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Herbal Alternative Medicine

TERJEMAH KEBAHASA MALAYSIA KLIK SINI

 
Introduction

For thousands of years, human being has been using plants, herbs and spices to survive and maintain good health.  It is the most natural, sensible and greatly beneficial way of life. In the Asian tradition, the Chinese, Indian and Malays have been using mixtures of herbs in herbal tea, drink, soup and dishes

 

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Nutritional support for wound healing

Healing of wounds, whether from accidental injury or surgical intervention, involves the activity of an intricate network of blood cells, tissue types, cytokines, and growth factors. This results in increased cellular activity, which causes an intensified metabolic demand for nutrients.  Nutritional deficiencies can impede wound healing, and several nutritional factors required for wound repair may improve healing time and wound outcome. Vitamin A is required for epithelial and bone formation, cellular differentiation, and immune function.

Vitamin C is necessary for collagen formation, proper immune function, and as a tissue antioxidant Vitamin E is the major lipid-soluble antioxidant in the skin; however, the effect of vitamin E on surgical wounds is inconclusive. Bromelain reduces edema, bruising, pain, and healing time following trauma and surgical procedures. Glucosamine appears to be the rate-limiting substrate for hyaluronic acid production in the wound. Adequate dietary protein is absolutely essential for proper, wound healing, and tissue levels of the amino acids arginine and glutamine may influence wound repair and immune function. The botanical medicines Centella asiatica and Aloe vera have been used for decades, both topically and internally, to enhance wound repair, and scientific studies are now beginning to validate efficacy and explore mechanisms of action for these botanicals To promote wound healing in

the shortest time possible, with minimal pain, discomfort, and scarring to the patient, it is important to explore nutritional and botanical influences on wound outcome.

Experimental protein depletion in animals caused a decrease in the tensile strength of wounds. Rats fed a diet deficient in protein exhibited decreased wound integrity and strength versus control animals." In a study of 108 human patients with experimental wounds, individuals with either low serum protein or serum albumin had significantly weaker wounds than those with normal protein values.

Protein calorie malnutrition increases morbidity and mortality in the surgical/trauma patient. Many studies have found hospitalized patients in a state of malnutrition at admission. Thus, it is Important to increase protein intake to optimize healing and immune function, and to prevent post-surgical complications in these individual

Protein supplementation of elderly patients with liquid protein formulas significantly enhanced healing of pressure ulcers. The change in ulcer area was significantly correlated with the amount of protein in the diet.

The surgical or trauma patient exists in a state of metabolic stress, with the severity of the stress depending on the severity of the wounded state. An injured patient requires more protein than a non-injured patient because of the increased metabolic activity of wound healing, acute-phase protein production in response to stress, and amino acid mobilization from muscle used for hepatic gluconeogenesis.

In a non-injured state, adults require approximately 0.8 g dietary protein/kg body wt/day. Elderly patients have a higher protein requirement (I - 1.2 g/kg body wt day) due to a decreased ability to synthesize proteins. The surgical/trauma patient can require significantly more protein. Minor surgery may not significantly increase the protein requirement; however, if the patient is already protein malnourished, wound healing will be adversely affected unless dietary protein intake is increased. Major surgery can increase protein requirements 10 percent, while a patient with multiple traumas may need 75-percent more protein. Bum wounds cause tremendous metabolic stress and have the greatest impact on protein requirements increasing protein need 75-100 percent.

Amino Acids in Wound Healing

It is well accepted that sufficient protein is necessary for wound healing. This appears to be due to the increased overall protein n need for tissue regeneration and repair. Researchers have investigated the effects of specific amino acids on the healing process and determined that arginine and glutamine appear to be necessary for proper wound healing.

Arginine

Arginine is a nonessential amino acid that plays a key role In protein and amino acid syhthesis It is acquired from the diet and derived endogenously from citrulline in a reaction catalyzed by the enzyme arginine synthetase. Adequate tissue arginine appears to be essential for efficient wound repair and immune function."

Arginine (17 g/day) was given to 30 elderly patients (>65 years of age) Who Sustained an experimental surgical injury. Supplernented patients demonstrated significantly greater hydroxyproline (a sign of collagen deposition) and protein accumulation at the wound site, compared to non-supplemented controls. Lymphocyte response, signifying greater immune activity, was elevated in the supplemented group, as was insulin-like growth factor-1, which is a control molecule for wound repair." Other studies have found similar results.

Glutamine

Glutamine is used by inflammatory cells within the wound for proliferation and as a source of energy. Fibroblasts use glutamine for these same purposes, as well as for protein and nucleic acid synthesis. Because optimal functioning of these cells is paramount to the healing process, glutamine is a necessary component of the process of tissue repair. Glutamine is a non-essential amino acid that can become a "conditionally essential” amino acid in certain circumstances including tissue injury. Glutamine is released from skeletal muscle following injury or surgery, which can cause a relative deficiency of glutamine in skeletal muscle and the gut, as intestinal uptake is frequently diminished as well.

Studies utilizing oral glutamine pre and psot-surgery, and in burn patients, have shown mixed results.  Oral feeding of glutamine in surgery patients did not affect plasma glutamine in surgery patients as an alanine-glutamine dipeptide showed consistently better post-operative results, as seen by significantly decreased length of hospital stays (average of four days or less).  A significantly smaller incidence of pneumonia, bacteremia, and sepsis was noted in patients with multiple trauma given enteral glutamine feedings.  Whether glutamine supplementation will enhance wound healing in less severely injured individuals is not known.

A mixture of arginine (14g/day), glutamine (14g/day), and beta-hydroxy-beta methylbutyrate (HMB) (3g/day) was given to 18 elderly (>70 years) individuals who then underwent experimental implantation of sterile polytetrafluoroethylene tubes that could later be excised and studied for fibroblastic migration and collagen deposition.  Supplementation with this mixture resulted in significantly greater wound collagen deposition than in 17 controls not supplemented.

Botanical Medicines in Wound Healing

Centella asiatica and Aloe vera

Centella asiatica and Aloe vera have been used for decades as folk remedies for burns, wounds, and scars.  Improved wound healing has been reported from topical or internal application of these two botanical medicines.  Continued use of these plants as healing agents has led to scientific investigation of their efficacy as wound healing agents.

Centella asiatica (gotu kola) has been documented to aid wound healing in several scientific studies.  One of the primary mechanisms of action of Centella appears to be the stimulation of type-1 collagen production.  Animal studies have consistently shown topical application of Centella asiatica to a sutured wound significantly increased the breaking strength of the wound. 

 

 

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