Although we think our bodies handle healing automatically, much depends on our nutritional status. A high-fat diet or malnutrition/malabsorption, particularly in the elderly, will substantially impair wound healing (Am J Med, 1986; 81: 670). Nutritional support through appropriate supplementation or a good low-fat diet has been shown to enhance the body's response to injury (Lancet, 1989; i: 995-7).

WDDTY panellist Melvyn Werbach has gathered a wealth of scientific evidence showing that nutritional support furthers wound healing (Nutritional Influences on Illness: A Sourcebook of Clinical Research, Wellingborough, Northants: Thorsons, 1989: 446-8):

* vitamin A (retinol, retinal and retinoic acid): can make scar tissue strong and resistant to tearing

* vitamin B1 (thiamine): a deficiency interferes with collagen synthesis

* vitamin B5 (pantothenic acid): can accelerate normal healing

* vitamin C (ascorbic acid): promotes formation of elastin and collagen; a low C intake may impair healing

* vitamin E (any tocopherol, tocol or tocotrienol): may facilitate skin-graft healing

* copper: makes strong bonds in collagen

* manganese: makes collagen

* zinc: stimulates wound healing in zinc-deficient patients only; after surgery, accidental trauma or burns, blood zinc decreases while urinary zinc excretion increases

* L-arginine: accelerates healing and may minimise immediate postinjury weight loss (but, in those with acute low l-lysine, may trigger a herpes simplex outbreak)

* essential fatty acids: necessary for transporting substances across cell membranes; deficiencies are associated with very slow and imperfect wound healing.

Although herbal ointments will stimulate cell repair in open injuries, wound healing responds better to treatment with moist herbal compresses. After a while, wound healing using ointments will stop. However, several days of moist dressings will produce a clean wound base, better able to respond to further treatment.

The successful treatment of wounds is seen when the dressing is changed often and when the plant extracts used are varied as required. Sterile gauze compresses should be soaked in preboiled filtered water and placed onto the wound. Herbal tinctures or decoctions may be added to the preboiled water first or may even replace it.

Poorly healing wounds should be bathed in camomile (Matricaria chamomilla: 1 g of flowers to 1 L of water) between dressings (Zeitschr Hautkr, 1987; 62: 1262, 1267-71).

Despite its popularity for wounds, Arnica montana is poorly tolerated by a small number of people and must never be applied to unbroken skin (British Herbal Pharmacopoeia, vol II, West Yorkshire: Scientific Committee of The British Herbal Medicine Association, 1979: 9-11).

Very painful wounds can be promptly relieved by applying tincture of Populus candicans (balm of Gilead) (Willard T, Textbook of Modern Herbology, Calgary, Alberta: CW Progressive Publishing, 1988: 227).

For ulcers that won’t heal, 15-20 drops of digitalis (foxglove) applied to the ulcer two or three times daily will promote skin formation. (Do not attempt this without the constant supervision of a qualified practitioner.) Massaging any protruding veins with the fingertips in a soft, gentle manner also helps (Med Klin, 1965; 60: 2028; Wien Med Wochenschr, 1969; 49: 850).

Topical application of tea tree (Melaleuca alternifolia) oil or lotion has been shown to be useful in helping to heal canker sores, athlete’s foot, burns, herpes simplex, impetigo, infections of the nailbed, psoriasis and tinea (Austr J Pharm, 1988; 69: 276-8). Tea tree oil may be diluted with olive oil.

The Blackfoot Indians in the Western US traditionally applied the leaves of Artemisia frigida (pasture sagewort) to wounds to reduce swelling, and many traditional cultures from diverse parts of sub-Sahara Africa apply a close relative, Artemisia afra Jacq (wild wormwood), to stimulate wound healing (Pharmazie, 1949; 4: 463).

Topical application of a salve made from Echinacea angustifolia (purple cone flower - not E. purpurea, the most common form) can promote wound healing (Med Klin, 1984; 79: 580-3).

Calendula officinalis (common marigold) is often used as a moist compress (one tablespoonful of the dried flower boiled up briefly in 500 mL of water) (Weiss RF, Herbal Medicine, Gothenburg: Ab Arcanum, 1988: 344).

Hydrocotyle asiatica (Centella asiatica, South African pennywort, gotu kola) has a long history of successful use in African, Chinese and Ayurvedic herbal medicine. Controlled trials have produced excellent results in the healing of surgical wounds, skin ulcers, punctures, lacerations, surgical skin cuts, skin grafts and even tears resulting from childbirth. The herb mainly supports the development of normal connective tissue (Herbs Spices Med Plants, 1988; 3: 146-73).

Aloe vera, used topically, has moisturising, anti-inflammatory and mildly antiseptic effects, all at once. It speeds wound healing as a liquid tincture, but has been shown to retard it as a gel and should not be used on deep, vertical surgical wounds (such as in laparotomy or caesarean section). The wound healing properties of aloe vera has been seen in cases of frostbite, burns, electrical injury and damage from intra-arterial drug abuse. Aloe vera has even demonstrated an ability to reverse tissue death in drug-abuse patients (Phytother Res, 1993; 7: S48-52).

Glycosaminoglycans, as a fine powder of calf tracheal cartilage digested by hydrochloric acid plus pepsin, may accelerate wound healing if applied topically, and will probably increase the flexibility of any resulting scar (JAMA, 1965; 192: 352-6).

A word of warning against the use of sugar pastes or honey for wounds. Although they facilitate wound healing by reducing the amount of water within the wound, which significantly retards bacterial growth (J Exp Pathol, 1990; 71: 155-70), sugar pastes have been known to bring on sucrose-induced osmotic nephrosis, a form of acute kidney failure, after only four days of treatment (Lancet, 1987; i: 1034-5). Although this condition appears to occur only in patients with preexisting kidney problems, extreme caution is essential. Nevertheless, sugar-based pastes have proved to be very useful for healing infected bedsores (Lancet, 1987; i: 1485-6).

Harald Gaier is a registered homoeopath, naturopath and osteopath.