Frankincense, Indian
Boswellia serrata Roxb. Family: Burseraceae
Indian frankincense tree , “ salai guggal ” (term for the gum resin of the tree)
 
Clinical Overview
Uses
The extract of Indian frankincense tree has anti-inflammatory activity. Boswellic acids may play a role in preventing formation of anaphylatoxins during severe acute allergic reactions.

Dosing
An extract of frankincense (H15) was studied in arthritis at a dose of 3.6 g daily. The gum resin of frankincense has been used at a daily dose of 900 mg for bronchial asthma.

Contraindications
Contraindications have not yet been identified.

Pregnancy/Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions
None well documented.

Adverse Reactions
Although data are limited, no side effects have been reported that necessitated stopping treatment.

Toxicology
No data.

 
Botany
The Burseraceae family of trees and shrubs has 18 genera and 540 species that grow mostly in tropical regions of America, North Africa, and Arabia. Most species contain resin ducts in the bark, which yield the products myrrh and frankincense. 1 The Boswellia serrata tree grows on dry hilly areas throughout most of India. When the bark is cut, the “aromatic balsam” or “gum resin” oozes out and is used for medicinal purposes. 2
 
History
The Indian frankincense tree is related to the tree that brought forth the frankincense given as a gift to baby Jesus by the wise men. Ayurvedic medicine has been practiced in India for thousands of years, using different parts of the tree for asthma, rheumatism, dysentery, skin ailments, ulcers, blood purification, bronchial conditions, and wound treatment. 2,  Frankincense also is used to perfume clothes, hair, and rooms. It is enjoyed at traditional festivities such as weddings or religious celebrations. 1
 
Chemistry
The gum resin of Boswellia serrata contains the biologically active boswellic acid (3-alpha-hydroxy-urs-12-en-23-oic acid) and its derivatives. 3
  Boswellin (patented product of Sabinsa Corporation ) 2 is the standardized ethanol extract of Boswellia serrata gum resin. It contains 60% to 65% boswellic acids and can be found in health food stores. 2
Isolation and identification of a 4-O-methyl-glucuronoarabinogalactan from Boswellia serrata have been performed. 4
Other compounds found in the gum resin include volatile oils, terpinols, arabinose, xylose, galactose, uronic acids, beta-sitosterin and phlobaphenes. 5
 
Uses and Pharmacology
Anti-inflammatory   Boswellic acids in vitro are specific inhibitors of 5-lipoxygenase, the key enzyme of leukotriene biosynthesis. Leukotrienes are biochemicals in the body that maintain inflammation. Boswellic acids may offer an alternative to corticosteroid and NSAID therapy in treating such inflammatory conditions as arthritis, tendinitis, or bursitis. 2,  , 3
Animal data   Anti-inflammatory activity has been studied in animals. 3,  The plant extract displays marked anti-inflammatory action as well as anti-arthritic activity with no significant side effects in rats. 6,  One report evaluates boswellic acid inhibition on leukotriene synthesis (via 5-lipoxygenase), finding it to have no effect on 12-lipoxygenase, cyclooxygenase, or the peroxidation of arachidonic acid by iron and ascorbate, suggesting the boswellic acid component to be a specific, non-redox inhibitor of leukotriene synthesis. 7,  Similar results were found in rat peritoneal neutrophils. 8,  , 9
Clinical data   A mixture of boswellic acid and its derivatives is used in India to treat arthritis. 3 Boswellia serrata in an herbomineral combination was studied in 42 osteoarthritic patients in a randomized, double blind, placebo controlled crossover study. Pain and disability scores were decreased significantly, but radiological assessment showed no change. 10
Ulcerative colitis, also an inflammatory disease, seems to benefit from Boswellia's ability to inhibit 5-lipoxygenase as well. In patients given Boswellia serrata gum resin preparation (350 mg 3 times daily) for 6 weeks compared with sulfasalazine (1 g 3 times daily), parameters of ulcerative colitis (eg, stool properties, histopathology, rectal biopsies, blood work) were improved. Remission was 82% with the resin and 75% with sulfasalazine. 11
Other uses   In an immunological study, boswellic acids also have been shown to possess anticomplementary activity via C3-convertase inhibition. 12,  C3-convertase is involved in the production of anaphylatoxin. 13
Salai guggal, the gum resin exudate of Boswellia serrata , has been evaluated for effects on: Glycosaminoglycan metabolism in rats, 14,  humoral immune response, inhibiting infiltration of polymorphonuclear leukocytes in rats, 15,  and some analgesic and psychopharmacological effects. 16
 
Administration & Dosage
An extract of frankincense (H15) was studied in arthritis at a dose of 3.6 gm daily. The gum resin of frankincense has been used at a daily dose of 900 mg for bronchial asthma. 17,  , 18
 
Pregnancy/Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking.
 
Interactions
None well documented.
 
Adverse Reactions
The limited data available on toxicity of the Indian frankincense tree include: No side effects, 2,  , 5,  no cytotoxic effect, 15,  no effects on cardiovascular, respiratory or CNS function, no ulcerogenic effects, 6,  or “side effects observed...did not necessitate withdrawal of treatment.” 10
 
Toxicology
Research reveals little or no information regarding toxicology with the use of this product.
 
References
 

1. Ghazanfar S. Handbook of Arabian Medicinal Plants . Boca Raton, FL: CRC Press 1994:62.

 

2. Broadhurst C, et al. Herbal chemistry. Herbs for Health . 1998;Jan/Feb:20.

 

3. Bruneton J. Pharmacognosy, Phytochemistry, Medicinal Plants . Paris, France: Lavoisier Pub 1995:607-8.

 

4. Sen A, et al. Isolation and structure of a 4-O-methyl-glucuronoarabinogalactan from Boswellia serrata . Carbohydr Res . 1992;223:321-27.  PubMed

 

5. Ammon H. Salai guggal Boswellia serrata : from a herbal medicine to a non-redox inhibitor of leukotriene biosynthesis. Eur J Med Res . 1996;1(8):369-70.  PubMed

 

6. Singh G, et al. Pharmacology of an extract of salai guggal ex- Boswellia serrata , a new non-steroidal anti-inflammatory agent. Agents Actions . 1986;18(3-4):407-12.

 

7. Ammon H, et al. Mechanism of antiinflammatory actions of curcumine and boswellic acids. J Ethnopharmacol . 1993;38(2-3):113-19.  PubMed

 

8. Ammon H, et al. Inhibition of leukotriene B4 formation in rat peritoneal neutrophils by an ethaolic extract of the gum resin exudate of Boswellia serrata . Planta Med . 1991;57(3):203-7.  PubMed

 

9. Safayhi H, et al. Boswellic acids: novel, specific, nonredox inhibitors of 5-lipoxygenase. J Pharmacol Exp Ther . 1992;261(3):1143-46.  PubMed

 

10. Kulkarni R, et al. Treatment of osteoarthritis with a herbomineral formulation: a double-blind, placebo-controlled, cross-over study. J Ethnopharmacol . 1991;33(1-2):91-95.  PubMed

 

11. Gupta I, et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res . 1997;2(1):37-43.

 

12. Kapil A, et al. Anticomplementary activity of boswellic acids—an inhibitor of C3-convertase of the classical complement pathway. Int J Immunopharmacol . 1992;14(7):1139-43.  PubMed

 

13. Barrett JT. Textbook of Immunology, 4th Ed . St Louis, MO: CV Mosby Company 1983:177.

 

14. Reddy G, et al. Studies on the metabolism of glycosaminoglycans under the influence of new herbal anti-inflammatory agents. Biochem Pharmacol . 1989;38(20):3527-34.  PubMed

 

15. Sharma M, et al. Effect of salai guggal ex- Boswellia serrata on cellular and humoral immune responses and leucocyte migration. Agents Actions . 1988;24(1-2):161-64.  PubMed

 

16. Menon M, et al. Analgesic and psychopharmacological effects of the gum resin of Boswellia serrata . Planta Med . 1971;19(4):333-41.  PubMed

 

17. Gupta I, Gupta V, Parihar A, Gupta S, Ludtke R, Safayhi H, Ammon HP. Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled 6-week clinical study. Eur J Med Res . 1998 Nov 17;3(11):511-514.

 

18. Sander O, Herborn G, Rau R. Is H15 (resin extract of Boswellia serrata , “incense”) a useful supplement to established drug therapy of chronic polyarthritis? Results of a double-blind pilot study [in German]. Z Rheumatol . 1998 Feb;57(1):11-16.