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Evaluation of the Safety of External Application of Herbal Oil (“Gidan”) on Horses’ Limbs Savariego, G., Tatz, J.A., Segev, G., Kelmer, G

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Evaluation of the Safety of External Application of Herbal Oil (“Gidan”) on Horses’ Limbs Savariego, G., Tatz, J.A., Segev, G., Kelmer, G Evaluation of the Safety of External Application of Herbal Oil (“Gidan”) on Horses’ Limbs Savariego, G., Tatz, J.A., Segev, G., Kelmer, G. Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O.B. 12, Rehovot 76100, Israel. * Corresponding Author: Dr. Gal Kelmer, DVM., Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel. ABSTRACT Tendons and ligaments injuries are highly common in the equine population and they tend to carry a high recurrence rate and prolonged healing period. The treatment and prevention of tendon injuries is complex and the combination of complementary and alternative methods into current regimes may be beneficial. However, the literature regarding the safety and efficacy of such treatments is scarce. “Gidan” is an herbal liniment, designed according to traditional Chinese methods, for the relief of muscle and tendon related pain. This study aimed to evaluate the safety of external application of “Gidan” on distal limbs of horses and lay the foundation for future studies evaluating the efficacy of “Gidan” and similar materials. “Gidan” was applied twice daily on two distal limbs of 10 horses for a 7 day period. The two remaining limbs served as controls and were treated with a carrier liniment without the “Gidan” herbal extracts. Two limbs of each horse (“Gidan” and control) were bandaged. Allocation to treatments was random. Adverse skin reactions were assessed, ranked and photographed during the trial period and at 5 days following last application. Nearly half of the limbs tested exhibited mild adverse skin reactions, most of them delayed and were only visible days after application was ceased. Analysis shows that bandaging was clearly the main risk factor for developing such reactions. It was concluded that “Gidan” was not the cause of the dermatological reactions. The external topical use of “Gidan” herbal liniment on horses’ distal limbs appeared to be safe on non- bandaged limbs. The use of bandaging requires further evaluation. Keywords: Gidan; Herbal; Safety; Chinese Medicine; Equine; Tendonitis. INTRODUCTION successfully (2). The anatomical architecture of tendons Lameness and other orthopedic problems were ranked in and ligaments is designed to allow tendons to passively a comprehensive survey conducted in the USA as the most transfer force generated by muscle to bony attachments prevalent health issue affecting horses (1). Furthermore, on the opposite side of a joint, or joints and in so doing lameness was ranked by horse owners, riders and veterinar- provide movement. The biomechanically most significant ians as the most concerning problem regarding the horse’s tendons and ligaments are located on the palmar/plantar health as it leads to a substantial loss of working days and aspect of the equine distal limb. At that location they receive may even lead to euthanasia (1). Injuries attributed to significant weight-bearing loads and, are responsible for the tendons and ligaments are perceived as being potentially majority of the movements of the horse (3). The unique threatening to an equine athlete’s career as their initial structural arrangement within tendons and ligaments al- subtle clinical sign often tend to delay recognition at lows the horse to exercise at high speeds while minimizing which point they become severe and difficult to manage energy expenditure (3). 26 Savariego, G. Israel Journal of Veterinary Medicine Vol. 70 (3) September 2015 Research Articles The tendons, type 1 collagen fibers, have a crimp pattern the herbal essence to directly reach the underlying tissues that contributes to its elasticity and enables storing energy in (10). Compared with oral route of administration avoiding an effective manner. These tendons are subjected to repeated the initial hepatic screening and allows the medication to motion and degeneration over time and thus they are prone exert its effect continuously as absorption advances (10). to both acute and chronic injuries (4). Due to high collagen Allergies are a potential adverse effect of virtually any content and low cell numbers, tendons and ligaments have a herbal or synthetic medication applied topically or systemi- slow metabolic rate of activity and it may take 8–12 months cally (11). Numerous human reports of allergic and other to regain adequate tensile strength after significant damage dermatological reaction to herbal medicines are known to (5). Recurrence of tendon injury after return to full work occur, tending to be mild to moderate and transient in nature is rather frequent, depending on the severity of the injury, (11). Though herbal medication is generally perceived as safe, rehabilitation program, tendon involved, forelimb versus especially when applied topically, a cutaneous adverse effect is hind-limb and the therapies applied (5). always a possibility and topical application of herbal remedies The treatment and prevention of tendon and ligament is not without risk (11). injuries is complex and usually requires a combination of TCM is considered one of the most ancient healing arts methods and disciplines in order to achieve the optimal known to man, with documentation of practice of over 3000 results. Currently used modalities include, among others, years. The Traditional Chinese Veterinary Medicine (TCVM) conservative methods such as anti-inflammatory medication, has developed in close conjunction with the TCM. Though ice and bandaging incorporated into a long resting period relatively new to western culture, the implementation of simi- (5). Recent and advanced methods aim to reduce healing lar methods in animal medicine, has been known and well period and re-injury occurrence. One potentially useful documented for thousands of years (12). The incorporation of modality is the extracorporeal shockwave therapy, due to its TCVM methods to the western veterinary medicine practice analgesic properties and it possible enhanced tendon healing is continuously growing due to increased interest both by by stimulating vascular in-growth (6). Recently regenera- pet owners and practitioners, seeking complementary and tive medicine has been gaining increasing popularity; these alternative treatment modalities and options (13). therapies include autogenous stem cell implantation, bone According to the TCM, herbs used for medicinal pur- marrow or adipose tissue derived and platelets rich plasma poses hold a variety of characteristics, representing different (PRP) (7). All these regenerative modalities are aimed at traits that are harnessed in order to apply proper medication. promoting cell proliferation, differentiation and improving Formulating herbal remedies requires proper integration of the quality and the speed of healing. These methods seem those characteristics in order to achieve harmony and regain to carry an enormous potential but at this point lack solid balance (13). scientific support (5). “Gidan” liniment has been used by athletes, physical Currently, the use of complementary and alternative therapist and orthopedists for the relief of muscle and ten- medicine is slowly establishing its status among other don related pain post exercise for almost a decade, without therapeutic options as a valid and beneficial modality avail- any known adverse effects (14). “Gidan” is composed of an able for the equine practitioner (8). One major mode is the assembly of herbs extracts and essential oils based on their use of herbs and herbal extracts from traditional Chinese therapeutic and medicinal virtues as attributed by TCM. medicine (TCM) via topical application. This mode of ap- The basis of the liniment is Olive oil (olea europaea, 68%) plication has major advantages as it increases the assurance solidified with bee wax (18%) and it contains the following that the herb interacts with the target tissue and reduces extracts: MO YAO (Myrrh, commiphora myrrha), XIANG concern of systemic effects. Topical application also allows RU) Olibanum, Boswellia carteri), HONG HUA (Safflower, easy monitoring and observation regarding treatment effec- Carthamus tinctorius) and SAN QI (Notoginseng, Panax tiveness and whether adverse reactions, e.g. allergy, irritation, pseudoginseng) that according to TCM invigorates blood to or progression of the disease, are on going (9). TCM prac- relieve pain, reduce swelling, and promotes tissue regenera- titioners usually rely on the use of topical herbal pastes for tion (15). The liniment also contains the following essential metabolic enhancements of tissue repairs. This route allows oils (<0.5% each): Eucalyptus )Eucalyptus globules(, Lavender Israel Journal of Veterinary Medicine Vol. 70 (3) September 2015 Safety Study of Gidan Treatment 27 Research Articles (Lavandula officinalis), Lemon (Citrus limonum), Rosmary and were treated with the solidified olive oil, and afterwards (Rosmarinus officinalis), Mint (Mentha piperita), Nutmeg one of the two limbs was also bandaged in the same manner (Myristica fragrans) and Vitamin E (Tocopherol). as the treated one. The materials were administered twice The rising interest in combining herbal use with routine daily (q12h), manually, using new examination gloves for veterinary medicine is in contrast to the lack of studies evalu- each material for each horse. ating the efficacy and safety. This study aims to evaluate the safety of external application of “Gidan” on distal limbs of Designation of groups horses. Ideally, this safety study
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