Commiphora sp. / Myrrhe
Commiphora myrrha is a small, thorny tree or shrub that can grow to 9 feet tall.1,2 It is native to southwest Asia, including Arabia, and most commonly east and northeast Africa near the region of the Red Sea or Arabian Gulf,3-6 specifically Ethiopia, Somalia, and Kenya.7 Other resin-producing Commiphora species (C. abyssinica, C. foliacea, C. playfairii, and C. serrulata) that may enter commerce (as adulterants or inferior grades of myrrh) grow in southern Arabia, Sudan, Ethiopia, Eritrea, Somalia, and Kenya.8 A thick, pale-yellow, liquid oleoresin flows from the naturally occurring cracks and incisions in the bark of myrrh and hardens into a reddish-brown tear-shaped mass about the size of a walnut.1,4 The oleo-gum-resin is described as aromatic, bitter, and acrid in taste.9 Purposeful damage done to the stems of the myrrh tree in order to increase the amount of oleoresin may result in an inferior product.1
The genus Commiphora includes approximately 200 species and there is some taxonomic confusion. Both the European Pharmacopoeia (PhEur 7.0) and the United States Pharmacopeia (USP 34) define myrrh as the gum-resin obtained from the stems and branches of C. molmol and/or other related species of Commiphora.9,10 Brendler et al. (2010), in the African Herbal Pharmacopoeia, state that although there are arguments in favor of using the name C. myrrha for Arabian myrrh and C. molmol for African myrrh, both names are synonymous and the name C. myrrha has precedence.7 The American Herbal Products Association’s Herbs of Commerce, 2nd edition, assigned myrrh as the Standardized Common Name for C. africana, C. erythracea, C. madagascariensis, C. molmol, and C. schimperi, as well as C. myrrha.11 However, the United States Department of Agriculture (USDA) Agricultural Research Service's Germplasm Resources Information Network (ARS-GRIN) lists only C. myrrha as myrrh, with C. molmol, C. myrrha var. molmol, and Balsamodendrum myrrha being synonyms.6 [Note: ARS-GRIN does list Myrrhis odorata as myrrh, further muddying the taxonomic waters; M. odorata is a completely different genus that does not exude the typical oleoresin of the Commiphora genus.] James A. Duke states in Duke’s Handbook of Medicinal Plants of the Bible that it would be hard to identify the species of any given sample of myrrh “when faced only with the imported gum, and not flowering and fruiting herbarium vouchers.”12 Various other species of Commiphora are being traded under the common name “myrrh” and/or are being used as substitutes in products that formerly contained true myrrh.8 For example, commercial harvesting of gum-resin from C. wildii began in Namibia as recently as 2007, and there are already a number of companies importing it for use in place of myrrh.13,14 Besides C. myrrha, many other Commiphora species in Ethiopia produce gums that are collected and sold under the name “myrrh” or “opoponax,” including C. boranensis, C. habessinica, and C. corrugata.15 For the purposes of this article, however, information will be limited to C. myrrha, synonyms C. molmol, C. myrrha var. molmol, and Balsamodendrum myrrha.6
History and Cultural Significance
The common name myrrh comes from the Hebrew mor, meaning bitterness or acrimony (Aramaic murr or mura, “was bitter”).5,16 The generic name, Commiphora, derives from the Greek kommi for gum and phoros for carrier.17 Other common names include common myrrh, hirabol myrrh, gum myrrh, African myrrh, Somali myrrh, bola (Ayurveda), and mo yao shu and mo yao (Pinyin).3,6,11
Myrrh is most widely known for its use as incense in religious rituals and, in ancient times, was highly valued in trade. In ancient Egypt it was used in embalming fluids.3
Historically, myrrh was used in Middle Eastern medicine to treat wounds and infections.3 In Ayurvedic medicine, myrrh has long been used to treat problems associated with the mouth, such as gingivitis (swelling and soreness of the gums), mouth ulcers, and pharyngitis (sore throat).3 In modern Chinese medicine, myrrh (or mo yao) is used for improving blood circulation; treating traumatic injuries; incised wounds; bone, tendon, and ligament pain; amenorrhea; and hemorrhoids or other painful swellings.3,18
In folk medicine, myrrh has been used internally for colds, coughs, indigestion, asthma, arthritis pain, leprosy, cancer, syphilis, chlorosis (a type of anemia typified by a greenish skin tint), diphtheria, dysmenorrhea, tuberculosis, and to increase milk flow.12,19,20 It has been used by women to stimulate menstrual flow and help relieve menopausal symptoms.3,20
Externally, myrrh has been used for hemorrhoids and wounds.19 It has also been used in mouthwash and gargles to fight bad breath and infections, and to help heal mouth sores and loose teeth. Myrrh has astringent properties that help bind skin to create a barrier against infection.3
Currently, myrrh is used as a flavoring agent in beverages, candy, baked goods, chewing gum, gelatins, frozen desserts, puddings, soft drinks, and meat products, and as a fragrance in cosmetics, soaps, perfumes, and incense.4,12,18,21 It is an ingredient in mouthwashes and toothpastes, as well as being available as a liquid extract and encapsulated dried extract.
Current Authorized Uses in Cosmetics, Foods, and Medicines
In 2011, the European Medicines Agency (EMA) published a final labeling standards monograph on myrrh gum-resin tincture (extraction ratio 1:5; extraction solvent ethanol 90% V/V) which supersedes existing monographs of EU national authorities for the registration and marketing authorization of traditional herbal medicinal products that contain myrrh tincture. The authorized traditional medicinal uses for myrrh tincture are (1) for treatment of minor ulcers and inflammation in the mouth (stomatitis and gingivitis); and (2) for treatment of minor wounds and small boils (furuncles).22 A prerequisite of registration is that the quality complies with the corresponding quality standards monographs of the European Pharmacopoeia (e.g. Myrrh PhEur and Myrrh Tincture PhEur).23 Concerning myrrh use in cosmetic products in the European Union (EU), the European Commission Health and Consumers Directorate lists both “Commiphora Myrrha Gum Extract” (aka “Myrrh Absolute;” extract obtained from the gum-resin exudate containing myrrhin-resin [25-40%], essential oil [3-8%], and bitter principles) and “Commiphora Myrrha Gum Oil” (aka “Myrrh Oil” or “Heerabol;” essential oil obtained from the gum-resin) for use as perfuming ingredients. Both “Commiphora Myrrha Resin” and “Commiphora Myrrha Resin Water” (aqueous solution of the steam distillate obtained from the resin) are listed as masking ingredients (to reduce or inhibit the basic odor or taste of the product) while “Commiphora Myrrha Resin Extract” (extract of the resin) is listed for nail conditioning (improves the cosmetic characteristics of the nail) and skin-conditioning (helps to avoid harmful effects to the skin from external factors) functions. “Commiphora Myrrha Leaf Cell Extract” (extract of a culture of the leaf cells) is listed for both masking and skin-protecting functions while “Commiphora Myrrha Oil” (volatile oil obtained by the steam distillation) is listed for masking, skin-protecting, and tonic (produces a feeling of well-being on skin and hair) functions.24
In the United States, myrrh oleo-gum-resin, essential oil, and extract appear in the “Everything Added to Food in the United States” (EAFUS) list of substances that are added directly to food that the Food and Drug Administration (FDA) has either approved as food additives or are listed or affirmed as GRAS (Generally Recognized As Safe).25 Correspondingly, in the Code of Federal Regulations (CFR), myrrh (C. molmol, C. abyssinica, or other Commiphora species) is listed as a natural flavoring substance and natural adjuvant that may be safely used in food.26 For the use of myrrh essential oil as a flavoring agent, a quality standards monograph is published in the Food Chemicals Codex (Myrrh Oil FCC 7).27 For the use of myrrh in drug products, myrrh tincture as an astringent active ingredient of oral healthcare products is presently classified as a Category II active agent (not Generally Recognized as Safe and Effective or GRASE). However, myrrh as an active ingredient for relief of oral discomfort is presently classified as a Category IIISE active agent (insufficient data are available to classify this agent as safe and effective) with a decision pending.28 Additionally, FDA has proposed to include myrrh gum tincture on its list of bulk drug substances that may be used in pharmacy compounding for topical use drugs only.29 A final decision on this use of myrrh has not yet been codified in the CFR.30 For the use of myrrh or myrrh tincture as active ingredients or components of drug products there are 2 quality standards monographs available, Myrrh USP and Myrrh Topical Solution USP. Myrrh topical solution is basically a hydroalcoholic (mixture of alcohol and water 85:15) tincture (1:5).9
Infection by worm-like parasites called helminths—which are contracted via mosquitoes, drinking contaminated water, eating infected food, and exposure to infected soil—is a major health issue in developing tropical and subtropical countries. The World Health Organization (WHO) estimates that 207 million people worldwide are infected with schistosomiasis (bilharzia) alone and 700 million people may be as risk of infection.31 According to WHO, the drug praziquantel is the only treatment available against all forms of schistosomiasis.31 Since 2001, an alternative, Mirazid®, has been available from Pharco Pharmaceuticals, in Alexandria, Egypt. Mirazid is the result of an alcohol extract of myrrh followed by steam distillation yielding a resin and volatile oil (no further information provided by the manufacturer). An early opinion paper suggested, based on 1 negative study, that Mirazid had insignificant cure rates and should be withdrawn from the market.32 A later (2010) review of the studies to date on Mirazid (human and animal) stated that articles that reported high cure rates of over 90% in human infection with schistosomiasis, fascioliasis, and other parasitic infections, had used the recommended dosage of 10 mg/kg body weight, a minimum of 600 mg Mirazid daily (2 capsules) 1 hour before breakfast for 6 successive days.33 According to this review, studies that reported low cure rates had “different doses and duration of treatment.” A search of PubMed for human clinical studies on the efficacy of Mirazid on parasitic infections revealed 9 clinical trials with positive outcomes and 5 clinical trials with negative results. Thus, confirmation of the efficacy of Mirazid for this use in not yet established based on the equivocal nature of these results.
A randomized, double-blind, controlled study with parallel groups (n=30) investigated the effectiveness of an herbal toothpaste containing myrrh (Colgate Herbal®, % myrrh not stated) against a conventional Colgate toothpaste.34 Participants all had at least 20 natural teeth, no periodontal pockets > (greater than) 3 mm, a gingival index of ≥ (greater or equal to) one at 60% of the sites examined, and a plaque index > 2. Participants were given 150 gm of either Colgate Herbal toothpaste or the control (conventional non-herbal Colgate toothpaste) and instructed to brush twice daily for 30 days. At the end of the test period, there were statistically significant reductions in the gingival and plaque index scores within the test group, but no statistically significant difference between the test and control groups. The authors concluded that the herbal toothpaste was as effective against plaque and gingivitis as the conventional toothpaste.
A 2010 randomized, controlled study investigated clinical and teeth-staining effects of a Swiss mouth rinse containing 0.05% chlorhexadine (CHX), 1.9 mg myrrh tincture, 0.1 g peppermint oil (Mentha x piperita, Lamiaceae), 0.5 mg sage oil (Salvia officinalis, Lamiaceae), 0.11 g sodium fluoride, 3 g zylitol, 77.8 g H2O, 3.0 g glycerine, and 15% volume alcohol (Paradentosan®, Tentan AG, Ramlinsburg, Switzerland) compared to a 0.1% CHX solution (control).35 Each of 45 subjects was assigned to 4 weeks of rinsing with either the Paradentosan or the CHX solution. At weeks 4 and 12, more staining was found in the control group. It was also suggested that the Paradentosan may be able to enhance stain removal as an adjunct to tooth brushing. Probing pocket depth decreases were significant and similar in both groups. However, although there was a decrease in bacterial counts between baseline and week 4, there were no differences in bacterial counts in the 2 groups.
Self-treatment with complementary and alternative medicine (CAM) products is fairly common in Saudi Arabia. A 2010 survey of self-reported use of CAM products in topical treatment of diabetic foot disorders revealed that, of the 346 respondents who used either CAM products alone (142) or CAM and conventional products (204), 37.4% used myrrh as a topical treatment, either alone or in combination with honey or honey and nigella (aka black seed; Nigella sativa, Ranunculaceae).36
Demand for myrrh resin is difficult to quantify due in part to unofficial trade across borders and because official production and internal consumption statistics may not be kept by the producing countries.37 In 2000, the estimated production area of Gum Commiphora (myrrh 88%, opoponax 12%) in Ethiopia was 171,300 hectares (ha), corresponding to an annual production of about 8,565 metric tons (MT). Furthermore, export trade data is confounded by the fact that most natural gum-resins (frankincense, myrrh, opoponax, balsam, etc.) are aggregated as a single commodity classification under a general harmonized system tariff code (HS Code) for gums and resins.15 In 1987, the world trade of myrrh produced in Somalia, Ethiopia, and Kenya was approximated at 1,100 tons.37 The main consumers of myrrh were China and Saudi Arabia.37 By 2001, exports of myrrh from Somalia declined to nil and have remained low. The main producers and exporters are Ethiopia and Kenya (although “myrrh” of different species and origins is increasingly entering the global market).8 Sales of myrrh and myrrh products in the United States in 2010 were estimated at $113,519 (based on retail store scan data), an increase of 30.8% over 2009.38 Market reports for the pricing and availability of myrrh gum-resin in 2011 reported high prices from all sources. In March 2011, indicative prices for myrrh ranged from 1,200 USD/MT for Ethiopian origin, 5.2 USD/kg for Kenyan origin, and 5.8-6.2 USD/kg for Somalian origin myrrh.39 In December 2011, CE Roeper, a major European importer and distributor of myrrh, reported, “The market situation for Gum Myrrh is still a very difficult one. Raw material available on the market is not sufficient to cover demand and quality of available quantities is poor, too, while prices remain on a very high level.”40
—Gayle Engels and Josef Brinckmann
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2. European Commission Health & Consumers Directorate. Cosmetic Ingredients and Substances (CosIng®) Database. Brussels, Belgium: European Commission. Available at: http://ec.europa.eu/consumers/cosmetics/cosing. Accessed December 23, 2011.
25. Food and Drug Administration (FDA). Everything Added to Food in the United States (EAFUS) Database. College Park, MD: FDA. November 2011. Available at: www.fda.gov/Food/FoodIngredientsPackaging/ucm115326.htm. Accessed December 23, 2011
26. Food and Drug Administration (FDA). 21CFR §172.510 Natural flavoring substances and natural substances used in conjunction with flavors. In: Code of Federal Regulations. Washington, DC: National Archives and Records Administration. April 1, 2011. Available at: www.gpo.gov/fdsys/pkg/CFR-2011-title21-vol3/pdf/CFR-2011-title21-vol3-sec172-510.pdf. Accessed December 23, 2011.
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29. Food and Drug Administration (FDA). 21CFR Part 216 List of Bulk Drug Substances That May Be Used in Pharmacy Compounding. Proposed Rule. Federal Register. January 7, 1999;64(4):996-1003. Available at: www.gpo.gov/fdsys/pkg/FR-1999-01-07/pdf/99-277.pdf. Accessed December 23, 2011.
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35. Duss C, Lang NP, Cosyn J, Persson GR. A randomized, controlled clinical trial on the clinical, microbiological, and staining effects of a novel 0.05% chlorhexidine/herbal extract and a 0.1% chlorhexidine mouthrinse adjunct to periodontal surgery. J. Clin Periodontol. November 2010;37(11):988-997.
36. Bakhotmah BA, Alzahrani HA. Self-reported use of complementary and alternative medicine (CAM) products in topical treatment of diabetic foot disorders by diabetic patients in Jeddah, Western Saudi Arabia. BMC Res Notes. October 6, 2010;3:254.
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