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Phytotherapy Review & Commentaryby Kerry Bone, FNIMH, FNHAA

www.mediherb.com

Myrrh: A Significant Developmentin the Treatment of Parasites

Myrrh has been used as a medicinal herb for thousands ofyears. It is mentioned several times in the Bible, in writings asold as Psalms and the Song of Solomon, and of course it is wellknown as one of the three gifts that the Magi brought to JesusChrist.'

Despite this ancient record of use, clinical trials on mjTrhwere lacking until recently when a group of Egyptian scientistsexamined its value in the treatment of fascioliasis (liver fluke).^Since then, a numher of other clinical studies have beenpublished that suggest the clinical use of myrrh represents asignificant advance in the herbal treatment of parasites. Whatis particularly interesting is that myrrh seems to he activeagainst parasites that infest deeper in the hody than the gut,such as in the liver and bladder {the latter in the case ofsehistosomiasis).

What is Myrrh?The name "myrrh" is probably derived from the Arabic or

Hebrew word "mur," which means bitter. Myrrh (Arabian orSomali Myrrh) is an oleo-gum resin, obtained from the stem ofvarious species of Commiphora (Burseraceae) growing innortheast Africa and Arahia. Texts have traditionally given theprincipal source as C molmol, but the chief source today is C.myrrha.'^

Almost all memhers of the Burseraeeae possess oleoresincanals in the phloem, and when cracks and fissures form in thebark, the resin exudes spontaneously. This yellowish-whiteviscous fluid soon hardens in the heat to reddish-browncrystalline masses. In some cases, incisions are made in thebark to encourage the resin production.^

Chemical CompositionMyrrh is composed of a volatile (essential) oil (two to ten

percent), including sesquiterpenes, an alcohol-soluble resin (25to 40%) containing eommiphoric acids and a water-soluble gum(30 to 60%).*

Traditional Uses of MyrrhMyrrh has been used in all the great traditions of herbal

medicine. Traditional Western herbal uses include the following:• mouth ulcers, pharyngitis, gingivitis, laryngitis,

respiratory catarrb, the common cold, chronic catarrh,bronchitis, excessive mucous secretion, boils,̂ '̂

• chronic gastritis, atonic dyspepsia; amenorrhea, femalereproductive tract disorders accompanied by a draggingsensation and leukorrhea,**

• topically for damaged gums, wounds, abrasions, poorlyhealing skin ulcers, and sinusitis.^^

Uses and properties from traditional Chinese medicineinclude the following:

• invigoration of the blood, dispersing congealed blood,redueing of swelling and alleviating pain, thus used to treattrauma, sores, boils, swelling, abdominal masses or pain, chestpain, amenorrhea,®

• topically, for ebronic poorly healing sores."

Traditional Ayurvedic uses include the following:• dyspepsia, chlorosis (hypoehromic anemia), amenorrhea,

uterine disorders, menstrual disorders in young girls, chropicbronchitis, tuberculosis,^

• a mouthwash for mouth uleers and sore throat.*In modem Western herbal use, myrrh (as noted above) has

been largely relegated to a topical agent, especially for themouth, gums, and throat. Hence, the rediscovery of theantiparasitie properties of myrrh places this herh into acompletely new perspective. Rediscovery is the appropriate termsince the US Eclectic text King's Dispensatory'^'^ mentions itsuse as a vermifuge, and Maude Grieve also makes mention ofthe same use."

Pharmacological Activity

Antiparasitie ActivityA study on mice demonstrated that myrrh at an oral dose of

500 mg/g for five days before infection or one day after infectionbad a valuable schistosomicidal effect against the differentmaturation stages of Schistosoma mansoni.^'

This is the organism that causes bilharzia. In addition, thelivers of mice treated with myrrh (500 mg/g orally) for eightweeks after infection with schistosoma showed a markedreduction in degenerative changes.'^ Myrrh has alsodemonstrated activity against S. mansoni worms in wiYro.'•'Notall the studies have been positive. There is one reported studywhere myrrh failed to exhibit any significant antiparasitieactivity in mice and bamsters infected with S. mansoni.^^

Molluscicidal ActivitySnails act as vectors for S. mansoni, hence molluscicidal

activity can play a role in the prevention of biiharzia(sehistosomiasis). The moUuseicidal properties of the oil extractof myrrh were tested against the Egyptian snail speciesBiomphalaria alexandrina, Bulinus truncates, and LimnaeacailUaudi. The impact of the extract on the egg clutches of B.alexandrina and L. cailliaudi was also evaluated. Snails andtheir eggs were exposed for 24 and 48 hours at 22°C to 26°C tovarious concentrations of the extract. The results showeddifferent susceptibilities. B. alexandrina showed higher LD50and LD90 (155,195 ppm) concentrations than B. truncatus (50,

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SPECIAL SECTION: TREATING MALARIA and PARASITE DISORDERS with NATURAL MEDICINE

95 ppm) and L. cailliaudi (50, 85 ppm) after 24-hour exposure.One hundred percent mortality was obtained for the eggclutches of B. alexandrina and L. cailliaudi at concentrationsof 100 ppm and 75 ppm, respectively.'^ Myrrh also inhibitedthe spreading of S. mansoni eggs from infected snails at aconcentration of one part per million.'^

The effect of exposing B. alexandrina to a sub-lethal dose(LDIO and LD20) of myrrh (on its susceptibility to infectionwith S. mansoni) was also determined.^" Starting three weekspost exposure, cercarial shedding was monitored. No sheddingof cercariae were observed from snails treated with the LD20dose. The study revealed that sub-lethal exposure to myrrhdecreased the compatibility of B. alexandrina to S. mansoniinfection, thus playing an important role in tbe control ofsehistosomiasis.

Insecticidal ActivityMyrrh has been shown in vitro to be toxic to the fowl tick

Argas persicus^^ and was larvicidal against tbe Culex pipiensand Aedes caspius mosquitos.^°>^'

Other ActivityA sesquiterpene fraction from myrrh (a mixture of

furanodiene-6-one and methoxyfuranoguaia-9-ene-8-one)demonstrated local anesthetic activity in vivo and showedantibacterial and antifungal activity against standardpathogenic strains of Escherichia coli, Staphylococcus aureus,Pseudomonas aeruginosa, and Candida albicans, withminimum inhibitory coneentrations ranging from 0.18 to 2.8

Myrrh increased glucose tolerance in vivo under botb normaland diabetic conditions.^^ Two furanosesquiterpenes isolatedfrom myrrh exhibited hypoglycemic activity in an experimentalmodel of diabetes.^'' Myrrh exhibited strong antithromboticactivity in vivo.^^

Pretreatment with an aqueous suspension of myrrh (250-1000 mg/mL) protected against the ulcerogenic effects of severalnecrotizing agents, including ethanol and indomethacin. Theprotective effect of myrrh was attributed to its effect on mucusproduction and an increase in nucleic acid and non-proteinsulfhydryl coneentrations, which appeared to be mediatedthrough its free radical-scavenging, thyroid-stimulating, andprostaglandin -inducing properties. ̂ ^

Petroleum ether extract of myrrh (500 mg/kg, oral route)produced significant anti-inflammatory activity in carrageenan-induced infiammation and cotton pellet granuloma models.Antipyretic activity was also ohserved in vivo}'' Myrrhdemonstrated significant anti-inflammatory activity in thefollowing experimental models: xylene-induced ear edema (400mg/kg pretreatment by injection) and cotton pellet granuloma(400 mg/kg, oral).28

An analgesic activity was demonstrated after oraladministration of myrrh in vivo. The active analgesiccompounds were identified as two sesquiterpenes, particularlyfuranoeudesma-l,3-diene. This compound was shown to bindto opioid receptors in isolated brain membrane. Naloxone, anopioid antagonist, completely inhibited tbe analgesic effect ofthis compound by injection in vivo. Furanoeudesma-l,3-dieneexhibited structural similarities witb two opioid agonists(morphiceptin and DPDPE).̂ '̂̂ ^

Treatment with myrrh was found to have an anti-carcinogenic effect in vivo on solid tumors induced by Ehrlichcarcinoma cells. The activity was comparable to the standardcytotoxic drug cyclophosphamide and was more pronounced

after 25 days compared to 50 days of treatment.^'^^ Anotherstudy found that pretreatment with myrrh did not alter thebiochemical and cytological effects of cyclophosphamide and didnot show any additive effect.̂ ^ Both an extract and a fraction ofmyrrh stimulated phagocytosis in vivo after intraperitonealinjection.̂ '*

Veterinary StudiesMyrrh has heen tested in uncontrolled field trials for the

treatment of various parasitic infestations in sheep. In sheepnaturally infected with fascioliasis, doses of 300 to 600 mg ofextract were administered for one to three days.̂ '̂ A total doseof 900 to 1200 mg of extract gave a complete cure rate asassessed by stool or physical examination.

Fifteen sheep naturally infected with Dicrocoeliumdendriticum (as proven parasitologically) were successfully andsafely treated with two capsules of myrrh (300 mg each ofextract) on an empty stomach an hour before eating for foursuccessive days.̂ ^ Cure (100%) was successfully achieved asdetermined by stool analysis for seven days and macroscopieallyfor detection of any adult worms.

In sheep infected naturally with Moniezia expansa, a totaldose of 3600 mg of myrrh extract (as 900 mg per day for fourdays) or 4800 mg (as 600mg of extract for eight days) gave 100%cure rates.^'Response rates were assessed by microscopic andmacroscopic stool examination.

Clinical StudiesAll tbe studies cited below were open-label pilot studies.

However, it can be reasonably inferred that a marked placeboeffect in parasitic infestation is unlikely and that a truetherapeutic effect was observed for myrrh. The mode of actionof myrrh has not been established. Rather than exerting a directantiparasitie effect, it could be acting via stimulation of thepatient's natural immunity against parasites.

FascioliasisAn open-label pilot study examined the action of myrrh in

seven patients with fascioiiasis.^^ The treatment (a formulationconsisting of eight parts of resin and 3.5 parts of volatile oil, allextracted from myrrh) was given at a dose of 12 mg/kg per dayfor six consecutive days in the morning on an empty stomach.Patients were followed for three months. The therapy provedto be effective, with pronouneed improvement of the generalcondition of patients and amelioration of all symptoms andsigns. A dramatic drop in the egg count was detected at the endof treatment. Eggs were no longer detectable in the feees threeweeks after treatment and after a follow-up period of threemonths. High eosinophilic counts, elevated liver enzymes, andfaseiola antibody titers returned to nearly normal. No signs oftoxicity or adverse effects were observed. The authors concluded

Liver'The liver is the second-largest organ in the body (your skin isthe largest) and is the largest gland, tt performs manyessential functions and you cannot live without i t ." wikipedia

'The liver is among the few internal human organs capable ofnatural regeneration of lost tissue; as little as 25% ofremaining liver can regenerate into a whole liver again."

- Wikipedia

'Medical terms related to the liver often start in hepato- orhepatic from the Greek word for liver, hepar." Wikipedia

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that the formulation of myrrh was safe, well tolerated, andeffective for treating fascioliasis.

In an open-label controlled study, 68 patients were included:30 with faseiola infection; 20 were infected with other parasitesbut not faseiola (infected control group); and 18 individuals wereparasite-free (normal control group).^^ For all groups, stoolsamples were evaluated for egg counts; circulating faseiolaantigens (CFAgs) and the anti-fasciola IgG4 isotype were alsoevaluated. Complete blood count, liver function tests, andabdominal ultrasonography were performed for all fasciola-infected patients. Patients with fascioiiasis received myrrhextract at a dose of 10 mg/kg, one hour before breakfast for sixconsecutive days. Detection of CFAgs was found to be a usefulmarker for assessment. No cross-reaction was observed betweenfaseiola and otber parasites by using CFAg (100% specificity).Tbe level of tbese antigens correlated positively witb signs ofcure, parasitologically, clinically, or ultrasonographically. Myrrhextract was found to have a bigb tberapeutic efficacy (100%cure rate) on fascioliasis without remarkable side effects.

To determine their role in the immunopathogenesis offascioliasis in relation to treatment with myrrh, a study wasdesigned to evaluate total IgE and the in vitro production ofIL-1 beta and IL-4 by peripheral blood mononuclear cells.*" Atotal of 35 patients witb chronic fascioliasis with an age rangefrom nine to 45 years were included in tbe trial. In addition,ten bealtby subjects witb matched age and sex served ascontrols. Serum IgE and in vitro IL-1 and IL-4 were estimatedby enzyme immuno-assay (ELISA) before and three monthsafter therapy. Results revealed significant elevation of IL-1 hetain patients before treatment compared to controls (p<0.001),but this decreased significantly after therapy (p<0.001) to reachthe control level (p=0.16). In contrast, IL-4 was significantlylower than controls before therapy (p=0.04) and increasedsignificantly after treatment (p<0.001) to reach control levels(p=0.59). Total IgE was significantly elevated in patients beforetreatment (p<0.001), and it did decrease significantly withtreatment (p<0.001), altbougb it remained significantly bigbertban the control level. Tbe authors concluded that myrrh is aneffective fasciolicidal drug. IL-1 may he involved in diseaseimmunopathogenesis and depressed IL-4 may be a pbenomenonof parasite immune suppression.

A field trial was conducted in Egypt to assess the efficacyand safety of a myrrh extract (1200 mg per day for sixconsecutive days) for the treatment of human fascioliasis.^'Evaluation of 1019 individuals revealed the presence offascioliasis in 17. Cure rates in these patients were 88.2% and94.1%, respectively, at two and three months followingtreatment.

A total of 21 children with fascioliasis (eight males and 13females) with a mean age of 10.4 years and eigbt childreninfected with Sehistosomiasis mansoni (six males and twofemales) withameanageof 11.37 years were treated witb myrrhextract in an open-label trial.''^ Also, ten healthy matchedchildren were utilized as controls. Diagnosis was based on thedetection of Faseiola hepatica or Schistosoma mansoni eggs instool samples. Myrrh extract was given as 10 mg/kg/d one hourbefore breakfast for three consecutive days in sehistosomiasisand for six days in fascioliasis. Clinical evaluation and stoolanalysis were done initially and at two, four, and 12 weeks post-treatment to evaluate cure. Rectal snip was done for respondingsehistosomiasis cases to confirm recovery. Tbe cure rate was90.9% in fascioliasis and 100% in sehistosomiasis at four weekspost-treatment. After a second course of treatment, tbose

faseiola patients who remained positive were cured. Total IgEwas significantly higher in faseiola and scbistosoma patientsbefore treatment compared to controls (p < 0.001; 0.005,respectively) and decreased significantly with therapy (p =0.001; 0.036). IL-lheta was higher in both patient groups thancontrols (p < 0.001; 0.003) and decreased significantly 12 weeksafter therapy to control levels (p < 0.001; 0.017). IL-5 was bigbbefore treatment in botb groups (p = 0.041; 0.027) and deereasedsignificantly 12 weeks after tberapy (p = 0.005; 0.012). IL-4 didnot differ from control before therapy (p = 0.58; 0.79) hutincreased significantly after treatment in hoth patient groups(p = 0.04; 0.02). It was concluded that myrrh is an effectivefasciolicidal and sehistosomicidal treatment.

SehistosomiasisAs well as tbe trial described above, other studies conducted

in Egypt have investigated the activity of myrrh extract inschistosomiasis. An open-label trial was conducted on 204patients suffering from tbis infestation.'*^

Myrrh extract was given at a dose of 10 mg/kg for threedays and found to effect a cure rate of 91.7%. Retreatment ofthe nonresponsive cases witb tbe same dose for six daysincreased the overall cure rate to 98%. Myrrb was ohserved tobe well tolerated, and side effects were mild and transient.Twenty cases provided biopsy specimens six months later, andnone showed living ova.

Among 1019 individuals parasitologically examined in anopen-label field trial, the prevalence of S. haematobium and S.mansoni were 4.2% and 2.4%, respectively, and tbe geometricmean egg count were 33.2 eggs/10 mL urine and 113.3 eggs/gram stool.''•'

Most of tbe patients with hematohiasis and mansoniasiswere <15 years (56.4% and 53.8%) and males (56.4% and 53.8%).All cases were treated by myrrh extract as two capsules (600mg) on an empty stomach an hour before breakfast for sixconsecutive days and were followed up clinically andparasitoiogically by urine and stool analysis. The parasitologicalcure rate after three months was 97.4% and 96.2% for S.haematobium and S. mansoni eases, respectively, witbout anymajor side effects. Patients not completely responding to a singlecourse of treatment showed a marked reduction of egg levels.

A more recent trial was again an open-label design, but withtbe important inclusion of randomization and an active controlgroup. The results for myrrb were less impressive tban theahove, but the trial dosage used was either lower or for lesstime than in previous clinical evaluations (600 mg per day forthree consecutive days). One hundred and four individualsinfected with Schistosoma mansoni were randomized in twogroups, one for myrrh and tbe second for praziquantel.*^Treatment, whether myrrb or praziquantel, was given twicewitb a three-week interval. The cure rate witb myrrh was verylow, 15.6% after the first treatment and 8.9% after the secondtreatment. Egg reduction among uncured persons was also verylow, being 17.2% after the first treatment and 28% after thesecond treatment. Tbe praziquantel cure rate was 73.7% and76.3%, and individuals still passing S. mansoni ova afterpraziquantel treatment sbowed a substantial reduction in thegeometric mean egg counts (84% and 88.2% after the first andsecond treatments, respectively). Similarly, another trialcomparing myrrh witb praziquantel found low cure rates formyrrh (around 9%), but again a lower dose than that used inprevious trials was employed (300 mg of extract per day forthree

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SPECIAL SECTION: TREATING MALARIA and PARASITE DISORDERS with NATURAL MEDICINE

ToxicologyThe LD50 for an oil of myrrh was given as 1.65 g/kg in rats.*'

Doses of an ethanolic extract given by mouth at 1000 mg/kg tomale Wistar rats for two weeks led to depression, jaundice,ruffled hair, bepatonephropathy, hemorrhagic myositis, anddeatb, accompanied by increases in serum ALP and ALTactivities, bilirubin, cholesterol, and creatinine concentrations;decreases in total protein and albumin levels, and macrocyticanemia and leucopenia.**' In acute toxicity testing, myrrh oieo-gum resin exhihited no visible signs of toxicity, and no mortalitywas observed up to 3 g/kg in mice. A decrease in locomotoractivity was noticed at 3 g/kg. In chronic oral testing (100 mg/kg/day, 90 days), there was no significant difference in mortalitycompared to controls. At the end of treatment, there was asignificant increase in weight of testes, caudae epididjTnides,and seminal vesicles, and in red hlood count and hemoglobinlevels in the myrrh-treated group.*^

Death occurred after consumption of between 5 g and 16 gplant resin/kg/day in goats. Entero-bepatonephrotoxicity wasaccompanied by anemia, leucopenia, increases in serum ALPactivity and concentrations of biliruhin, cholesterol,triglycerides, and creatinine, and decreases in total protein andalhumin. The oral dose of 0.25 g plant resin/kg/day was nottoxic.^

Prescribing InformationActions

Astringent, antimicrobial, antiparasitie, anti-inflammatory,vulnerary

Potential IndicationsBased on appropriate evaluation of the patient, consider

prescribing myrrh in formulations in the context of thefollowing:

• parasitic infestations• chronic bronchitis, the common cold, chronic catarrh;

inflammation of the mouth and throat• gastritis, dyspepsia; amenorrhea, leukorrhea• topical treatment for inflammations of the mouth and

throat, skin inflammations, wounds, ahrasions• In Germany, the use of myrrb topically to treat mild

inflammations of the oral and pharyngeal mucosa is supportedhy the Commission E.̂ ^

• ESCOP recommends myrrh for the topical treatment ofgingivitis, stomatitis (mouth ulcers), minor skin inflammations,and minor wounds and ahrasions, and as a supportive treatmentfor pharyngitis and tonsillitis.*^

ContraindicationsKnown allergy. According to traditional Chinese medicine,

myrrh is contraindicated in pregnancy and in cases of excessiveuterine bleeding.*

Warnings and PrecautionsDepending on the level of dilution of the tincture, a transient

burning sensation on the skin or mucous membranes may beexperienced from the topical application of myrrh. Myrrh shouldnot be ingested for prolonged periods (more than a few weeksat a time) because of the potential of allergic contact dermatitisand other allergic reactions. >•

INSTITUTE OF QUANTUM AND MOLECULAR MEDICINE ( IQMM)

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DANIEL G. CLARKPRESENTS

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DosageThe typical adult dose is 1.5 to 4.5 mL per day of the 90%

ethanol 1:5 tincture for most of the clinical indications describedabove. However, for the antiparasitie effects, higher doses forshort periods (three to six days) are required. For example, 600mg of the myrrh extract used in the trials probably correspondsto about 2 g of crude resin or 10 mL of 1:5 tincture.

Use in PregnancyNo increase in frequency of malformation or other harmful

effects on the fetus from limited use in women. No evidence ofincreased fetal damage in animal studies. Administration of acombination of resin and volatile oil extracted from myrrh topregnant rats (50-200 mg/kg from days six to 15) caused noabnormalities in the fetal skeleton.*^

According to traditional Chinese medicine, however, myrrhis contraindicated in pregnancy.^''

Adverse ReactionsContact allergy has been reported in the use of myrrh for

topical application.̂ ^"^^ Continued topical use of essential oils,including those of myrrh, were associated with a deteriorationof symptoms in a study on children with atopic eczema,suggesting a possihle build up of contact sensitivity.^^

Two cases of allergy due to oral administration of myrrhhave been reported in traditional Chinese medicine literature.In both cases, the patients received a formulation containingmyrrh, which was subsequently identified as the allergen.**

InteractionsOne case has been reported from Saudi Arabia of an

antagonism of the anticoagulant effect of warfarin.'"

Kerry BoneP.O. Box 713Warwick QLD 4370, Australia+6 7 4661 0700; Fax +6 7 4661 0788

Notes1, Nabataean Trade Items, Nabataea.Net, CanBooks. 2002,2, Massoud A, E! Sisi S, Salama O et al. Preliminary study of therapeutic efRcacy of a

new fasciolicidal drug derived from Commipkora motmot {myrrh). Am J Trop MedHyg. 2001; 65(2); 96-99,

3, Evana WC, Trease and Evana'Pharmacognosy. 14th Ed, London: WB Saundera, 1996,p289,

4, Mills S, Bone K The Esneniiat Guide to Herbal Safety. Churchill Livingstone, USA.2006, p 514,

5, British Herbal Medicine Association's Scientific Committee, British HerbalPharmacopoeia. BHMA, Bournemouth, 1983.

6, Felter HW, The Eclectic Materia Medica. Pharmacology and Therapeutics. 1922,(Reprintedi Portland: Eclectic Medical Publications, 1983,

7, British Herbal Medicine Association, British Herbal Compendium. Bournemouth:BHMA, 1992,

8, Bensky D, Gamble A, Chinese Herbal Medicine Materia Medica. Seattle: EastlandPreaa. 1986,

9, Chopra RN, Chopra IC,HandaKLeta1, Chopra's Indigenous Drugs of India, 2nd Ed,1958, (Reprinted] Calcutta: Academic Publishers, 1982,

10, Felter HW, Lloyd JU, King's American Dispensatory. 18th Ed,, 3rd revision, 1905,(Reprinted) Portland: Eclectic Medical Publications, 1983. pp, 1298-1301,

11, Grieve M, A Modern Werba/, Vol,II, New York: Dover Publications, 1971, pp,571-572,12, Massoud AM, El Ebiary FH, Abou-Gamra MM et al. Evaluation of schiatoaomicidal

activity of myrrh extract parasitolngical and histological study. J Egypt Soc Parasitol,2004; 34(3 Svippl): 1051-1076,

13, Masaoud AM. El Ebiary FH, Abd El Saiam NF, Effect of myrrh extract on the liver ofnormal and bilharzially infected mice. An ultrastructural study, J Egypt Soc Parasitol,2004; 34(1): 1 21,

The Tbwnsend Letter officeswill be closed June 26 to July 9

for summer holidays

14, Hassan M, El-Motaiem M, Afify H et al. In vitro effect of Mirazid on Schistosomamansoni worma. J Egypt Sac Parasitol. 2003; 33l3): 999-1008,

15, Botros S, William S, Ebeid F et al. Lack of evidence for an antischistosomal activityof myrrh in experimental animals, AfnJ Trop Med Hyg. 2004; 71(2): 206-210,

16, AllamAF, el-SayadMH. KhaliISS, Laboratory assessment of the molluscicidal activityof Commiphora motmol (Myrrh) on Biomphataria alexandrina, Bulinus truncatusand Lymnaea cailliaudi. J Egypt Soc Parasitol. 2001; 31(31: 683-690,

17, Massoud AM, Habib FS, The effects of myrrh {Commiphora molmol) on the infectedsnails of Schistosoma sp. and their egg massea: effect on shedding ofcercariae and onsnail fecundity. J Egypt Soc Parasitot. 2003;33(2): 585-596,

18, Maasoud A, Metwally DM, Khalifa KE et al. Compatibility of Biomphalariaalexandrina snails to infection with Schistosoma mansoni after exposure to suhlethalconcentrations of Myrrh, Jfi^ejp^ Soc Parasitol. 2004;34(3): 995-1008,

19, Massoud AM, Kutkat MA. Abdel Shafy S et al, Acaricidal efficacy of MyrrhiCommiphoro motmol) on the fowl tick Argas persicus(Acari:ArgaBidaelJ£^jp( SocpQrasiro;,2005;35(2): 667-686,

20, Massoud AM, Labib IM, Rady M, Biochemical changes of Cuiex/)if>iens larvae treatedwith oil and oleo-reain extracts of Myrrh Commiphora molmot. J Egypt Soc Paraiitol.2001;31(2): 517-529,

21, Maaaoud AM, Labib IM, Larvicidal activity of Commiphora molmol against Cultxpipiens anA Aedes caspius larvae, J Egypt Soc Parasitol. 2000;30(ll: 101-115,

22, Dolara P, Corte B, Ghelardini C et al, Pianto Med. 2000;66(4): 356-358,23- Al-Awadi FM. Gumaa KA. Acto Z>io6e(o; Lat, 1987; 24(11: 37-41.24, Uhillas RP, Mendez CD, Jolad SD et al, Ptanta Med. 1999; 65(8): 778-779,25- O]a}ide OA. Phytother Res. 1999;1313): 231-232-26, al-Harbi MM, Qureshi S, Raza M et al, J Kthnopharmacol. 1997;55(2): 141-150,27, Tariq M, Agee! AM, Ai-Yahya MAet al. Agents Actions. 1986;17(3-4): 381-382,28, AttaAH, Alkofahi A, JEf/inopftormoco/. 1998,60:117-124,29, Dolara P, Luceri C, Ghelardini C et al. Nature. 1996;37916560); 29,30, Dolara P, Moneti G, Pieraccini H et al, Phytother Ren. 1996;10(Supp 11: S81-S83,31, al-Harbi MM, Qureshi S, Ra^a M et al. Chemotherapy. 1994;40(5): 337-347,32- Qureshi S, al-Harbi MM, Ahmed MM et al. Cancer Chemother Pharmacol.

1993;33(2):130-138,33, al-Harbi MM, Qureshi S, Ahmed MM etal. Am JC/iinilfed, 1994; 22(l):77-82,34, DelaveauP, Lallouette P,1taaier AM. P;an(a Med, 1980;40( 1): 49-54,35, Haridy FM, El Garby MF, Moray TA, Efficacy of Miraiid (Commiphara molmol) against

faacioliasLs in Egyptian aheep. J Egypt Soc Paraaitol. 2003;33(3):9l7-924,36, Al-Mathai EM, Fouad MA, Myrrh iCommiphora molmot) in treatment of human and

aheep Dicrocoeiiasis dendriticum in Saudi Arabia, J Egypt Soc Parasitol. 2(X)4;34(2):713-720,

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