Efficacy and safety of herbal medicines in treating gastric ulcer: A review

Table 1 Efficacy and safety of herbal medicines for gastric ulcer in animal models and possible mechanisms

Herbal extracts	Model	Treatment course (d)	Efficacy		Possible mechanisms	Adverse effects	Ref.
			Herbal extract	Positive control
Myristica malabarica	NSAID	3	62%-86%1	76%-79%1	↑ EGF, ↑ VEGF, ↓ endostatin	None	[18]
Piper betel	NSAID	7	93.4%2	85.4%2	Antioxidant, ↑ mucus content	N/D	[20]
Teucrium polium	NSAID	28	90%2	N/D	↑ Proliferation, ↓ inflammation	N/D	[21]
Phyllanthus emblica fruits	NSAID	7	80%2	N/D	Antioxidant	N/D	[22]
Beeswax	NSAID, acetic acid	3 h for NSAID, 5 d for acetic acid	56%3 for NSAID; 65.8%3 for acetic acid	N/D	N/D	N/D	[23]
Qualea grandiflora	Acetic acid	14	83%4	76%4	↑ Mucus production, ↑ Proliferation, ↓ acid secretion	N/D	[24]
Centella asiatica	Acetic acid	7	50%4	N/D	↑ bFGF, ↑ proliferation, ↓ MPO	N/D	[25]
Ocimum sanctum Linn.	Acetic acid	20	92.75%2	87%2	↑ Mucin content, ↑ proliferation, ↓ acid secretion	N/D	[26]
Alchornea glandulosa	Acetic acid	14	43%4	16%4	↑ Proliferation, ↓ acid secretion	None	[27]
Radix Bupleuri, Radix Codonopsis, radix paeoniae alba, rhizoma corydalis, rhizoma bletilla, margarita, indigo naturalis, radix glycyrrhizae	IL-1b, acetic acid	7-92	56%2 at 7 d, 12.5% recurrence rate at 92 d	27%2 at 7 d, 25% recurrence rate at 92 d	↑ VEGF, ↓ inflammation, ↑ Microvasculature density, ↓ NF-κB mrna and protein	N/D	[28,29]
Bacopa monniera	Acetic acid	10	85.9%2 in normal; 52.5%2 in diabetes rats	68%2 in normal; 41.8%2 in diabetes rats	N/D	N/D	[30]
Azadirachta indica	Acetic acid	10	65.6%2 in normal; 71.5%2 in diabetic rats	68%2 in normal; 41.8%2 in diabetic rats	N/D	N/D	[30]
Chitosan, chitin	Acetic acid	14	60%2	46%2	↓ Acid secretion, ↑ mucus	N/D	[31]
Salvia miltiorrhiza	Acetic acid	5-30	31%2 for 5 d 59%2 for 30 d	19%2 for 5 d 33%2 for 30 d	↑ Proliferation	N/D	[32]
Ganoderma lucidum	Acetic acid	14	55.9%2	82.8%2	↑ Mucus content, ↑ PGE2	N/D	[33]
Tea catechin	Acetic acid	14	66%2	59%-77%2	Antioxidant	N/D	[34]
Solanum nigrum	Acetic acid	7	70.1%2	75.7%2	H+/K+-atpase activity, ↓ gastrin, ↓ acid secretion	None	[35]
Cochinchina momordica seed	Acetic acid	14	71.2%3	N/D	↑ VEGF (protein and mrna), ↑ Microvasculature density	N/D	[36]
Rhizoma Coptis Chinensis	Acetic acid	10	53.86%3	36.47%3	↓ Acid secretion	N/D	[37]
Glycyrrhetic acid, β-sitosterol, berberine, baicalin and ginsenoside	Acetic acid				↓ Endothelin-1, ↑ leptin		[38]
Curcumin and bisdemethoxycurcumin	Acetic acid	10	86.05%4	82.42%4	↓ iNOS, ↓ acid secretion, ↓ inflammation	N/D	[39]
Bupleurum falcatum L.	Acetic acid	14	51.9%4	83.1%4	N/D	N/D	[40]
Plantago lanceolata L	Acetic acid	10	77.9%2	76.2%2	↑ Mucus content, ↓ gastric secretion, ↓ acid secretion	None	[41]
Croton lechleri	Acetic acid	7	55%3	N/D	↓ Bacterial colonization, ↓ MPO, ↓ iNOS, ↓ inflammation	N/D	[42]
Panax notoginseng, rhizoma bletilla, Poria cocos, Taraxacum mongolicum Hand	Acetic acid	7	N/D	N/D	N/D	N/D	[43]
Tabebuia avellanedae	Acetic acid	7	36%3	48%3	↑ Proliferation, ↑ mucus content	N/D	[44]
Sea buckthorn bark	Acetic acid	14	80%2	70%2	↑ Plasma EGF, ↑ EGFR, ↑ PCNA	N/D	[45]
Astaxanthin	Acetic acid	10	93.5%3	N/D	Antioxidant, ↓ inflammation	N/D	[46]
Angelica sinensis	Acetic acid	3-7	95%3 for 3 d, 62%3 for 7 d	N/D	↑ Mucus content	N/D	[47]
Radix Aristolochiae, Potentilla bifurca L, Resina Draconis, Taraxacum mongolicum Hand, radix paeoniae alba, Saussurea costus (Falc.) Lipech, radix glycyrrhizae	Acetic acid	16	N/D	N/D	↑ Proliferation, ↑ NO, ↑ EGF	N/D	[48]
Rhizoma Atractylodis macrocephalae, Radix Linderae, Rhizoma Dioscoreae, rhizoma bletilla, Pericarpium Citri Reticulatae Viride, Rhizoma Alpiniae Officinarum, Radix Paeoniae Rubra, Herba Agrimoniae	Acetic acid	14	45.15%4	72.12%4	↑ Serum EGF, ↑ serum no, ↓ Acid secretion, ↑ PGE2	N/D	[49]
Nyctanthes arbortristis Linn	Acetic acid	10	55%-60%3	N/D	↓ Inflammation	N/D	[50]
Radix Codonopsis, Radix Adenophorae, Radix Angelica Sinensis, Rhizoma Chuanxiong, radix paeoniae alba, Poria, Rhizoma Atractylodis macrocephalae, Radix Bupleuri, Radix Scutellariae, Rhizoma Coptidis, Fructus Aurantii Immaturus, Radix Salviae Miltiorrhiza, Taraxacum mongolicum Hand, rhizoma corydali, Panax notoginseng, Radix Glycyrrhizae. Preparata	Acetic acid	14	49%3	30%3	↑ Serum and mucosal EGF, ↑ EGFR	N/D	[51]
Bacopa monniera	HCI	10	91.8%2 in normal; 76.2%2 in diabetes	92.5%2 in normal; 71.5%2 in diabetes	N/D	N/D	[30]
Azadirachta indica	HCI	10	93.4%2 in normal; 91.2%2 in diabetes	92.5%2 in normal; 71.5%2 in diabetes	N/D	N/D	[30]
Prumnopitys andina wood and bark	Acetic acid	14	92.5%4	79.6%4	↑ Proliferation, antioxidant (only lipoperoxidation, no change in reduced glutathione content), ↑ PGE2	N/D	[52]
Bupleuri Radix, Pinelliae Tuber, Scutellariae Radix Glycyrrhizae, Radix Cinnamomi Cortex, Ginseng Radix, Paeoniae Radix, Zizyphi Fructus, Zingiberis Rhizoma	Cold water restraint stress	3 h	24%2	N/D	N/D	N/D	[54]
Coptidis Rhizoma, Scutellariae Radix, Phellodendri Cortex, Gardeniae Fructus	Cold water restraint stress	3 h	62%2	N/D	Antioxidant	N/D	[54]
Bupleuri Radix, Paeoniae Radix, Aurantii Fructus Immaturus, Glycyrrhizae Radix	Cold water restraint stress	3 h	20%2	N/D	N/D	N/D	[54]
Curcumin	pyloric ligation	19 h	90.79%2	N/D	Antioxidant, ↓ acid secretion, ↓ inflammation	N/D	[55]

¹Reduction in macroscopic damage score;

²Reduction in ulcer index;

³Reduction in ulcer size;

⁴Cure rate. bFGF: Basic fibroblast growth factor; MPO: Myeloperoxidase; N/D: Not determined; None: Not toxic; PGE2: Prostaglandin E2; VEGF: Vascular endothelial growth factor.