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Colleague's E-mail is Invalid. Your message has been successfully sent to your colleague. Save my selection. Wellness and healing are the challenges traditionally addressed by medicine, empirically shaped along with the evolution of civilizations. Western medicine WM originates from Middle-Eastern and Mediterranean medicine during the Egyptian, Greek, and Roman empires and has established itself as the reference in most countries with undisputable benefits on health and life expectancy.

Traditional medicines TMs are millennia old and offer empirical practices including medication with natural elements and focus on overall wellness. Although the purpose of relief is similar in WM and TM approaches, the philosophies and methodologies differ. TM emphasizes the consideration of the patient body and mind as a whole for diagnosis, prevention, and treatment; WM focuses on the suppression of symptoms on targeted parts of the body.

The acceptance of TM by the scientific community is limited by the lack of ground-breaking scientific evidence of its benefits and efficiency, coupled to the ignorance of its inherent medical basis. We review the origins and concepts of TM from Southern and Eastern Asia, as compared with WM, and believe it can help to create a modern systems biology -based approach to health and healing, in the sense of predictive, preventive, personalized, and participatory P4 medicine.

Email address: sagner esprevmed. The work cannot be changed in any way or used commercially without permission from the journal. Back then, the explanation and treatment of all sorts of diseases was based on sacred and spiritual beliefs. Thus, healing of patients involved a mix of prayers, magic practices, and herbal mixtures. Egyptian physicians, mostly priests, developed early surgery and anatomy knowledge thanks to the dissection of human bodies. Hippocrates work was in opposition with the mainstream Aesclepian beliefs, based on religion.

This marked the first split between science-based and religion-based medicine, and Hippocrates is nowadays considered as the Father of Medicine—the Hippocratic Oath being an ethical reference and motto in the medical community worldwide. Galen, a Greek physician, later contributed to the expansion of Greek medical knowledge within the Roman Empire, which became the dominant reference for more than a millennium. However, the knowledge build by Greek Medicine was transmitted and preserved within Arabic Medicine during the medieval times,[ 4 ] and was brought as far as the Indian subcontinent with the Mughal invasions.

Not until the Renaissance did medicine experience a significant revival based upon a better understanding of anatomy and the functions of organisms neurology, blood circulation. Emergence of new tools during the post-Renaissance period thermometer: 16th century; microscope: 17th century; stethoscope: 19th century; anesthesia and X-rays: 20th century triggered significant progress within several domains: hematology with William Harvey — blood circulation , Athanasius Kircher — blood observation , Richard Lower — transfusion , William Hewson — blood coagulation ; histology with Marcello Malpighi — glandula and viscera physiology ; bacteriology with Louis Pasteur — and Robert Koch — for pathogenic micro-organisms; and surgery and experimental medicine with John Hunter — and Claude Bernard — The 19th century industrial revolution led to several advances, playing a role in the rise of modern medicine.

Indeed, the improvement of life conditions, hygiene and sterilization helped in better understanding of pathological causes. During the 20th century, laboratory research became an integral component of medical practice at hospitals and universities. Modern medicine was largely disseminated across the world during recent centuries by explorers, missionaries, and merchants, following the path of trans-continental history and human migration events, and more recently through the industrial revolution and the globalization of the pharmaceutical market.

It is now widely used as the conventional medicine of reference in a majority of countries and cultures. Even though progresses in medicine are based on scientifically proven evidence contributed by laboratory research or clinical outcomes, it has emerged gradually from the empirical knowledge of traditional medicines in ancient civilizations Egypt, Mesopotamia, Greece, India, China. Despite the indisputable benefits of modern medicine, leveraging scientific assays and results to establish diagnosis and fight against diseases, a large part of the world still relies on the contemporary forms of Traditional, Complementary, and Alternative Medicines TCAM or CAM ,[ 5 ] which will be here referred to as traditional knowledge-based medicine TKBM to avoid confusion with the traditional Chinese medicine TCM acronym.

TKBM is even integrated in the national health-care program in some countries. Basically, using a wide variety of therapies, from administration of natural herbal products to chiropractic therapies, the Asian TKBMs place the patient wellness at the center of care and treatment instead of focusing on the eradication of the pathology symptoms as in WM.

Although TKBM developed based on some kind of scientific evidence in terms of diagnosis and treatment, as an ancient medicine it was much limited by the primitive tools available for both medical observation and evaluation; hence, the understanding of human health and disease status was not based on anatomy and physiology in such a precise manner than currently.

Nevertheless, many efforts are made nowadays to address these issues with clinical trials, identification of active ingredients, receptors, and involved pathways. Clearly, modern medicine evolved in the context of Western and Mediterranean cultures from a background of ancient TKBM. But how did TKBM evolve in other parts of the world like Asia within the context of current contemporary civilizations with the imprints of local cultures? We will now describe the principles and context of 2 Asian TKBMs: TCM, which derived in Japan and Korea into Kampo and Sa-sang respectively, and Ayurveda , a prominent Indian practice of medicine, and highlight the main similarities and differences between TKBM and WM, then discuss how the ongoing transition from reactive to proactive medicine could benefit from their convergence.

Although it is not clear when TCM originated, it is believed to be the result of a continuous series of observations and works, with one of the most important domains being the use of herbs toward medicinal purposes, or Materia Medica. It is considered as the most complete reference in herbal information for medicinal application in TCM. Archaeological evidence has been dated back to the Shang era during the Bronze Age 16th to 11th century BCE ,[ 7 ] although it is not completely clear whether herbal medicine was used at that time. It is believed to be the earliest and most important piece of Chinese ancient medicine work.

Written under the form of a dialog between the Yellow Emperor and his acupuncturist Qi Bo, one important figure in his government among other ministers, it depicts the philosophy and basics of TCM, without making reference to the magical and shamanistic beliefs.

Instead, it is centered on means to develop a natural equilibrium of the body and mind through a balanced lifestyle, and thus to reach wellness and health. During the succession of dynasties in the following centuries, the principles and theories of TCM did not evolve very much. Instead, each dynasty attempted to compile its own medical books, retrieving as much of the ancient and increasing knowledge. This was facilitated by the 10th century development of woodblock printing to combine works on particular medical domains.

As a result, by the 17th and 18th centuries, TCM had not evolved as much as WM in Europe, and China took the benefits of the first Christian missionaries to reach their land. More efficient and safe practices were thus introduced, for example, Jennerian smallpox vaccination in Canton in ,[ 9 ] which produced better results than the TCM-based preventive inoculation of small amounts of smallpox dried crusts into subjects nostrils.

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However, TCM was still valued over the whole country, and the governments in the second half of the 20th century helped in the creation of hospitals and schools based on TCM. To date, WM remains the medicine of choice, but both medicines coexist, TCM being strongly anchored into the Chinese culture. Chinese Medicine principles rely on the theory that the human body is an open organism operating in a continuous biological and mental exchange process with the outside environment. When exchanges are in a balanced state, then the health of the human organism is optimal.

On the contrary, a challenged or compromised balance means illness occurrence. The understanding of this dual conception of 2 parts having influence on each other leads to the Chinese concept of yin and yang , 2 fundamentals of the Chinese philosophy, of equal forces in a balanced condition, and representing the positive and negative factors, which influence equilibrium. These initial translations of the definitions developed in the absence of better, more faithful and relevant words.

As medical knowledge of body anatomy and physiology was not as exhaustive as in current modern medicine, it is understandable that the TCM definitions were only vaguely approaching the contemporary accurate descriptions of how human body functions. Chinese Medicine divides the organs into 2 categories: the storing organs and the transforming organs.

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  • Thus, the function of an organ is of greater importance than its structure. The psychological consequence of an organ function or dysfunction is also depicted in TCM, which emphasizes the importance of psychosomatic disorders.

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    There are 5 storing organs, named Zang. They are symbolically associated with natural elements to point their role; each of them includes an organ, a biological function, and a psychological function. Xin is associated with fire: it spans the heart, brain function, and psychological function of the mind. Gan is associated with wood: it spans the liver, the liver function, and sensory-motor system, the psychological function of equilibrium and tranquility. Pi is associated with earth: it spans the spleen and pancreas, the functions of absorption, digestion, distribution and utilization of nutriments, and the psychological components of temper and intelligence.

    Fei is associated with metal: it spans the lung, the respiratory function and the psychological function of willpower. Shen is associated with water: it spans the kidney, the endocrine system, and the psychological function of willingness. Complementary to the 5 solid organs, there are 6 transforming organs, named Fu. Similar to the 5 Zang , each is also associated with elements, organs, a function or system, and a psychological function. Dan is associated with wood: it includes the gall bladder, controls the circulation of body fluids, and the psychological function of equilibrium and tranquility.

    Xiaochang is associated with fire: it includes the small intestine, the absorption of nutriments and transportation of waste, and the psychological function of the mind. Wei is associated with earth: it includes the stomach, the digestion function and muscular contraction system, and the psychological function of temper and intelligence. Dachang is associated with metal: it includes the large intestine, the immunological system and cellular response to pathogen, and the psychological function of willpower.

    Pangguang is associated with water: it includes the urinary bladder, the water balance and excretion system, and the psychological function of compliance. Additionally, another entity named Sanjiao , which could be considered as the sixth fu , is associated with fire, and is the coordinator of the 3 parts of the body: the upper zone with the respiratory and cardiovascular system, the middle zone with digestion, and the lower zone with excretion.

    Note that each of these types corresponds more to a system than to any particular anatomical feature or organ. Thus, at its theoretical heart, TCM is a systems-oriented interpretation of medical science. TCM differentiates signs and symptoms of a disease by 8 principles that are in 4 pairs of 2, for example, cold and heat, exterior and interior, deficiency and excess, and Yin and Yang.

    Cold and heat are 2 principles differentiating the nature of a disease, in that cold refers to syndromes caused by exogenous pathogenic cold, whereas heat represents syndromes caused by exogenous pathogenic heat. Cold syndromes include aversion to cold and preference for warmth, tastelessness in the mouth, absence of thirst, pallor, cold extremities, clear and profuse urine, loose stool, pale tongue proper with a white slippery coating, slow pulse, etc.

    Exterior and interior are 2 principles indicating the depth and development of a disease. Exterior refers to syndromes caused by the invasion of exogenous pathogenic factors into the surface of the body and generally located in the superficial portion, whereas interior refers to syndromes caused by the transmission of exogenous pathogenic factors into the interior of body or from the dysfunction of the Zang - Fu organs.

    Deficiency refers to symptoms caused by the weakness and insufficiency of body defense, whereas excess refers to symptoms induced by an overabundance of exogenous pathogenic factors. Deficiency syndromes are mainly due to an insufficiency of antipathogenic factors when exogenous pathogenic factors are also in a weakened state.

    An excess of exogenous pathogenic factors mainly causes excess syndromes, with body defense not yet weakened. Yin and Yang are 2 general principles used to categorize the other 6 principles, that is, heat, exterior, and excess belong to the category of Yang , whereas cold, interior, and deficiency belong to Yin. TCM identifies different patterns of the evolution of disease by classifying factors of pathology according to climatic influences.

    Such factors impact the organism by triggering modification of the body homeostasis. The understanding is that climatic factors foster the development of pathology because of the transport of pathogens virus, bacteria , and promote the establishment of such pathogens with proper temperature and humidity conditions. The establishment of a diagnosis in TCM is a crucial step after several actions such as a visual observation, interrogation, body palpation, body sounds, and smell.

    A complete diagnosis pattern in TCM will thus include not only the localization of the organism disbalance source, but also its nature. One of the classification methods of the established patterns dates back to CE and is exposed in the Shanghan Lun , or Treatise on Cold Damage Disorders, written by Zhang Zhongjing. This treatise develops 6 stages of disease, supposedly relating the evolution of disease from symptoms of a simple cold to death. TCM prescribes formula to treat diseases.

    Another aspect is the modernization of TCM, which could benefit from the latest advances of modern medicine technologies to develop more evidence-based and personalized medicine. The earlier steps of Japanese medicine are linked to the spread of TCM. The name to design this medicine, Kampo or Kanpo is derived from 2 symbols:.

    With the decision of the Edo period government to cease exchanges with overseas nations during years from the 17th to 19th century — , the importance of private schools soared, and the Japanese medicine identity strengthened. Several physicians and doctors travelled to Europe and brought modern methods back to Japan, attempting to integrate and harmonize them with the developing Japanese medicine. By the 19th century during the Meiji period, the commercial and cultural exchanges with the foreign countries had started again, mainly through Dutch representatives.

    This triggered the rise of Western culture in Japan, collaterally forsaking the development of Kampo medicine to fully embrace WM. In the process, Kampo was left behind and no longer taught nor recognized as a medical profession. A few years later in , lectures on Kampo were given in Takushoku University. By the middle of the 20th century, Kampo was simplified to a modern concept, which allowed understanding and acceptance for WM trained doctors and physicians.

    As a result of those efforts, the first 4 Kampo formulas were accepted into the national health-care program in Nine years later, Taro Takemi — , as the 11th President of the Japan Medical Association, convinced the government to integrate herbal prescriptions to the national health-care program.

    Traditional Chinese medicine

    To date, Kampo medicine courses are offered in all 80 medical schools from the Japanese public and private universities, with mitigated success and heterogeneous teaching,[ 31 ] and with less visibility and importance than WM. Even though the utilization of Kampo drugs is different from one medical domain to another, a vast majority Thus, among physicians working in the cancer field, Kampo drugs were delivered to Still, the purpose to deliver an optimal treatment to a patient is set by defining patterns, from which the most appropriate medication can be administered against various symptoms.

    Unlike Western conventional medicine, the focus is on the patient condition rather than on the eradication of the pathology. Any disease is explained by a deviation of the patient equilibrium from the normal status, either in deficiency or in excess. The diagnosis in Kampo medicine will require the physician to establish in which terms and which amplitude this deviation occurs. The tools used differ from those in WM and rely on intuitive examination of the general condition of the patient organism and mind, resulting in qualitative descriptions, rather than the quantitative results.

    The solution considered in Kampo medicine is to assist the organism to adapt and return to homeostasis rather than eradicate the pathology. The level reached by the deviation in either direction, positive or negative, corresponds to a codified definition of the symptoms, leading to predefined patterns. To each pattern corresponds one formulation of herbal extracts; the challenge is then to determine the appropriate matching of pattern and formula. Kampo medicine may also require the use of subtle TCM stages of the pathology derived from the Chinese Shanghan Lun see Diagnosis and stages of pathology.

    The elaboration of Sho leads to the prescription of herbal extracts, or formula, among the covered by the Japanese health insurance program. The development of traditional medicine in Korea derives from 2 major philosophical traditions in China: Taoism and Confucianism. The first developed on the basis of the relevant classical texts of Chinese medicine, such as Huangdi Neijing. Taoism in medicine can be seen to emphasize nature, the universe, and therefore the environmental influences on health and disease. This tradition matches that of Western systems approaches to medicine in regarding organisms as fully open systems.

    Confucianism by contrast emphasized the inner person, the strengths and weaknesses of the individual. The influence of its philosophy on social aspects, politics, economics, and ethics was profound. But Confucianism largely left science and medicine to the Taoists. Korea became very strongly Confucian during the long Jeoson dynasty — , when the more Taoist-friendly Buddhism was sidelined. It is not therefore surprising that Korean traditional medicine grew out of a need to synthesize the Taoist and Confucian systems of thought and practice.

    This synthesis was almost entirely achieved through the work of one man, Lee Je-ma. It has been translated only recently , 2nd edition into English with the title Longevity and life Preservation in Eastern Medicine. The book consists of 2 parts. It is difficult reading even for practitioners of traditional Korean medicine, who naturally focus on the second part, which is essentially a formulary based on sources such as the Shanghanlun. Korean traditional medicine is not therefore very different from TCM in its use of herbal formulas and other treatments.

    Treatment is decided on the basis of that typology. To be sure, there were also typologies in ancient Chinese medicine, notably Yin Yang Ershiwu ren. Yin-yang with 25 types of people within the Huangdi Neijing. Each type is based on assessments of personality, psychological state, and functions of organs of the body represented as the equilibrium status of 2 seesaws between the intake and discharge processes and between the catabolism and anabolism processes.

    Sa-sang is therefore an early version of patient-specific medication. Moreover, herbal medicine is strictly regulated and controlled to comply with the Korean Good Manufacturing Practice standards. Modern research on Sa-sang is focused on quantifying the diagnostic methods, including analyses of face shape, body shape, voice characteristics, skin properties, pulse properties, temperament, and other ordinary symptoms. This research has transformed these features into various quantified variables and integrated them to develop algorithms for constitutional typing.

    This work was recently reviewed. Notably, Sa-sang typology is investigated in current diseases or health conditions, such as obesity,[ 45 ] cardiovascular disease,[ 46 ] diabetes,[ 47 ] cancer incidence,[ 48 ] or allergic rhinitis. The 21st century will therefore witness the ideas and methods being put on a firm scientific basis. It will be interesting to see what happens in consequence to the typology.

    Will physiological analysis confirm the usefulness of 4 basic types much easier for a practitioner than 25 types! How will it relate to Western-style research on patient classification using genomics and phenotyping? These are questions for future research. It is a recognized medical system with all regulatory procedures, related to health care, education, and quality standards of medicines in place. In Ayurveda , etiological factors, pathogenesis, clinical features, and therapeutic modalities of diseases are described based on subtype, stage, and severity of the disease. Delivery of medicines in a personalized manner is possible with a thorough examination of diseased individual, advised to select appropriate medicine in appropriate dosage for the right person.

    Understanding of human individuality through assessment of each individual constitution type forms the fundamental basis for this year-old medical system, comparable with current P4 systems medicine , as it also promotes a proactive attitude to disease understanding and treatment. The foundations of traditional medical knowledge in the Indian subcontinent are known to date back to the ancient Vedic era ca. There is a close link between traditional medicine in India and Veda, wherein the philosophical and spiritual aspects of Ayurveda are described in Atharva-Veda.

    Nevertheless, the matter of healing still opposed heterodox tradition evidence based and empirical exploration of healing organisms to orthodox tradition based on religious rituals and beliefs. The drug must first diffuse out of the vehicle to the skin surface and then, it must penetrate the natural barrier to enter into the site of action. Carbopol polymers are bearing very good water sorption property.

    They swell in water up to times their original volume and 10 times their original diameter to form a gel when exposed to a pH environment above 4. Because the pKa of these polymers is 6. However, glass transition temperature decreases significantly as the polymer comes into contact of water. The polymer chains start gyrating and radius of gyration becomes increasingly larger. Macroscopically, this phenomenon manifests itself as swelling. Wound healing is a natural restorative response to tissue injury.

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    Healing is the interaction of a complex cascade of cellular events that generates resurfacing, reconstitution, and restoration of the tensile strength of injured skin. Healing is a systematic process, traditionally explained in terms of 3 classic phases: inflammation, proliferation, and maturation. A clot forms and inflammatory cells debride injured tissue during the inflammatory phase. Epithelialization, fibroplasia, and angiogenesis occur during the proliferative phase. Meanwhile, granulation tissue forms and the wound begin to contract. Finally, during the maturation phase, collagen forms tight cross-links to other collagen and with protein molecules, increasing the tensile strength of the scar.

    Biological Methods for the Study of Wound Healing7 Animal models and in-vitro assays have become indispensable tools for researchers in nearly every scientific discipline. In product development there is a need for translational research to obtain data that can lead to sound clinical trials and ultimately, improved wound care. This process is usually performed in a stepwise fashion starting with in-vitro testing, preclinical, and then clinical evaluations. In-vitro studies help determine which concentrations may be effective in-vivo and determine whether certain products are effective on various cell types e.

    This facilitates investigation of the product in the presence of wound fluid, blood, immune cells, proteases, etc. It is important to be sure that these agents do not have a toxic effect on tissues. Efficacy animal trials are conducted after the safety studies are completed. This eventually allows the product to be evaluated in human trials. Although definitive studies conducted on human subjects are needed, such studies present several practical, ethical, and moral concerns.

    For example, in order to examine wounds histologically throughout the entire healing process one must biopsy a human subject at multiple time points, which is impractical. Furthermore, ethical considerations prevent the intentional infection of a wound on a human or the use of an untreated control subject. Some of the practical difficulties lie in obtaining enough subjects with similar or identical situations to conduct well controlled studies. Another complication to factor in with human trials is compliance e.

    The above difficulties have led researchers to develop multiple in-vitro and in-vivo models that attempt to mimic or reproduce human conditions. They are relatively inexpensive, fast, and convenient for the researcher. In addition to providing useful results in a short time, they possess an obvious humane appeal since they usually do not involve the use of animals or humans.

    In-vitro assays are useful in wound healing research for determining the possible effectiveness of various treatments, particularly antimicrobial and healing enhancing agents. Another noteworthy attribute of in-vitro testing is the ability to screen multiple agents or samples simultaneously. Assays can aid in the early detection of antimicrobial resistance among pathogens and determination of minimal inhibitory concentrations MIC , and allow for highly specific control over the experimental conditions.

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    Although some variables such as pH, salinity, and temperature are easily controlled, in-vitro assays are incapable of completely reproducing biological conditions e. In order to approximate in-vivo experiments, in-vitro assays have been developed that incorporate some variety of cell or tissue system. Wound closure studies have been conducted on single cell monolayer systems. The principle in vitro technique for studying the skin penetration evolves the use of variety of diffusion cells in which animal or human skin is fastened to a holder and the passage of compounds from epidermal surface to a fluid bath is measured.

    Many chemical agents can be used which penetrate in sufficient concentration to be determined by different physical and chemical analysis. More recently model systems have been used which do not use membranes. Solvent such as alcohol —water have been used as models chosen to have negligible solubility in phase representing the skin, but in which drug is fairly soluble. A receptor phase like chloroform and isopropyl myristate can also be used to receive the penetrant. Important factors influencing release in to receptor phase are solubility in the vehicle and partition coefficient of the drug between vehicle and the receptor phase.

    Optimum release is obtained from vehicle containing the minimum concentration of solvent required for complete solubilization of the drug. Rodent and small mammal models of wound healing have emerged as the model of choice for many researchers. This type of study is beneficial to wound research for multiple reasons.

    Small animals are inexpensive, easily obtainable, and require less space, food, and water. Additionally, they often have multiple offspring, which develop quickly allowing experiments to proceed through multiple generations. Small animals usually have accelerated modes of healing compared to humans, thus experiment duration lasts for days, as opposed to weeks or months in human experiments.

    Some small mammals can easily be altered genetically and provide a wound model capable of approximating defective human conditions such as diabetes, immunological deficiencies, and obesity. Another advantage of small mammal models is their ability to serve in experiments where death is an endpoint, as is some cases of bacterial or viral infection.

    Small animals provide a multitude of model choices for various human wound conditions. Some models have been developed to investigate the mechanistic particulars of certain aspects of healing. The major in-vivo methods are histological techniques, use of tracers, analysis of body fluids and tissues and elicitation of biological response. Tissue changes in skin following the application of various substances to the cuetaneous surface can yield information about specific tissues affected, so that not only absorption is revealed but also the route of penetration.

    For studying the wound in the laboratory, mainly two types of wounds are produced experimentally. These are excised or open wounds and incised or sutured wounds. The assessment of healing is made by studying the regenerating tissue by different parameters. Following types of wounds are made in laboratory animals for studying the effect of various drugs. Back of each animal is shaved and prepared after washing with spirit for operation. An area of about 2. The marked area is excised with sharp knife and scissors under ether anesthesia.

    After making wound the animals are divided in two groups. One control group and the other test group and are kept in isolated cages. Topical application of ointments or lotions are made on is founds daily. On desired postoperative days this founded animals are sacrifice and the contraction measured.

    Wounds are closed by interrupted cotton threads stitches, which are placed approximately at equal distance. The tensile strengths, biochemical and histological study of the wound are carried out. The wound is caused in one layer by interrupted linen stitches.

    Tensile strength and busting abdomen, by chemical and histological studies are done on this wounds tissue, after sacrifice the animals on desired post operative days. It is heated to a red hot over flying and is placed in contact with the back of the anaesthetized rat up to ten seconds, with out any pressure. Medication is applied these animals are sacrificed on desired days and the regenerated tissues are removed for biochemical and the histological studies etc.

    The 10th day old granulomas are carefully dissected and cleared of the tissues. Buy Horse Chestnut Bulk Organic. Horse chestnut is valued in herbal medicine for it's support of the circulatory system. The herb is anti-inflammatory which decreases swelling and astringent which reduces bleeding and adds tone to connective tissue. Much of the medicinal value of horse chestnut is attributed to the phytochemical aescin, which has a stabilizing action on veins and capillaries.

    This strengthening of veins improves circulation to areas of cellulite and heals bruising. Balch Aescin also "firms up" varicose veins including hemorrhoids by increasing the tone of the muscle layers underlying them.

    White Look for creams containing horse chestnut as a defense against wrinkles and in body lotions to help reduce cellulite. Horse chestnut can be combined with other herbs to treat chronic coughs with congestion. The whole nut is preferable when it is to be used for external applications. The most potent form of the herb is an extract of its active constituent, aescin.