Scientific Name(s): Commiphora abyssinica (Bevg.) Engl., Commiphora molmol Engl., Commiphora myrrha (T. Nees) Engl.
Common Name(s): African myrrh, Arabian and Yemen myrrh, Bal, Bol, Bola, Gum myrrh, Heerabol, Myrrha, Myrrhe, Somali Myrrh
The Commiphora species that serve as sources of myrrh are thorny shrubs or small trees that grow to up to 3 meters high. They are native to Africa, eastern Mediterranean countries, and South Arabia. A pale yellow-white viscous liquid exudes from natural cracks or fissures in the bark or from fissures cut intentionally to harvest the material.3 When air-dried, this exudate hardens into a reddish-brown mass that often contains white patches. These tears are approximately the size of a walnut and form the basis of myrrh resin. Myrrh is usually collected in the summer months.2, 3, 4 Though related, Commiphora mukul or "false" myrrh does not provide a source of myrrh, but rather guggulu resin, which is believed to lower cholesterol levels.4
Myrrh has been used for centuries3 as incense and for medicinal purposes.4 Medicinally, it has been used as an astringent, antiseptic, antiparasitic, antitussive, emmenagogue, and antispasmodic agent. It was commonly included in mixtures used to treat worms, wounds, and sepsis during the 4th century BC.4 Myrrh has also been reported to treat gout, headache, jaundice, throat ailments, indigestion, fatigue, and paralysis.5 Myrrh has been used in a variety of infectious diseases, including leprosy and syphilis, and to treat cancers.2 The Chinese have used myrrh in the management of a variety of skin and mouth infections.4 During the 10th century, myrrh was recommended to protect against plagues when travelling in endemic areas.4 It was also believed by the Greeks and Romans to be effective in the treatment of snake bites and is still used in parts of East Africa today for this indication.4 Myrrh was one of the first treatments of cough in children.4 Additionally, myrrh was incorporated as part of the mummification and cremation processes.4 Lotions containing myrrh have been made for use as cleansing agents, moisturizers, skin lesion treatments, and fragrances.5 Myrrh played a key role in the religious ceremonies of the ancient Egyptians.6 In the Bible, myrrh is cited as one of the 3 gifts (in addition to gold and frankincense) presented to Jesus by the Magi following his birth (Matthew 2:11) and was offered in a mixture of wine to Jesus during his crucifixion as an anesthetic (Mark 15:23).4 These gifts were a sign of wealth because they were rare and expensive.5 Myrrh is also a part of African, Middle Eastern, and Chinese traditional medicine. The Arabic term "murr" means "bitter" and describes myrrh's taste and balsamic odor.4, 7 Today, myrrh is used as a component of fragrances and as an astringent in mouthwashes and gargles.2, 8 It is sometimes used to flavor beverages and foods. The French and British continue to use myrrh in mixtures for the treatment of cough and in suppository form to treat proctitis.4
Myrrh is an oleo-gum-resin obtained from the stem of C. molmol3, 4 that consists of 2% to 10% of a volatile oil composed predominantly of sesquiterpenes, sterols, and steroids. The water-soluble gum portion (30% to 60%) contains polysaccharides and proteins as well as ethanol-soluble resins (25% to 40%). After undergoing hydrolysis, the gum produces a variety of sugars.9 Furanosesquiterpenes are responsible for myrrh's odor and are believed to exert anesthetic, antibacterial, antifungal, and hypoglycemic effects.9, 10 Additionally, 2 sesquiterpenes, furaneudesma-1-3-diene and curzarene, extracted from C. molmol have demonstrated activity on CNS opioid receptors.11 The gum has been reported to contain an oxidase enzyme.3 The related C. guidottii contains the sesquiterpene (+)-T-cadinol.12 When the oleo-gum-resin is mixed with water, it forms an emulsion.7
Uses and Pharmacology
Myrrh has been used for its antiparasitic effects against various schistosome species, including Schistosoma mansoni, Schistosoma haematobium, and Schistosoma japonicum. Myrrh's effectiveness against these species may be caused by a separation of male and female couples through a loss of the musculature. As a result, the worms are shifted to the liver where they undergo phagocytosis.13 Additionally, myrrh has been used to treat fascioliasis, a zoonotic condition resulting from infection by Fasciola hepatica, a liver fluke that commonly infects sheep, goats, and cattle.14
The effect of an oleo-resin extract of myrrh in the form of a gelatinous capsule (Mirazid) on the ultrastructure of mice liver was assessed. Sixty male mice were divided into 3 groups: group 1 was the noninfected control group; group 2 contained biharzially infected mice; and group 3 contained biharzially infected mice that were treated with myrrh extract 500 mg/kg for 5 consecutive days 8 weeks after infection. The livers of the mice in group 1 had a normal ultrastructural profile. The livers of group 2 were noted to have alterations in the ultrastructural profile, with the presence of granulomas and intercellular fibrosis. In group 3, the mice had marked reductions in granulomas and fibrosis. This study suggested that myrrh extract may have a role as an antischistosomal agent.15
In a multicenter investigation, mice and hamsters were infected with various strains of S. mansoni. The subjects were given myrrh or Mirazid in doses ranging from 180 mg/kg to 10,000 mg/kg for 6 to 8 weeks following infection. Parasite reductions were noted in 2 of 6 groups (27% and 19%) who received myrrh powder and Mirazid capsules, respectively, at doses of 1,250 mg/kg. Those subjects receiving praziquantel, the standard of therapy for schistosomal infections, experienced a 94% parasite reduction. Neither myrrh nor Mirazid reduced hepatic or intestinal tissue egg loads, whereas praziquantel reduced these levels by 60% and 90%, respectively. In this study, it was concluded that Mirazid should not be recommended for use in humans for schistosomal infections.16
In another study, 90 mice were divided into 1 of 3 groups: group 1 consisted of noninfected mice; group 2 contained mice that were infected but not treated; and group 3 contained mice that were infected and treated. Group 3 received 500 mg/kg of myrrh and was further subdivided into the following 4 groups: group 3A received the drug for 5 days before infection; group 3B received myrrh on postinfection day 1; group 3C received myrrh at 21 days postinfection; and group 3D received myrrh on day 45 postinfection. Eighty days after study initiation, the percentage of reduction in worm burden was 30%, 65%, 77%, and 98%, respectively, for the mice in the treatment subgroups compared with mice in group 2. The oogram pattern assessed in the subjects demonstrated antischistosomal activity. The mice receiving myrrh also had fewer biharzial granulomas compared with those who were infected and untreated. This study concluded that myrrh may have a potential role as a chemoprophylactic agent for the prevention of schistosomiasis. Additionally, the chemotherapeutic effect was more evident when the drug was given on day 21 and day 45 postinfection.17
In a field survey of patients in Egypt, 1,019 patients were examined for schistosomal infections. The prevalence of S. haematobium was 4%, and the prevalence of S. mansoni was 2%. All patients received Mirazid 600 mg one hour before breakfast for 6 consecutive days. Patients were followed and assessed for parasitic infections via urinalysis and stool analysis. After 3 months, the parasitological cure rate was 97% and 96% for S. haematobium and S. mansoni, respectively. Patients did not experience any adverse drug reactions. The authors of this study suggest that Mirazid is safe and effective for the treatment of S. haematobium and S. mansoni infections.18
In another study, 21 children with fascioliasis (mean age, 10 years) and 8 children with S. mansoni (mean age, 11 years) received 10 mg/kg/day of myrrh (Mirazid) 1 hour before breakfast for 6 consecutive days (fascioliasis) or 3 consecutive days (schistosomiasis). A control group of 10 healthy children was included. Four weeks following treatment, 91% of patients with fascioliasis and 100% of patients with schistosomiasis who received Mirazid experienced a parasitologic cure. Total immunoglobulin E levels declined significantly following 12 weeks of treatment with myrrh in patients with fascioliasis and schistosomiasis (P = 0.001; 0.036, respectively). In both groups, interleukin (IL)-5 levels (P = 0.005; 0.012, respectively) and IL-1beta levels (P < 0.001; 0.003, respectively) also declined significantly. IL-4 levels were not significantly different prior to treatment with myrrh (P = 0.58; 0.72, respectively) but increased significantly following treatment for patients with fascioliasis and schistosomiasis (P = 0.04; 0.02, respectively). This study concluded that the Mirazid formulation of myrrh has demonstrated efficacy as a fasciolicidal and schistosomicidal agent. It was also suggested that cytokine levels may be evaluated to assess cure.19
Another study in Egypt involved 204 patients ranging from 12 to 68 years of age with schiostomiasis. Twenty healthy subjects were also followed as controls. The infected patients were divided into 1 of 2 groups: those with schistosomal colitis or those with compensated or decompensated hepatosplenic schistosomiasis. All patients and controls received a formulation of myrrh at a dose of 10 mg/kg/day for 3 consecutive days on a empty stomach 1 hour before breakfast. After 2 months, patients who still had evidence of ova received another course of myrrh for 6 days. The overall cure rate was 91% for all infected patients. The cure rates for patients with schistosomal colitis, compensated hepatosplenic schistosomiasis, and decompensated hepatosplenic schistosomiasis were 90%, 94%, and 90%, respectively. For 12 patients who had never received treatment with praziquantel, the cure rate associated with myrrh was 100%. Patients with liver dysfunction experienced a lower cure rate, but it was not statistically significant. This may be partially explained by more adequate absorption and metabolism in patients with normal hepatic function. All 4 patients with S. hematobium infections experienced a 100% cure rate. Those with S. mansoni had a 91% cure rate. Adverse reactions were reported by 12% of patients. The most common adverse reactions were giddiness, somnolence, mild fatigue, and abdominal pain.20
A study was conducted to assess the efficacy of Mirazid compared with praziquantel in 459 children between 12 and 18 years of age and 672 household contacts. Patients were stratified into 3 groups based on tissue egg loads: low infection (ie, less than 100 eggs per g of feces), moderate infection (ie, 100 to 400 eggs per g of feces), and heavy infection (ie, more than 400 eggs per g of feces). Within each stratum, patients were randomized to receive Mirazid 300 mg/day for 3 days on an empty stomach or praziquantel 40 mg/kg. The children were assessed 4 weeks following treatment, and household contacts were reassessed between 5 and 6 weeks following treatment. At the end of this study, the overall cure rate for children receiving Mirazid was 9%, compared with 63% for those receiving praziquantel. The low-infection group had a cure rate of 18% for those treated with Mirazid, compared with 71% of patients receiving praziquantel (P < 0.001). The cure rates for patients in the moderate- and heavy-infection groups were 0%. The overall cure rate for household contacts receiving Mirazid was 9%, compared with 80% for those receiving praziquantel. A cure rate of 27% was reported for a control group, which was randomized but consisted of household contacts who didn't receive therapy. In the infection subgroups, the cure rate was 12% for patients in the low-infection group receiving Mirazid, 83% for patients in the praziquantel group, and 33% for patients in the untreated control group (P < 0.01). For those with moderate infections, the cure rates were 0% for Mirazid -treated patients, 71% for praziquantel-treated patients, and 0% for control patients (P < 0.01). Finally, in the heavy-infection group, the cure rate was 0% for patients receiving Mirazid, 67% for those receiving praziquantel, and 0% for the control group. The observed cure rate may be considered to be false because of a reported cure rate of 27% in the control group, although the patients reported that they had not received any antischistosomal drugs. This study suggests that the value of myrrh in the treatment of schistosomiasis is questionable.21
In one Egyptian village, patients were screened for the presence of S. mansoni; prevalence was determined to be 15%. Of the infected subjects, 104 were randomized to receive either myrrh (2 capsules of Mirazid on an empty stomach for 3 consecutive days) or 2 doses praziquantel (40 mg/kg after breakfast) at a 3-week interval as antischistosomal therapy. The medications were offered twice because the study was conducted during schistosomiasis transmission season, and the investigators wanted to eliminate any immature worms that might not have been eradicated with the first treatment. The cure rate for subjects treated with myrrh was 16% after the first treatment compared with 74% of those treated with praziquantel ( P < 0.05). After the second treatment, the cure rate for patients treated with myrrh was 9%, compared with 76% of patients receiving praziquantel (P < 0.05). Patients in either treatment group who did not respond to the first 2 doses were given praziquantel. After 4 weeks of receiving praziquantel, 95% of these patients stopped passing schistosomal eggs in the stool. The findings from this study cast doubt on the antischistosomal effects of myrrh.13
A small 3-month study was conducted to assess the effects of myrrh on fascioliasis. The study included 7 patients between 10 and 41 years of age with confirmed fascioliasis as well as 10 healthy subjects. All participants were given a formulation of myrrh at a dose of 12 mg/kg/day for 6 consecutive days on an empty stomach in the morning. All infected patients passed Fasciola eggs in the stool, and the average egg load was 36 ± 5 eggs per g of stool. By the completion of therapy (6 days), the average egg count was 6 ± 2 eggs per g of stool. Eggs had completely disappeared within 3 weeks following treatment and remained eradicated up to the 3-month follow-up. No adverse reactions were reported.14
An in vitro study of 2 sesquiterpenes derived from myrrh (furanodiene-6-one and methoxyfuranoguaia-9-ene-8-one) discovered antibacterial activity against Pseudomonas aeruginosa (minimum inhibitory concentration [MIC] 1.4 mcg/mL), Staphylococcus aureus (MIC 0.18 mcg/mL), and Escherichia coli (MIC 2.8 mcg/mL). Additionally, these sesquiterpenes demonstrated antifungal activity against Candida albicans (MIC 1.4 mcg/mL). Local anesthetic activity was also noted in mammalian nerve cells.11
In a case report, a 65-year-old man with diabetes had a wound on his right foot with tissue loss. He was managed with antibiotics, glycemic control, pentoxifylline, vitamin C, calcium carbonate, vitamin E, vitamin A, zinc, and bee propolis. Additionally, a paste containing 800 mg of bee propolis and 50 g of myrrh mixed in honey was applied topically to the wound. Every 3 days, the paste was made and refrigerated. The wound was cleaned daily followed by application of the paste. After 4 weeks of treatment the wound healed completely. Although myrrh's exact role in wound healing is difficult to determine because of many confounding factors in this case report, data suggest there may be a potential role for topically applied products containing myrrh.6
Myrrh has a locally stimulating action on smooth muscle tissue and may stimulate peristalsis.22, 23 By contrast, T-cadinol has a concentration-dependent smooth muscle relaxing effect on the isolated guinea pig ileum and a dose-dependent inhibitory effect on cholera toxin-induced intestinal hypersecretion in mice.12
Pretreatment with an aqueous solution of C. molmol provided dose-dependent protection against the development of GI ulcers in rats that received ethanol, 25% NaCl, 0.2 M NaOH, indomethacin, and combination ethanol and indomethacin. This protective effect is believed to be attributed to its effects on gastric mucus secretion and the ability to increase nucleic acid and nonprotein sulhydryl concentrations.24
A 12-month randomized, double-blind, active-controlled trial (n = 96) found no significant difference in relapse-free time, endoscopy, or fecal biomarkers in ulcerative colitis (UC) patients in remission treated with the gold standard, mesalazine, or a combination of dry extract of chamomile flowers (70 mg), myrrh (100 mg), and coffee charcoal (50 mg). Overall relapse rates were 53% and 45% in the herbal group versus the mesalazine group, respectively, and no significant differences were found between the 2 groups in Colitis Activity Index scores. This study describes first evidence of a potential non-inferior treatment to the gold standard treatment for UC.34
A plant mixture extract containing myrrh has been shown to reduce the rate of gluconeogenesis in hepatocytes of rats. Additionally, blood glucose levels were lowered from an average of 16.7 mmol/L at baseline to 8.5 mmol/L. Levels were compared to those of rats treated with phenformin whose blood glucose levels at baseline averaged 15.1 mmol/L and averaged 10.7 mmol/L following treatment. Myrrh may be of interest in the management of diabetes mellitus, although further clinical studies are necessary.25
No clinical studies of myrrh in the treatment of diabetes in humans have been documented.
Mice with Ehrlich solid tumors were given C. molmol and followed at 25 and 50 days of administration. Doses of 250 to 500 mg/kg/day were found to be cytotoxic in these solid tumor cells, and the effects were comparable to cyclophosphamide. However, after 50 days of therapy, the effects were not as significant; therefore, C. molmol may be of interest as an anticarcinogenic agent for solid tumors.26
In another study of mice, C. molmol doses of 125 to 500 mg/kg were not mutagenic. Mitodepressant effects in the femoral cells and reductions in RNA levels in liver cells were demonstrated and were dose-dependent in those mice receiving C. molmol and cyclophosphamide.27
No clinical studies of myrrh as an antitumor or anticarcinogenic agent in humans have been documented.
No studies have been conducted to determine the effects of myrrh on gingivitis in animals.
An in vitro study of the anti-inflammatory effects of myrrh oil on human gingival fibroblasts and epithelial cells was conducted. Myrrh oil inhibited the production of prostaglandin E2 via interleukin-1β stimulation by the fibroblasts (P = 0.001) but not by the epithelial cells.28 Further studies of myrrh's effects for gingival conditions are warranted.
Paint or dab on the affected area(s) 2 to 3 times daily. Do not dilute the tincture.
1 to 2 teaspoonfuls of resin per 1 cup of boiling water, steep for 10 to 15 minutes and drink 3 times daily.29
5 to 10 drops in a glass of water.
30 to 60 drops in a glass of water.
Pregnancy / Lactation
In a case report, a patient stabilized on warfarin experienced a reduction in INR following administration of an aqueous extract of myrrh. Myrrh may be an inducer of the hepatic enzymes responsible for warfarin's metabolism, though the exact mechanism is unknown. Therefore, products containing myrrh may interact with warfarin and other coumarin derivatives.31
Myrrh has demonstrated the ability to lower blood sugar levels. Use caution in patients also receiving antidiabetes medications, especially those that can lead to hypoglycemia. Careful monitoring of blood glucose is warranted.9, 25
Although myrrh is generally considered to be nonirritating, nonsensitizing, and nonphototoxic to human and animal skin2 several cases of dermatitis caused by myrrh have been reported.32 In case reports of 2 patients using transdermal myrrh formulations for tendonitis, both developed contact dermatitis at the application sites within a few weeks of administration. Both reactions resolved within several weeks to a month with the use of topical corticosteroid therapy.33
No serious toxicities have been reported with myrrh. Myrrh is approved by the FDA for food use and was "given generally recognized as safe" status as a flavoring agent.14
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