The scientific study of herbal wound healing therapies: Current state of play

SummaryAcute wound healing occurs in four stages, namely, haemostasis, inflammation, proliferation and remodelling. Underlying metabolic disturbances and/or disease may disrupt the regenerative process, causing delayed healing. This has imposed a huge financial burden in both the developed and undeveloped world. As a result, the possibility of deriving alternative, cost effective therapies from traditional plant-based medicines has been explored.The majority of such investigations take the form of in vitro assays based on cell culture models of the various phases of healing. Although insightful in terms of possible modes of drug action, it is conceded that in vitro assessments are insufficient to demonstrate efficacy and both animal testing and human trials are required for global scientific acceptance.Aloe vera is the only herbal medicine to be subjected to all three forms of assessment and is an appropriate example of the scientific methodologies to which herbal medicines are currently subjected. A discussion of the virtues and drawbacks of the in vivo and in vitro approach is given, together with an indication of the information which may be derived from each.It is concluded that in vitro models based on cells derived from diseased tissues are superior to other in vitro models and, in some respects, to animal studies.The investigation of wound healing herbal therapies should be directed toward clinical trials. For the purpose of the joint demonstration of efficacy and elucidation of drug mechanisms, such trials should, where possible, be performed with attendant tissue culture of cells derived from participants.