsible for turmeric’s vibrant yellow color. Turmeric has been investigated for its anti-inflammatory, antibacterial, antiparasitic, choleretic, antiviral, antiplatelet, analgesic, antioxidant, anticancer, antihepatotoxic and antitumor effects. Most investigations have been in vitro and vivo. Some of the human clinical trials have studied its ability to influence the secretion of bile (Ammon), gallbladder contraction (Rasyid), effects against inflammation (Satoskar), anti-rheumatic activity (Deodhar) ability to reduce cholesterol and lipid peroxides (Soni), and cancer-protective effects in chronic smokers (Polasa). Turmeric is useful for treating pain and inflammation for people coming off non-steroidal anti-inflammatory drugs (NSAIDs), particularly in combination with other anti- inflammatories such as Ananas sativas (bromelain, a proteolytic enzyme from the stem of the pineapple) and bioflavonoids such as quercetin (high in onions, evening primrose leaf). See Case Study. In human clinical trials the constituent curcumin has been shown as effective as NSAIDs, without the side effects. In one double-blind study, 45 patients aged 15-68 received either 400 mg. curcumin, placebo, or 100 mg. of the NSAID phenylbutazone three times daily for six days following inguinal hernia and/or hydrocele (accumulation of fluid in scrotum or spermatic cord) surgery. Patients receiving the drug or curcumin produced a significantly greater anti-inflammatory response than placebo, and only curcumin reduced spermatic cord edema and cord tenderness significantly (Satoskar). In another double-blind study, patients were administered 1,200 mg. curcumin or 300 mg. phenylbutazone daily. Improvements in the duration of morning stiffness, walking time, and joint swelling were comparable in both groups (Deodhar). Although the mechanism of action is not fully understood, turmeric’s anti-inflammatory actions are thought due to its ability as an antioxidant to quench free radicals, hindering tissue degeneration and its ability to inhibit the arachidonic acid (AA) cascade. The AA cascade is a pathway in fatty acid metabolism that builds the pro-inflammatory series 2 prostaglandins (PGE2s). Curcumin has been shown to be a dual inhibitor of AA metabolism since it inhibits both the enzymes lipogenase and cycloxygenase (Ammon, Safayhi). The activity of lipogenase is required to transform AA to leukotrienes (triggers for the inflammatory process). Vitamin E, eicosapentaenoic acid (EPA), onion, garlic and Boswellia serata (boswellin) have also been shown to inhibit lipogenase. Cyclooxygenase is required to transform arachidonic acid to the series 2 prostaglandins and series 2 thromboxanes. Curcumin was shown to inhibit the activity of cyclooxygenase-2 (COX-2) in several gastrointestinal cell lines (Zhang). Two isoforms of cyclooxygenase are cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). COX-1 is involved in metabolic activities such as maintaining stomach lining integrity, regulating blood flow within the kidneys and balancing platelet function and is produced widely throughout the body. COX-2 is produced in response to tissue injury and plays a role in inflammation, infections, and cellular proliferation (Feldman). Most NSAIDs inhibit both COX-1 and COX-2 and studies have proposed COX-1 inhibition is the reason that long-term NSAID use leads to gastric ulcerations and perforations in 10 – 20% of patients using these drugs (Lichtenstein). The new NSAID celebrex (celecoxib) appears to inhibit COX-2 selectively, with less inhibition of COX-1. A recent meta-analysis showed that celebrex caused ulcers at only about one-third to one-half the rate of other NSAIDs (Silverstein). The lower rate is about the same as the rate of ulcers in the general population not taking NSAID according to an editorial in the Journal of the American Medical Association (Lichtenstein). Curcumin has also been compared to an NSAID for ulcerogenic potential in an animal study, where it had about one-third the ulcerogenic index score compared to phenylbutazone (Srimal). In another animal trial, curcumin protected against ulcer formation induced by phenylbutazone (Bhatia).

General Dosage

Ground turmeric rhizome: 1 teaspoon blended in water or juice up to four times daily (approximately 10 grams)

Standardized turmeric extract containing 400 – 600 mg curcumin three times daily (typically standardized to 95% curcuminoids)

Tincture: 1 – 1½ teaspoon three times daily (dried rhizome 1:5, 50% alcohol)

Side Effects

 According to the German Commission E, turmeric is contraindicated in persons with obstruction of bile passages. This is most likely due to turmeric’s cholagogue activity. The Botanical Safety Handbook states that use of turmeric should be avoided with bile duct obstruction or gallstones, and should not be administered to people who suffer from stomach ulcers or hyperacidity. It is also contraindicated in pregnancy. High doses should not be given to patients taking antiplatelet or anticoagulant drugs.

Used in the recommended amounts, turmeric is generally considered safe. It has been used in large quantities as a condiment with no adverse reactions.

Table 1

Curcuma: Rhizoma Curcumae (Jiang Huang)

Properties: Acrid, bitter, warm

Channels Entered: The Spleen, Stomach, Liver meridians

Clinical Uses

Invigorates the Blood and promotes menstruation.

Used for chest or abdominal pain, amenorrhea, or dysmenorrhea due to Congealed Blood generated by Deficiency Cold.

Used for pain and swelling from trauma.

Moves Qi and alleviates pain. Used for epigastric and abdominal pain due to Stagnant Qi.

Expels Wind and moves Blood. Used for damp painful obstruction with Congealed Blood, especially in the shoulders.

Stimulates bile secretion and increases detoxifying abilities of the liver.

Used for general pain, arthritis in the shoulders.

Stimulates the uterus, causing it to contract for five to seven hours.

Tuber Curcumae (Yu-Jin)

Properties: Bitter, pungent flavor, cool

Channels entered: The Heart, Lung, and Liver meridians

Clinical Uses

Invigorates the Blood and breaks up Congealed Blood. Used topically and internally for pain related to traumatic injury and to hasten the healing of chronic sores.

Used for chest, abdominal, flank, or menstrual pain from constrained Liver Qi. Used for constrained Liver Qi patterns with heat signs.

Clears the Heart and cools the Blood. Used when hot phlegm obstructs the Heart orifices with symptoms such as anxiety, agitation, seizures, or mental derangement.

Facilitates gallbladder function by promoting the secretion of bile from the liver.

Used for jaundice.

Stimulates gastric secretion, thereby increasing appetite.

Contraindications for rhizome and tuber

When either Stagnant Qi or Congealed Blood are not present

Cases of Deficient Yin from loss of blood

Pregnancy

Dosage for rhizome and tuber

 3 – 9 g

 (Bensky and Gamble; Hsu)

References

Ammon HPT, Wahl MA. Pharmacology of Curcuma longa. Planta Medica 1991;57:1-6

Ammon HP, Safayhi H, Mack T, Sabieraj J. Mechanism of anti-inflammatory actions of curcumine and boswellic acids. Journal of Ethnopharmacology. 1993;38(2-3):113-119

Bensky D, Gamble A, with Kaptchuk T. Chinese Herbal Medicine Materia Medica. Seattle, Washington: Eastland Press, Inc., 1986

Bhatia A, Singh GB, Khanna, NM, Indian Journal of Experimental Biology. 1964;2: 158-160

Blumenthal M. Herbal Medicine Expanded Commission E Monographs. Boston, Massachusetts: Integrative Medicine Communications, 2000

Buhner SH. Herb for Hepatitis C and the Liver. Pownal Vermont: Storey Books, 2000

Deodhar SD, Sethi R, Srimal RC. Preliminary study of antirheumatic activity of curcumin (diferuloyl methane). Indian Journal of Medical Research 1980; 71:632-634

Feldman M, McMahon A. Do Cyclooxygenase-2 Inhibitors Provide Benefits Similar to Those of Traditional Nonsteroidal AntiInflammatory Drugs, with Less Gastrointestinal toxicity? Annals of Internal Medicine. 2000;132(2):134-143

Gerard, J. The Herbal or General History of Plants. New York, New York: Dover Publications, Inc., 1975 (reprinted from the 1633 original)

Hsu HY, Chen Y, Shen S, Hsu C, Chen C, Change H. Oriental Materia Medica. New Canaan, Connecticut: Keats Publishing, 1986

Lichtenstein D, Wolfe M. COX-2 Selective NSAIDs. New and Improved? JAMA. 2000;284(10)

McCaleb R, Leigh E, Morien K. The Encyclopedia of Popular Herbs. Rocklin, California: Prima Publishing, 2000

Mills S., Bone K. Principles and Practice of Phytotherapy. London, England: Churchill Livingstone, 2000

Nadkarni’s KM. Indian Materia Medica. Mumbai, India: Popular Prakashan Private Limited, 1999

Pizzorno J. Total Wellness. Rocklin, California: Prima Publishing, 1998

Polasa K, Raghuram TC, Krishna TP, Krishnaswamy K. Effect of turmeric on urinary mutagens in smokers. Mutagenesis 1992;2:107-109

Ramirez-Bosc A, Soler A, Gutierrez MAC, et al. Antioxidant Curcuma extracts decrease the blood lipid peroxide levels of human subjects. Age 1995; 18:167-16

Rasyid A, Lelo A. The effect of curcumin and placebo on human gall-bladder function: an ultrasound study. Ailment Pharmacological Therapy 1999; 13(2): 245-249

Satoskar RR, Shah SJ, Shenoy SG. Evaluation of anti-inflammatory property of curcumin (diferuloyl methane) in patients with postoperative inflammation. International Journal of Clinical Pharmacology, Therapy and Toxicology 1986; 24(12):651-654

Silverstein FE, Faich G, Golsdstein JL, Simon LS, et al. Gastrointestinal Toxicity With Celecoxib vs Nonsteroidal Anti-inflammatory Drugs for Osteoarthritis and Rheumatoid Arthritis: The CLASS Study: A Randomized Controlled Trial. JAMA 2000; 284(10):1247-1255

Soni KB, Kuttan R. Effect of oral curcumin administration on serum peroxides and cholesterol levels in human volunteers. Indian Journal of Physiology and Pharmacology 1992;36(4):273-275

Srimal RC, Dhawan BN. Journal Pharm Pharmacology 1973; 25(6)447-452 Cited in: Mills S., Bone, K,

Werbach M, Murray M. Botanical Influences on Illness A Sourcebook of Clinical Research. Tarzana, California: Third Line Press, Inc., 2000