Current scenario of traditional medicines in management of diabetic foot ulcers: A review

Table 1 Contents of formulations used in managing diabetic foot ulcers

Name of formulation	Contents
Hongyou ointment[28]	Jiuyi Pellet (Gypsum Fibrosum: hydrargyrum oxydatum crudum), Dong Pellet (main ingredients: sminium), and Vaseline
Shengji powder[28]	Gypsum Fibrosuum, Resina Draconis, Resina Olibanum, Myrrh, and Borneolum syntheticum
Cortex Phellodendri Compound Fluid[32]	Huangbai (Phellodendron Chinese Schneid), Lianqiao (Forsythia suspensa), Jinyinhua (Lonicera japonica Thunb), Pugongying (Taraxacum mongolicum Hand. -Mazz), and Wugong (Scolopendra)
Tangzu Yuyang ointment[35]	Coptis chinensis Franch (Huanglian), Ligusticum chuanxiong Hort. – (Chuanxiong), Atractylodes lancea (Thund.) DC. (Cangzhu), Panax notoginseng (Burk.) F.H. Chen. (Sanqi), Angelica sinensis (Oliv.) Diels. (Danggui), Arnebia euchroma (Royle) Johnst. (Zicao), Phellodendron chinense Schneid. (Huangbo), Rheum officinale Baill. (Dahuang), Borneolum syntheticum (Bingpian), Daemonorops draco Bl. (Xuejie), Gypsum fibrosum praeparatum (Duanshigao), and Sesame oil and Beeswax served as bases
Zizhu ointment[36]	Cinnabar (Zhusha), Astragalus mongholicus (Huangqi), Arnebia guttata (Zicao), Donkey hide gelatin (Ejiao), Borneol (Bingpian), and Dragon’s Blood (Xuejie)
Shenghong liquid[37]	Radix rehmanniae, Carthamus tinctorius, Coptis chinensis, Rheum officinale, Radix lithospermi, Fructus gardenia, and licorice
WH1 and ON101 creams[38,39]	PA-F4 from an extract of Plectranthus amboinicus and S1 from an extract of Centella asiatica.
Panchvalka[104,109]	Stem bark of Ficus benghalensis, F. glomerata, F. religiosa, F. virens, and Thespesia populnea
Jatyadi tailam[105,109]	Chameli (Jasminum grandiflorum) Neem (Azadirachta indica) Patol (Trichosanthes Dioica), Karanj (Pongamia glabra), Yashtimadhu (Glycyrrhiza glabra), Haridra (Curcuma longa), Daruharidra (Berberis aristate), Kutki (Picrorhiza kurrooa), Manjistha (Rubia cordifolia), Padmakh (Prunus cerasoides), Lodhra (Symplocos racemose), Haritaki (Terminalia chebula), Nilofer (Nymphaea alba), Tutiya (Copper sulfate), Sariva (Hemidesmus indicus), Mom (Wax), Chandan Oil (Santalum album), Kumari oil, and Sesame oil

Table 2 Results of various trials that used traditional Chinese medicines topically

Ref.	Test group	Control group	Results
Li et al[28]	Hongyou ointment and Shengji powder (CM group) (n = 27)	WM (mupirocin ointment, growth factor, and vaseline gauze) (n = 26)	Overall effective rate (healed and completely effective) in CM group (22/27, 81.48%) was significantly higher than that in WM group (15/26, 57.69%, P = 0.04). The mean wound healing time was 22.71 ± 5.46 d in CM group vs 26.56 ± 7.56 d in WM group (t = 2.13, P = 0.04)
Liu et al[32]	CPCF	KFS	CPCF group: Initial wound area was 7.58 ± 2.13 cm2, improved to 3.83 ± 3.13 cm2 on 14th d, 2.39 ± 2.53 cm2 on 21st d, and 1.18 ± 2.49 cm2 on 28th d. The mean wound area of 7.73 ± 2.11 cm2 in KFS group had improved through 5.66 ± 2.58 cm2 on day 14, 4.42 ± 2.87 cm2 on day 21, and 2.78 ± 3.32 cm2 on 28th d (P < 0.05)
Huang et al[39]	ON101 cream (n = 118)	Sodium carboxymethyl cellulose absorbant dressing (n = 112)	At 16 wk, 74 patients (60.7%) of ON101 group and 40 (35.1%) of comparison group had achieved ulcer closure (OR = 2.84; 95%CI 1.66-4.84; P < 0.001). No difference between rates of 50% ulcer reduction at 16 wk (82.8% vs 86.0%)
Li et al[35]	TYO (n = 24)	SWT (n = 24)	Improved healing rate of only 4% (37.5% TYO group vs 33.3% SWT group). Significant improvement in TYO group at 12 wk (79.2% vs 41.7%; P = 0.017) and 24 wk (91.7% vs 50%; P = 0.003)
Xie et al[37]	SH (n = 30)	Recombinant human basic FGF gel ( n = 30)	Significant reduction in ulcer size by 4, 8, and 12 wk. Ulcer size was reduced from 15.90 ± 3.27 cm2 to 2.75 ± 1.08 cm2 in the SH group and from 15.72 ± 3.11 cm2 to 8.36 ± 2.07 cm2 in controls (P < 0.001)
Jiang et al[40]	Jingwanhong ointment (n = 67)	Sulphadiazine zinc ointment (n = 64)	Epithelization was complete by 46.5 ± 15.6 d in Jingwanhong group and 67.9 ± 17.9 d in sulfadiazine zinc group (P < 0.05)
Cao et al[41]	Unspecified TCM ointment (n = 20)	Topical ethacridine lactate (n = 20)	Better wound healing at 10, 20, and 30 d in TCM group

FGF: Fibroblast growth factor; CM: Chinese medicine; WM: Western medicine; CPCF: Cortex Phellodendri Compound Fluid; KFS: Kangfuxin solution; TCM: Traditional Chinese medicines; TYO: Tangzu Yuyang Ointment plus standard therapy; SWT: Standard wound therapy; SH: Shenghong liquid.

Table 3 Results of various trials that used honey topically

Ref.	Test group	Control group	Results
Shukrimi et al[57]	Honey	Povidone iodine	Mean time for "ready for surgical closure" 14.4 d in honey group vs 15.4 d in povidone group (P < 0.005). Less pain and faster improvement in oedema and foul exudation in honey group. No significant changes in bioburden isolation before and after therapy
Hammouri et al[69]	Honey and normal saline (n = 100)	Povidone and H2O2 (n = 100)	Mean healing time 21 (7-70) d, hospital stay 13 (7-42) d, and low treatment costs in honey group. In povidone group, the mean healing time was 32 (7-90) d with a mean hospital stay of 23 (7-56) d (P < 0.001)
Jan et al[70]	Honey (n = 50)	Povidone iodine (n = 50)	Faster wound healing at various intervals. Healing at end of 8-10 wk: All patients in honey group and 74% in povidone group (P < 0.0001). No difference in amputation rates
Imran et al[71]	Honey (n = 179)	Saline dressings (n = 169)	By 120 d, complete healing in 136 (75.97%) wounds in honey group vs 97 (57.39%) wounds in saline group (P < 0.001). Mean wound healing time: 18 (6-120) d in honey group vs 29 (7-120) d in saline group (P < 0.001)
Kamaratos et al[72]	Manuka honey (n = 32)	Saline dressings (n = 31)	No statistical difference in the total healed ulcers (97% in honey vs 90% in saline group). Mean healing time: 31 ± 4 d in honey group vs 43 ± 3 d in saline group (P < 0.05)
Al Saeed et al[73]	Honey (n = 32)	Tulle grass dressings (n = 27)	Faster wound healing in honey group than simple tulle grass dressings [(61.3% vs 11.5%; P < 0.05) at 6 wk and (87.1% vs 42.3%; P < 0.05) at 6 mo]. Hospital stay and incidence of amputation were also lower in honey group
Siavash et al[74]	5% Royal jelly (bee product)	Placebo	No statistical difference regarding size reduction and complete healing (P > 0.5)

Table 4 Results of various trials that used aloe and ayurvedic medicines topically

Ref.	Test group	Control group	Results
Panahi et al[93]	AVO cream	Topical phenytoin	At 4 wk, wound healing scores (overall BJUA score, size, depth, slough, adjacent tissue inflammation) in AVO group were significantly better (P < 0.001) than the pre-treatment score and as compared with the phenytoin group
Avijgan et al[94]	Aloe vera ointment with conventional treatment	Only conventional treatment	At 3 mo, 28 (93.3%) patients in aloe vera group vs 14 (46.7%) from control group had complete wound healing (P < 0.05). The overall mean healing time and average cost were significantly lesser in aloe vera group
Najafian et al[95]	Aloevera/ Plantavera major gel (n = 20)	Placebo (n = 20)	After 4 wk, significant reduction of ulcer surface in the Plantavera group than in placebo group (P = 0.039). No statistical difference in ulcer depth
Tamoli et al[109]	Aerosol sprays (containing Panchvalka Kwatha and Jatyadi Taila) (n = 12)	Standard care (n = 14)	BJUA score: 30.59 ± 7.11 on the first day in herbal group, improved to 23.45 ± 8.79, and 15.32 ± 7.63 on days 30 and 90, respectively. In control group, score: 30.58 ± 8.72 and improved to 21.05 ± 9.78 and 14.92 ± 7.69 on days 30 and 90, respectively. Healing time was better in the aerosol spray group
Ajmeer et al[110]	Katupila Kalka (paste of S. leucopyrus leaves) with Tila Taila (sesame oil) (n = 13)	Betadine ointment (n = 10)	Complete healing was noted in 92.3% of cases of group A compared to 20 % of group B. Weekly improvement in exudate and peri-wound skin and size reduction were statistically significant in group A

AVO: Aloe vera-olive oil; BJUA: Bates-Jensen ulcer assessment.