This chapter deals with the review of literature related to turmeric for wound healing. The review of related literature is an essential aspect of scientific research. It includes critical analysis and existing information in relation of problem when interpreting the results of the study and when making judgments about applications of a new knowledge in nursing practices.
Research literature was reviewed and organized under the following headings.
Section A: Literature related to other non -pharmacological measures for wound
Section B: Literature related to turmeric for wound healing.
Section C: Literature related to turmeric for other disease conditions.
SECTION A: Literature related to other non - pharmacological measures for wound healing
The Agency for health care policy & Research,(1994) conducted a randomized clinical study to check the efficacy of electrical stimulation to treat stage III, IV pressure ulcers and enhance wound healing among 147 patients. Five clinical trials was conducted using pressure ulcer scale for healing. It was found that the therapy influences wound healing by attracting repair cells, changing the permeability of cell membranes, affects the secretions and creating new cell structures. A current is generated between the skin and inner tissues when a break in the skin occurs. This current is enhanced by moist wound environment and can be mimicked by electrical stimulation which is believed to accelerate the healing process. It uses electrodes that are positioned around the wound area. It can be used on most wounds during all three stages to improve wound healing .Results shows high statistical significance at p>0.01 since it speeds up the wound healing process.
Subramanyam,(1996) did a comparative study with honey and boiled potato peel as a dressing for fresh partial thickness wounds for 40 patients. Patients who treated with honey had positive swab cultures at the time of admission, 90% of their wounds rendered sterile with in 7 days. Other patients who treated with boiled potato peel had positive swab culture at the time of admission had persistent infection after 7 days.100% of wound healed with in 15 days which were treated with honey when compared to the wounds treated with boiled potato peal dressings which were healed by 50%.The effectiveness was measured using bates-jensen wound assessment scale. Patients who treated with honey showed effective healing with in 10.4 days when compare to the boiled potato peel since they took 16.2 days for healing. It shows the patients with honey shows high significance rate at 0.01 level.
Heuit Shery and Lopez ,(2002) conducted a study to find out the efficacy of papaya in treating pressure ulcer with full thickness wound for 79 patients in government hospital, Karachi for one month interval with the application of papaya twice daily. The improvement of wound status measured using pressure ulcer scale for healing. The findings of the study revealed that the level of wound status was improved for 61 patients.
A prospective randomized controlled trial was carried out to assess the effectiveness of honey - impregnated gauze, as a dressing for the diabetic wound among 23 patients using bates-jensen wound assessment scale.The wound status measured and the effectiveness showed highly significance for about 87% of patients.In wounds dressed with honey - impregnated gauze showed significantly faster healing at p>0.01 level. Mirrah,(2003)
Prasanna Baby, (2005) conducted an experimental study to find out the efficacy of two different dressing materials namely banana leaves and paraffin gauze on donor site wounds. The study was carried out for a period of 4 weeks in the month of November in primary health centre in Nagpur. Total subjects in the study group were 15 in each group. Pain, soakage of dressing, comfort and wound healing were observed in both study groups . The data were analyzed by using statistical tests like 't' test and chi square test. Study findings revealed banana leaf to be an effective dressing material for donor site wound dressing. It causes less pain (p<0.50) and the effectiveness was about 82% and the patient feels more comfort. It is highly cost effective where the lay peoples can also accept the treatment.
William James & Hacker, (2005) conducted a randomized clinical trial to assess the effectiveness of Hyperbaric oxygen therapy for 30 patients with serious wounds in the ayurvedic medical centre at Bihar. Here patient breathes 100% oxygen in a pressurized chamber for 90 - 120 minutes. The oxygen dissolves in to the blood and is distributed throughout the body, providing extra oxygen to the cells attempting to heal the wound. It increase the rate of collagen deposition, angiogenesis and bacterial clearance. It is the effective treatment for complicated, non - healing wounds and it shows high statistical significance at 0.05 level and about 90% of patient got improvement in wound status.
Warf & Caprin, (2006) did a clinical study on wound healing and assessed through whirlpool therapy for 24 patients with severe wounds in research centre, Newdelhi by various researchers. The therapy is used once or twice daily for about 20 minutes during the inflammatory stage of healing to enhance circulation and bring more oxygen in to the wound area. It softens, loosens dead tissue and cleanses the wound. It was also found that the therapy relieves wound pain and shows high statistical significance at 0.01 level. The analysis was interpreted through t-test.
A Comparative study was done for the irrigation of chronic wounds with normal saline and tap water. The patients were selected from private hospital, Bangalore. Randomized controlled trial was used in this study. 31 subjects were selected for tap water group, 30 subjects in normal saline group.The effectiveness was measured using bates-jensen wound assessment scale. After 5 weeks of follow up, percentage reduce in saline group was 45.34% (mean size : 8.42 + 6.57) compared to 40.58% (mean size of 5.36 + 7.89) in tap water group. There was no significant different between the groups (P>0.05). Overall post irrigation culture was 64.51%. positive in saline group, 58.06% positive in tap water group with p value of >0.05. There was no significant difference found between wounds in term of wound infection and healing rate. Tap water appears to provide safe alternative to sterile normal saline in irrigation of chronic wounds. Shrivani ,(2007)
Rathi & Chandrakala, (2009) conducted a research based on role of collagen sheet application in wound healing from the medical university of Chaiput. The samples selected through convenient sampling technique. About 123 patients involved in the study group with severe diabetic wound. Research has shown that some collagen - based dressings produce a significant increase in fibroblast production, have a hydrophilic property that may be important in encouraging, fibroblast permeation, enhance deposition of oriented, organized collagen fibers by attracting fibroblasts and causing a directed migration of cells aid in uptake and bio availability of fibronectin; help preserve leukocytes, macrophages, fibroblasts and epithelial cells and assist in maintenance of chemical and thermostatic microenvironment of wound collagen sheet has been found to be well tolerated in clinical trial. No reports of collagen sheet rejection. Thus it produces 92% of healing effects among diabetic patients and the researcher proved it was effective and shows high significance rate at (p>0.05) respectively.
Section B: Literature related to turmeric for wound healing.
Licj et al ,(1993) conducted a comparative randomized study for the total of 20 patients grouped in to 4 units based on wound size. The samples were selected from Medical research unit, U.K with four different interventions. The wounds in group I patients were dressed daily with 0.9% normal saline (controls). Turmeric powder was applied topically in an amount of 0.5gm/cm2 of wound surface to the wounds of group II patients. In group III patients, turmeric powder was applied topically to the wounds and were given 1.5% turmeric aqueous suspension by mouth (via) daily drinking water. Group IV patients were given 1.5% turmeric solution by mouth and their wounds were dressed daily with 0.9% normal saline. At 0,3,6 and 10 the mean area of the wounds was similar in all groups. At days 17 and 25 however, the treatment groups exhibited significantly smaller wounds when compared to control (P<0.05 each group). In addition, all patients in groups 2 and 3 and 75% of the patients in group IV had healed wounds at day 32, compared to only 38% in the control group. Thus, turmeric powder in both oral and topical applications, enhanced wound contraction and healing in this model. The wound status was examined through bates Jensen wound assessment scale. It indicates, that local application and oral intake of turmeric enhances wound contraction when compared to daily cleaning with saline. The effectiveness rate was about 78%and it shows highly significance.
Despandi, Marks & Begum,(2000) conducted a randomized clinical trial study for 78 patients with diabetic wounds in the foot from National Institute of Health in Pune based on structured questionnaire data collection on wound status and Batson Index, the treatment continues for 2 weeks and the healing effects noted for 81% of patients on continuous application of curcumin with the dose of 1.5gm daily twice. Thus the significance (p=0.05) shows highly reliable.
Shiva & Vandana,(2002) conducted a clinical study to evaluate the potential efficacy of fresh turmeric paste to heal wounds for 18 patients. The samples was selected from government ayurvedic college, Nagercoil. Turmeric paste was applied topically to the wound for 14 days. Wound healing was assessed on treatment0,3,7,14. At the end of 14th day it was observed that the wound healing was significantly faster (p>0.01) in experimental group.
Srivastava & Suvira,(2002) conducted a randomized experiments for 20 samples with leg ulcer from the village of Orissa, India.Curcumin were given in the dose of 0.1 mg / cm2 surface for a period of 3 months to enhance rapid wound healing. Enhancement of collagen synthesis and marked wound healing were demonstrated to a rate of 87% with the reliability of r=+1 and shows highly significance. The residents of Orissa village has shown the greater acceptance of curcumin application over the wound,where it is cost effective and easy for application.
Akanksha & Vikas,(2003) conducted a comparative randomized clinical trial of turmeric powder (0.85-1.5gm) and the neomycin sulphate (1.5gm) for the patients with cellulitis over the limbs in Brittania, U.K. The study was taken place for 50days with twice a day application of both turmeric powder and neomycin sulphate and the complaints like redness, pain and itching reduced (78%) with in 45 days and produces synergic effects on wound healing with turmeric powder measured with functional score and shows the full stability with natural effects.
Rajinder Raina & Verma,(2008) conducted a randomized clinical trial of application of turmeric powder with the dose of 0.5-1gm for the period of 3 weeks and to find out the wound status level among diabetic clients in general clinics of West Bengal. Wound measurements was done using Bates-jensen wound assessment scale.At the end of the third week it was found the healing effects was noted for 73% of clients. Thus the significance( p=0.05) shows highly reliable.
Section C : Literature related to turmeric for other disease conditions
Charles & Geogr (1992) conducted a randomized, double-blind, placebo-controlled study of 6-month trial of curcumin oral intake in 89 patients as maintenance therapy in ulcerative Colitis in Philadelphia at St.George medical hospital.It showed differences in relapse rate compared with placebo. The dose of curcumin used was 1g twice daily, and was taken in combination with standard maintenance therapy of mesalamine or sulfasalazine. Improvement in ulcerative colitis has been recorded and its attributed to the anti-inflammatory and anti-oxidant effects of curcumin for both groups those who are participated in the study and shows statistically significance with curcumin for ulcerative colitis. Author suggest a role for turmeric in the treatment of other digestive disorders also (eg) duodenal or gastric ulcers.
Ronald & Rekha,(1992) researchers at the medical and cancer research and treatment centre, Nagercoil underwent an ayurvedic randomized herb study with turmeric.Turmeric was used as a paste for scabies in 814 people. In 97%of cases cure was obtained with in 3-15 days of treatment the effectiveness can be obtained significantly (p>0.01). These results indicate the turmeric offer a very cheap, easily available, effective and acceptable mode of treatment for the villages in the developing countries. However further research is needed.
Lal et al,(1999) conducted a study with 32 patients with chronic eye inflammation (anterior chamber uveitis) using clinical random trial, 375-mg dose of curcumin three times per day for three months was given. Results showed the improvement rate comparable to the effects (p>0.01) seen with a similar cortisone dose for 26 patients and the eye power increases and pain reduces for an extend with curcumin and the results are recorded.
Lourerico, Gerad & Revel,(1999) conducted a study to assess the effectiveness of turmeric oil application over the joints and painful site for arthritis patients for 3 weeks as the interval of twice daily. The samples was selected randomly from geriatric care centre in Pune. The severity of pain was assessed using numeric pain scale for the 96 samples in the study group. The results shows highly improvements for 97% and the associative significance at the rate of (p=0.01).
Mowrey & Oluwatosin,(1999) relates the results of one scientific research study in Metabolic care centre,Mumbai with a suspension of turmeric tablets to increase the bile production for 369 patients with liver disease. Using questionnaires the data's on symptoms can be obtained . After 8 weeks of intervention the bile production increases to 49 to 79% and shows highly significance at 0.05 level, turmeric was acts even a very good chologogue which induces bile production as compared to baseline levels.
Frawley, David & Vasant Lad,(2001) conducted a pilot study that investigates the use of standardized turmeric root powder at the dose of 3600mg/day in 207 patients with irritable bowel syndrome for the 61 samples who participated in the study (experimental and control group). The data can be obtained through structured questionnaires, after 12 weeks of treatment, improvement in quality of life score was reported by 72% of samples of experimental group. The samples feel more comfortable and there was no adverse reactions or toxic effects noticed.
A study was conducted in 1992 shows that turmeric may assist in lowering cholestrol and prevent atherosclerosis for 30 subjects with high cholestrol and high triglycerides for 3 month period, with the dose of 250mg twice /day, where the severity reduces the high cholestrol to 76% and triglycerides to 82% at the significance of (p>0.005). Turmeric also has the action on preventing platelet buildup along the walls of injured blood vessels, another common cause of blood clots and artery blockage that can result in heart attacks and strokes. The research group recommends to take high doses of turmeric in daily diet. Kang et al ,(2001)
Williamson & Elizabeth,(2002) conducted an additional research at the university of Texas which demonstrated that curcumin can stop the spread of multiple myeloma, a cancer of the bone marrow.14 patients were chosen as a study sample.They underwent analysis and treatment of turmeric capsules of 350mg daily twice for a period of 6 months was given to the patients and the improvement was obtained through history collection and researchers noted that curcumin inhibited the production of interleukin -8, a protein produced by white blood cells that contributes to tumor growth, cancer cells died and the effectiveness was reported by 9 patients. The study had attracted the heads of International cancer center towards this approach and brings satisfaction to the research team.
Kalpagam Polasa & T.C.Raghuram,(2003) conducted a clinically randomized trial for colorectal cancer with turmeric powder to reduce the toxicity and severity in government hospital, Kerala with the sample of 25 and data collected through the questionnaires and recommended 8g of curcumin for 4 months, without treatment related toxicity, it shows the significance and the changes in cytokine levels noted effectiveness recorded for 18 patients (32% Vs 27%) and notes the active level functions of the colon tissues was reported after the laboratory investigations.
Peter & Munk,(2003) conducted a clinical trial in Madonna University, the scientist have shown that curcumin prevents lipid peroxidation and the oxidation of cellular and subcellular membranes that are associated with atherosclerosis. Curcumin acts to lower total cholesterol levels. It prevents peroxidation of LDL (bad) cholesterol and the dosage recommends is 1000mg per day for 23 patients .Study shows curcumin inhibits LDL peroxidation and benefits cardiovascular health. Also researchers reported a high significant 29% increase in HDL among subjects who consumed one-half gram (500mg) of curcumin per day for seven days. Subjects also experienced a decrease in total serum cholesterol of more than 11% and a decrease serum lipid peroxides of 33%.
Alonso J,(2004) conducted a comparative clinical study on the effects of curcumin at dosages of 400mg per day to 1200mg per day to the drug phenylbutazone for 80 patients in treating post operative inflammation in St.Johns university,Banglore.It was found that curcumin was as effective as phenylbutazone in treating post-operative inflammation and arthritis. curcumin prevents the synthesis of several inflammatory prostaglandins and leukotrienes .curcumin has a similar action to aspirin except that curcumin does not cause vascular thrombosis the way aspirin does curcumin anti-inflammatory properties may be attributed to its ability to inhibit pro-inflammatory arachidonic acid, as well as neutrophil function during inflammatory states. The curcumin shows significance at 0.01 level of 't' test and functional assessment scale acts as effective treatment (72%) modality for the same and progresses towards the processes of healing properties.
Gescher, Mead, Desnottes & Badmaev,(2004) conducted a randomized clinical trial for reducing vitiligo by evaluating 15 Asian patients with acute vitiligo who consumed turmeric daily at the dose of 300mg twice for a period of 6 weeks. The patients grouped in to two groups with routine measures of control and experimentation with turmeric, where using cross sectional approach. After 6 weeks of treatment the facial repigmentation was nearly completed in 6 of the 8 patients, where as only minor to moderate or no response was obtained in the remaining 7 patients, researchers are very satisfied with the healing power of turmeric. Advance research in science has discovered that turmeric is having one of the prominent medical benefits for number of people. It is widely coming in to the literature at an increasing pace with its healthy benefits. Turmeric is used as an antiseptic because of its strong healing power.
Andrew Weil,(2005) conducted a randomized clinical research study funded by NIH's National Center for complementary and Alternative Medicine (NCCAM).It explored the use of turmeric for the treatment of rheumatoid arthritis, an autoimmune condition affecting two million Americans.40 patients were started with the treatment.The usual recommended dose is 400-600mg daily of turmeric tablets or capsules taken three times daily or as directed on the product label. Author recommends products labeled as standard curcuminoids, cautioning that it can take up to two months before results are observed using visual analogue pain scale and for 25 patients joint pain declined (p>0.05), edema and stiffness reduced and starts their daily activities.
A placebo controlled double blinded study conducted in 1986 showed that a dosage of 1200mg of curcumin a day was more effective in reducing post surgical inflammation than either the placebo group.The study suggest that turmeric /curcumin is most effective for acute inflammation, thus it reducing the post surgical inflammation, after treatment therapy those who took curcumin shows effective results and highly reliable (r=0.8) when compare to placebo effect and the same recommends for arthritis . Majeed,(2006)