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CHAPTER 4
Most Modern Approach to the
Phytochemistry and Therapeutic
Potential of Boswellia in
Ayurvedic Formulations
KARTHIK VARMA A. C.,* SASIKUMAR KUTTAPPAN* AND
AUGUSTINE AMALRAJ
R&D Centre, Aurea Biolabs (P) Ltd, Kolenchery, Cochin-682 311, Kerala,
India
*Emails: ackvarmaapm@gmail.com; sasikumartk@gmail.com
4.1 Introduction
Traditional systems of medicine have always gained many accolades from
the ancient days onwards because of their diverse range of pharmacological
activities and efficacy. One such system of medicine, which has gained huge
attention, includes the traditional Ayurvedic practices of the Indian medical
principles.
1
The principles of Ayurveda have a vast literature in almost all
of the Indian languages and especially in Sanskrit, which covers the u se of
the herbs, their dosages, and the methods of preparation.
2
The
treatment of Ayurveda is based on three basic princ iples called doshas
(vata, pitta, and kapha), which are obtained from the five elements of
Indian philosophy. Ayurveda’s doshasaretreatedasregulatorycontrol
factors for fundamental physiologic processes in biological systems
that maintain their identity throughout biologic history. Vata and its
subdoshas regulate input/output processes and motion; pitta and its
Chemistry, Biological Activities and Therapeutic Applications of Medicinal Plants in Ayurveda
Edited by Augustine Amalraj, Sasikumar Kuttappan and Karthik Varma A. C.
r The Royal Society of Chemistry 2023
Published by the Royal Society of Chemistry, www.rsc.org
73
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subdoshas regulate throughput, turnover, and hence energy; and kapha
and its subdoshas regulate storage, structure, and lubrication.
3
Studies
have proved that almost 95% of Ayurvedic formulations are prepared
using plants/herbs.
4
From ancient days onwards, plants and plant-derived
phytochemicals have contributed to curing many diseases. As time
has p rogressed, plants became the source of income for traditional com-
munities. One such species which has gained much importance is
Boswellia.
The genus Boswellia belongs to the Burseraceae family, which consist of
about 17 genera and around 600 species.
5
Some of the most important
species of this genus include Boswellia serrata, Boswellia sacra, Boswellia
carterii, Boswellia papyrifera, Boswellia neglecta, Boswellia rivae and Boswellia
frereana.
6
Boswellia gum resin is cultivated in many areas including the
Asian and African regions (Table 4.1). The phytochemical compounds mostly
contribute to the pharmacological activities, and include essential oil ter-
penes, resinous materials and other biologically active compounds.
7
In the
Ayurvedic system of medicine, the gum resin extract and its bioactive com-
ponents are used to treat a number of inflammatory diseases affecting skin,
eye, gastrointestinal tract (GIT) and respiratory inflammatory disorders,
such as asthma, bronchitis and laryngitis, etc.
8
Boswellia is commonly re-
ferred to as Ashvamutri, Kundara, and Shallaki in Sanskrit.
9
This chapter presents an overview on the taxonomy, phytochemical
compounds and uses in Ayurvedic formulations and various pharmaco-
logical activities of different Boswellia species.
4.2 Boswellia in Ayurvedic Texts
Boswellia, commonly referred to as Shallaki in Sanskrit, is cited in many
ancient Ayurvedic texts. The Ayurvedic sloka depict s the different uses of
Boswellia and Shallaki as:
Ath shompichuchannam sushyatam pratisaryet|Pri-yanjan yastavyar-
odhrachurne samantat//Shallaki phal-churne va shomdhyamain va punaha|Tato
vranam yatha yogam badhvaacharkamaadhishet//. Various Ayurvedic literatures
like Acharya Charak, Acharya Sushrut, Kaydev Nighantu, Dhanvanthari
Table 4.1 Different Boswellia species and their geographical locations.
Variety Geographical location
B. carterii Bird. Somalia
B. sacra Flueck Nubia South Arabia
B. frereana Birdw. Somalia
B. papyrifera Ethiopia
B. neglecta S Moore Somalia
B. odorata Hutch Africa
B. dalzielii Hutch Africa
B. serrata Roxeb India
B. rivae Ethiopia
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Nighantu, Bhavprakash Nighantu, Raj Nighantu, Charak Samhita, Sushrut
Samhita, etc. position the herb as having potential pharmacological activities.
The traditional uses of Boswellia in Ayurvedic practices include:
//Badararjunjambuaamshallakivetastwacha. Sharkarash-oudrasanyukta-
peeta// – The ash of the flax or the fruit powder are applied to cure wounds.
Palasham shyad shonitam ch anjanarthe shallakya va sharkara shoudra
yuktam// – The decoction of the barks of badar, arjun, jambu, Aamra, Shal-
laki and vetas are used to treat diarrhoea.
Turushksallakinam ch Guggalo Padhmakasya ch// – The smoke of the
Shallaki powder is inhaled to relieve the symptoms of asthma.
4.3 Ayurvedic Properties of Shallaki
Ayurvedic literatures describe the various properties of B. serrata in different
ways (Table 4.2).
4.4 Varg of Shallaki in Different Literature Sources
The use of Boswellia has been described in many Ayurvedic literatures
(Table 4.3).
4.5 Science Behind the Action of Ayurvedic
Formulations
The treatments of Ayurvedic medicines are mainly concentrated on the three
basic problems of the body, including Vata, kapha and pitta, which are
commonly referred to as doshas in the principle.
10
The majority of the
Ayurvedic formulations are based on the principles of poly-herbal combin-
ations.
11
Sarangdhar Samhita, one of the important literatures in Ayurveda,
Table 4.2 Various properties of Shallaki in Ayurveda.
Rasa Madhur, Katu, Tikta
Guna Guru, snigdha, Tikshna
Virya Ushna
Vipaka Madhur
Karma Balya, kaphahara, Vaathar, Kaphpitthar, Raktsthambhar, Svedhar
Table 4.3 Varg of Shallaki in Ayurvedic scripts.
Acharya Charak
Purishviranjaniya,
Shirovirechan, kashayaskand
Charak Samhita,
sutrasthan 4/32, 4/27
Vimansthan 8/144
Acharya Sushrut Rodraadi, Eladi, Kashyaskand
Kaydev Nighantu Aushadhi varg Shlok 861–863
Dhanvantri Nighantu Chandanaadi varg Shlok 122, 123
Most Modern Approach to the Phytochemistry and Therapeutic Potential 75
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highlights the use of polyherb al formulations and their role in treating
diseases.
12
In some cases of treating diseases, if the individual phyto-
chemical compounds are not effective enough to get the desired result,
formulations including multiple herbs are used to increase their efficacy.
13
There are two mechanisms behind this rationale, which involve pharmaco-
kinetic synergy and pharmacodynamic synergy.
14
The idea of pharmacoki-
netic synergy depends on the concept of the ability of the herbs to absorb,
proper distribution, metabolism and elimination of other herbs from the
body, and the second concept lies in the principle of the synergistic actions
of the ingredients.
15
4.6 Taxonomy and Phytochemistry
Phytochemical compounds are isolated from the trunks of various species of
trees of Boswellia. The trees are normally found in the dry mountainous re-
gions of India, northern Africa and the Middle East.
16
The yield and per-
centage of the bioactive components mainly depend on the climatic and
geographical conditions. Scientific studies have validated the presence of
valuable phytochemicals in this plant. Studies have proven that the plant
contains pentacyclic terpenoids, tetracyclic triterpenoids, macrocyclic di-
terpenoids and essential oils
17
(Figure 4.1). The major pentacyclic terpenoids
of the Boswellia species include b-boswellic acid (b-BA), 3-acetyl b-boswellic
acid, 11-keto-b-boswellic acid, 3-o-acetyl-11-keto beta boswellic acid (AKBA),
12-ursene-2-diketone and other major and minor compounds. The Boswellia
species also contain tetracyclic triterpenoids like a-elemonic acid, b-elemonic
acid, etc. (Figure 4.1). Studies have also found the presence of water-soluble
arabinogalactan proteins, which are mainly composed of
D-galactose units
with a molecular weight of 60 mol% in the core chains and branched via
positions 3 and 6 and in the side chains, which are uronic acids, glucuronic
acid (9 mol%) and terminal 4-O-methyl-glucuronic acid (13–26 mol%), and
arabinose (2–14 mol%).
18
4.7 Modern Medicinal Uses
The roles of Boswellia and its phytochemicals are cited in most modern and
many traditional systems of medicine. The modern system of medicine focuses
on the bioactive components and their bioavailabilities. The use of innovative
technologies has led researchers to focus on developing extracts with the en-
riched form of bioactives. This has led to a reduction in the dosage of the drug,
instead of supplementing the raw herb, the innovative technologies focus on
specific bioactive components and their pharmacological activities.
4.7.1 Sandhigata Vata/Arthritis
Sandhigata vata is mentioned as ‘‘vatavyadhi’’ in Ayurvedic texts. Charaka
was the first to describe separately ‘‘Sandhigata anila’’, but was not included
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under any of the 80 types of nanatmaja vatavyadhi. In modern terminology,
the symptoms associated with Sandhigata vata are more or less equal to
osteoarthritis (OA). Most of the studies of the Shallaki/Boswellia concentrate
on their potential to be used in inflammatory disorders. Gupta et al.
19
evaluated the role of Shallaki, in the management of Sandhigata vata/OA.
Subjects of 40–70 years of age and having clinical signs and symptoms of
Sandhigata, viz. shula (joint pain), shotha (joint-swelling), stambha (stiff-
ness), sparsha asahyata (tenderness), sphutana (crepitus) and akunchana
prasarana vedana (pain dur ing flexion and extension of the joint) were in-
cluded in the study. The study included supplementation of Shallaki
Figure 4.1 Structures of bioactive components in Boswellia.
Most Modern Approach to the Phytochemistry and Therapeutic Potential 77
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capsules and Shallaki ointment for topical application. Symptoms like
sandhishula (joint pain), Sandhishotha (joint swelling), Akunchana prasar-
anayoh vedana (pain during movement), Stambha (stiffness), sandhi-
sphutana (crepitations) and Sparsha asahyata (tenderness) all showed
significant improvements in both groups with slight variations in the extent
of improvement. The effect of therapy on symptoms of vata-vridhi included
positive effects reported in gatrasphurana (fasciculation) and asthishula
(pain in bones). Among the symptoms of vata-kshaya: alpa chesta, Angasada
(looseness of body parts) and apraharsha (unhappiness) all showed positive
improvements after the treatment period. The study also evaluated the im-
provement of symptoms of pittakshaya, which included stambha (stiffness),
toda (pricking pain) and gaurava (heaviness), and all of the parameters
evaluated showed a positive improvement. The effect of asthivahasrotas,
Asthishula (pain in bones) and asthibheda also showed significant im-
provement after the study duration and paved the way for the use of Shallaki
in treating OA and other inflammatory conditions.
19
In another study,
a double-blind, placebo-controlled human trial evaluated the efficacy of
Boswellia extract standardized to AKBA in patients with knee OA. The study,
with a duration of 120 days, proved that supplementing with Boswellia
showed a signi ficant improvement in the physical function of the patients by
reducing pain and stiffness compared with placebo. The study evaluated the
improved knee joint gap and re duced osteophytes (spur), confirming the
efficacy of the extract treatment. The study group also showed significant
improvement in the serum levels of high-sensitive C-reactive protein.
20
Sengupta et al.
21
also evaluated the role of Boswellia in OA. This study
showed significant improvements in the pain scores, physical function
scores, a reduction in synovial fluid matrix metalloproteinase-3 and proved
the safety of the product in OA.
21
Shallaki is also used in combination with
other herbs for the management of inflammatory disorders. A randomized
double-blind placebo-controlled study was conducted by Kimmatkar et al.
22
who evaluated the role of Boswellia extract and proved its efficacy in OA. The
study proved significant improvement in knee pain, infection, walking
distance and frequency of swelling, thus proving its efficacy.
22
Shallaki is also used as a single herb and in combination with other plant
extracts. A polyherbal formulation containing Boswellia serrata 240 mg,
Commiphora wightii (purified) 200 mg, Alpinia galanga 70 mg, Glycyrrhiza
glabra 70 mg, and extracts of Tribulus terrestris 60 mg and Tinospora cordi-
folia 60 mg. The study population included 50 enrolments in which one
group was supplemented with the formulation and another group was
supplemented with a placebo. Subjects were asked for follow-up every 4
weeks for 6 months. At the end of 6 months, subjective (symptomatic) as-
sessment was carried out using the scores below to determine the clinical
efficacy of the trial drug. The study showed that there was a 66.28% re-
duction in the number of joint involvements in the treated group and
51.94% in the placebo group. In a subjective symptomatic evaluation, the
study group showed 45.91% improvement in the relief symptoms as
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compared to 29.1% in the placebo group.
23
A novel formulation containing
Boswellia, bioavailable form of curcuminoids, Kaempferia galanga extract and
Piper nigrum oil proved its efficacy in controlling OA in patients with knee
OA. The study was done in comparison with a combination of glucosamine
and chondroitin as the reference product and proved that the test product at
a lower dosage of 250 mg per day showed significant results in comparison
with the reference product at dosage of 1500 mg þ 1200 mg.
24
Similarly, a formulation containing Boswellia extract (300 mg), curcuma
extract (100 mg), Pinus pinaster (80 mg) and ginger extract (40 mg) was used
as an anti-inflammatory drug to reduce joint pain. The pain reduction was
observed in a visual analogue scale (VAS) and WOMAC scale as compared to
the placebo group. The study showed significant effectiveness in reducing
pain and inflammation, with increased joint mobility and patients’ quality
of life.
25
The clinical efficacy of a herbo-mineral formulation containing
roots of Withania somnifera, the stem of Boswellia serrata, rhizomes of
Curcuma longa and a zinc comp lex, was evaluated in a randomized, double-
blind, placebo-controlled, cross-over study in subjects with OA. The study
included supplem entation of 42 subjects with knee OA who were randomly
divided into two groups. The clinical efficacy was evaluated every fortnight
based on pain symptoms. The study group showed significant improvement
in the severity of pain and disability score .
26
LI73014F2, a novel herbal for-
mulation containing fruit extract of Terminalia chebula, Curcuma longa and
Boswellia serrata was evaluated for efficacy in relieving joint discomfort in
human subjects with knee OA. The study parameters evaluated included
VAS, Lequesne’s functional index and WOMAC score, which all proved that
there was a significant improvement in the pain relief, improved physical
function and quality of life in OA subjects.
27
The effectiveness of an
Ayurvedic formulation containing Tinospora cordifolia, Zingiber officinale,
Emblica officinalis and Boswellia serrata was compared with glucosamine
sulfate (2 g daily) and celecoxib. In that study, 440 eligible subjects suffering
from symptomatic knee OA were enrolled and monitored as per protocol. In
the 6-month study, the Ayurvedic formulation proved to have efficacy similar
to glucosamine and celecoxib.
28
HFPM-01, a novel formulation containing
Boswellia serrata, Zingiber officinale, Withania somnifera, Curcuma longa and
Pluchea lanceolata as key ingredients out of a total of nine ingredients, was
evaluated for its efficacy in controlling knee OA. The study involved ran-
domization of 90 subjects into three groups. The study groups received either
test product, glucosamine or placebo. The change in the WOMAC score, the
increase in Short Form (SF-36) score, the decrease in VAS score, the decrease
in C-reactive protein levels and decrease in gastrointestinal symptoms were
found to be 33%, 38%, 60.44%, 52% and 40%, respectively, which showed
significant improvement in relieving the symptoms associated with OA.
29
The symptomatology Griva Sandhi disease includes shula (pain in cervical
region), prasar an akunchana vedana (pain during flexion and extension),
vatapurnadriti Sparsha (on palpation of the joints), hanti sandhigatah (loss
of function) and aatopa (cracking noise).
30
In modern medical science, this
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is described as cervical spondylosis. In the case of cervical spondylosis, the
degenerative changes in the intervertebral discs lead to secondary changes in
the adjacent vertebrae. In one study, which included supplementation of two
capsules of Shallaki Niryas in 10 subjects with clinically, pathologically and
radiologically diagnosed symptoms were evaluated. The study drug showed
significant improvement in the Shula, prasaran akunchanavedana and
tingling sensation, thus showing its positive role in treating spondylosis.
31
4.7.2 Antihyperlipidemic and Antidiabetic Activity
The gum resin of Shallaki was used in many traditional systems of medicine
for controlling diabetes mellitus/madhumeha. The anti-inflammatory action
of boswellic acids, predominantly the role of proinflammatory cytokines in
insulin resistance, is attributed to the antidiabetic activity of Shallaki.
Multiple clinical studies have given an insight into the different mechanisms
for the antidiabetic activity of the resin extract and its bioactive components.
In one study, subjects were supplemented with Boswellia gum resin extract
and metformin. The study group, in addition to metformin, received 400 mg
of the resin orally twice daily for 12 weeks. Compared with the placebo, the
study group showed a significant decrease in the fasting blood glucose,
haemoglobin A1c (HbA1c) and serum insulin. Moreover, a reduction of
serum cholesterol, low-density lipoprotein and triglycerides was reported,
and no adverse effects of the study product were recorded.
32
The role of
Boswellia extract in controlling blood glucose, insulin level and insulin re-
sistance in type 2 diabetic patients was evaluated in 60 subjects with type 2
diabetes. The subjects were divided into two groups in which the subjects
were supplemented with either placebo or test products. The 6-we ek ad-
ministration of the test product decreased the blood glucose level
(173.71 10 vs. 147.57 8mgdl
1
, Po0.01). The study also showed that
plasma insulin increased while the insulin resistance index did not have a
significant effect on the test product.
33
In addition to the supportive evidence from clinical trials, several pre-
clinical studies have also highlighted the antidiabetic act ivity of the gum
resin extract and its bioactive components, modulated by different pathways.
A novel formulation containing B. serrata oleo-gum-resin has been reported
to produce significant antidiabetic activity by affecting hepatic gluconeo-
genesis, pyruvate carboxylase and phosphoenol pyruvate carboxykinase.
34
Similarly, a study designed by Shehata et al.
35
involved the use of AKBA to
prevent the induction of autoimmune reactions, insulitis and hyper-
glycaemia in a model of multiple low-dose streptozotocin (MLD-STZ) dia-
betes. In the streptozotocin product-supplemented group there was a
significant burst of pro- and anti-inflammatory cytokines in the blood, in-
filtration of lymphocytes (CD3) int o pancreatic islets and the appearance of
peri-insular apoptotic cells was recorded. Plasma glucose increased signifi-
cantly, however the study product group showed a significant decrease in the
reduction in pro- and anti-inflammatory cytokines.
35
Not only B. serrata, but
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also Boswellia ovalifoliolata has promising antidiabetic activities. The oral
administration of 200 and 400 mgkg
1
bodyweight for a duration of 7 days
significantly reduced the blood glucose level in comparison to a 10 mg
dosage for glibenclamide.
36
4.7.3 Anticancer
The gum resin extract of the Shallaki is extensively used in most modern
medicines for anticancer activities. Various activities like cytostatic, anti-
apoptotic and antitumor properties have paved the way for the use of Bos-
wellia and its positive impact on gliom a, leukaemia, melanoma, hepatoma,
and prostate and breast cancers.
37–44
Several clinical and preclinical studies
have identified their potential in anticancer activities. The anticancer activity
of Boswellia extract was studied in 44 patients with primary or secondary
malignant cerebral tumours. The subjects were randomly allocated to
radiotherapy and either B. serrata 4200 mg per day or placebo. The primary
end of the study was measuring the volume of cerebral oedema in a T2-
weighted magnetic resonance imaging sequence. The results of the study
indicated that cerebral oedema was reduced by more than 75% in 60% of
patients receiving B. serrata and 26% of those receiving placebo.
45
Similarly,
a clinical study with brain tumour patients has also been conducted, in
which Boswellia extract was administered to 29 patients with gliomas. The
study supplementation involved three different doses of the Boswellia ex-
tract. After 7 days of treatment, prior to surgical intervention, the reduction
in size of perifocal oedema was found to be largest in the case of the group
having the highest intake of the extract, to a lesser extent in the group re-
ceiving less, and with no effect being seen in the group receiving the smallest
dose.
46
Several preclinical studies have also highlighted the potential use of
Boswellia extract in anticancer activities.
47–49
4.7.4 Antiulcer
Boswellic acid has a positive impact on the antiulcer activity mediated by the
anti-inflammatory pathway. Peptic ulcer in Ayurveda is considered a sort of
acid gastritis. This disorder is generally classified under Grahani disorder.
Acharya Charaka describes some of the common causes of peptic ulcer such
as deranged Agni. Because of the disarranged Agni or pitta vikara, there are
many possible causes of gastric disorders with one being ulcer (Annadrava
shoola). Several Ayurvedic formulations have proved their superiority in
treating peptic ulcers.
50
Singh et al.
51
evaluated the effect of boswellic acid-
enriched B. serrata extract in rats, using models of gastric ulcer induced by
pyloric ligation, ethanol–HCl, acetylsalicylic acid, indometacin and cold-
restraint stress. This study concentrated on elevating the dosage up to
500 mg kg
1
, and found that the extract was found to exhibit dose-
dependent antiulcer activity. The proposed mechanism was found to be
related to the increase in gastric mucosal resistance, local synthesis of
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