Santa Claus, Atlantis, and the Loch Ness monster have been included in countless stories. Generally recognized as folklore, they are harmless tales..
Occasionally lore is presented as science. Yarns, anecdotes, and hearsay sometime conflict with the hard facts that scientific query produce. Lore may have appeal, but evidence has more value to the chiropractic profession. A parallel example to the maturation of the science of chiropractic can be found in Aryuvedic medicine.
Cissus quadrangularis (CQ), also known as veldt grape or Asthishrunkhala, a native plant growing in large parts of Africa and India, has been used by traditional Aryuvedic practitioners. Many health benefits are attributed to CQ including the healing of fractures, tendons, ligaments, or as a tonic, anti-oxidant, anti-inflammatory, analgesic, anti-ulcer, and bactericidal. The fresh stem and leaves of CQ have been used for the treatment of hemorrhoids, menstrual disorders, scurvy, and flatulence.1
Aryuvedic medicine has centuries of observation plus trial and error in developing a sophisticated system. Fortunately, the scientific method has been applied to test the traditional uses of Cissus quadrangularis. Below are the take-home conclusions from studies performed to date.
• CQ was found to positively influence bone chemistry by reducing resorption and increasing alkaline phosphatase (associated with bone formation) in rats.2 • Fracture healing in dogs was significantly enhanced.3
• CQ had a protective effect on aspirin-induced gastric injury.4
• CQ has a broad anti-inflammatory chemistry when tested in vitro.5
• CQ has an analgesic effect in mice.6 • CQ both prevents and hastens the healing of gastric ulers.7
• CQ has anti-oxidant activity when measured in vitro.8
• In vitro, CQ triggered the molecules involved in bone formation and the molecules inhibiting bone resorption.9
• In vitro, CQ quadrangularis stimulates osteoblastogenesis.10
• In rats, CQ can effectively reduce bone loss and increase bone strength.11
• CQ, and other herbs, demonstrated potent estrogenic activity in ovariectomized rats.12
There is lore and there is some evidence in regard to CQ, now in the early stages of scientific testing. All of the above studies involved either rodents or dogs or were performed in vitro.
The only human intervention trial looking at CQ and bone in postmenopausal women found no change in bone mineral density but did show a beneficial reduction in bone turnover markers. This study was short term (6 months).13
• There are more questions. What parts of the plant should be used?
• At what stage should the plant parts be harvested?
• How are the plants best processed?
• Is it best to inject, take orally, or apply topically?
• What are the proper dosages for a given disease?
In regard to dosage, the researchers to date have used 250-750 mg/kg body weight. If we select the mid-range of 500 mg/kg, for a 110-pound person (50 kg), this would require 25 grams. Supplement manufacturers are selling CQ at various dosages, most commonly 500 mg/ pill. This may not be enough to be meaningful.
Identical thinking can be applied to chiropractic to
make the journey from lore to science. We have an abundance of lore that is expressed in the telling of anecdotes. And we have a growing body of evidence; though, not nearly enough.
The challenge for the profession is to graduate from anecdote to published case studies. Next step is to perform and publish case series (a collection of case studies for a given condition). Having accomplished these, we are now on the “scientific map.” Case studies and case series can and should be performed by the doctors who treat patients day after day.
With this enhanced credibility, larger clinical trials and/or practice-based research networks (PBRNs) can be pursued to investigate and, it’s hoped, yield the evidence for much of the long-discussed, but untested, chiropractic lore. Professional maturity is the progression of lore to science to improved patient care.
For DCs interested in contributing to the body of knowledge by writing a case study for publication, a FREE 1-hour video presentation that is approved for professional development/continuing education credit is available at www.easywebce.
Alan Cook, DC, has been in practice since 1989. He ran the Osteoporosis Diagnostic Center (1996-2019), participated in four clinical trials, and lectured nationally. He currently works with the Open Door Clinic system in a multidisciplinary setting and provides video-based continuing education with EasyWebCE. To see more of his work, log onto: www.EasyWebCE.com
References
1. Bhagath Kumar Potu, Kumar MR Bhat, Muddanna S Rao, Gopalan Kutty Nampurath, Mallikarjuna Rao Chamallamudi, Soubhagya Ranjan Nayak, Manjimatha S Muttigi. Petroleum Ether Extract of Cissus Quadrangularis (Linn.) Enhances Bone Marrow Mesenchymal Stem Cell Proliferation and Facilitates Osteoblastogenesis. Clinics (Sao Paulo). 2009; 64(10): 993-998.
2. Potu, B. K; Rao, M. S.; Nampurath, G. K; Chamallamudi, M. R; Prasad, K; Nayak, S. R.; Dharmavarapu, P. K; Kedage, V.; Bhat, K. M. R. (2009). ‘Evidence-based assessment of antiosteoporotic activity of petroleum-ether extract of Cissus quadrangularis Linn. On ovariectomy-induced osteoporosis. ” Upsala Journal of Medical Sciences.
114 (3): 140-8.
3. Deka, DK, Lahon LC, Saikia J, Mukit A. Effect of Cissus Quadrangularis in Accelerating Healing Process of Experimentally Fracture Radius-Ulna of Dog: A Preliminary Study. Indian Journal of Pharmacology 1994;26:44-45.
4. Jainu M, Mohan KV, Devi CSS. Protective effect of Cissus quadrangularis on neutrophil mediated tissue injury induced by aspirin in rats. J Ethnopharmacology 2006;104:302-305. https:// doi. org/10.1016/j.jep. 2005.08.076
5. Bhujade, A. “Evaluation of Cissus quadrangularis extracts as an inhibitor of COX, 5-LOX, and proinflammatory mediators. ” Journal of Ethnopharmacology. 2012;141 (3): 986-96. doi: 10.1016f.jep.2012.03.044. PMID 22484053
6. Singh SP, Mishra N, Dixit KS, et al. An experimental study of analgesic activity of Cissus quadrangularis. Indian J of Pharmacol. 1984; 79:162-63p.
7. Jainu M, Devi CSS. Effect of Cissus quadrangularis on Gastric Mucosal Defensive Factors in Experimentally Induced Gastric Ulcer—A Comparative Study with Sucralfate. J Medicinal Food 2004:372-376. http://doi.org/10.1089/ jmf.2004.7.372
8. Murthy KN et al. Antioxidant activity of Cissus quadrangularis Linn. J. Med. Food. 2003; 6(2): 99-105p.
9. Ruangsuriya J, Charumanee S, Jiranusornkul S, et al. Depletion of /{-sitosterol and enrichment of quercetin and rutin in Cissus quadrangularis Linn fraction enhanced osteogenic but reduced osteoclastogenic marker expression. BMC Complementary Medicine and Therapies 2020;20:105. https: doi. org/10.1186 si2906-020-02892-w
10. Potu BK, Bhat KMR, Rao MS, Nampurath GK, Chamallamudi MR, Nayak SR, Muttigi MS. Petroleum ether extract of cissus quadrangularis (linn.) enhances bone marrow mesenchymal stem cell proliferation and facilitates osteoblastogenesis. Clinics. 2009;64(10):993-8.
11. Sirasanagandla SR, Pai KSR, Bhat KMR. Preventive Role of Emblica Officinalis and Cissus Quadrangularis on Bone Loss in Osteoporosis. Int J Pharmacy and Pharmaceutical Sciences 2013;5:122-127.
12. Singh S, Kumar S, Singh S, et al. Estrogenic Effect of Asparagus racemosus, Cissus quadrangularis, Punica granatum and Pueraria tuberosa in Post-menopausal Syndrome. PharmacognRes. 2021;13(4):238-245
13. Benjcrwan S, Nimitphong H, Tragulpeankit P, et al. The effect of Cissus quadrangularis L. on delaying bone loss in postmenopausal women with osteopenia: A randomized placebo-controlled trial. Phytomedicine 2022;101:154115. https: doi. org/10.1016 j.phymed. 2022.154115
