Calendula for local and systemic treatment of wounds

Garden marigold (Calendula officinalis) is one of the best known medicinal plants today. It has a long tradition as a vulnerary, and Calendula preparations are part of numerous body care products in phytotherapy and anthro-posophical medicine. As in the case of sunflower, it is not possible to establish with certainty where this plant originated, but it is thought to be the Mediterranean region. Today, its distribution extends from the Canary Islands to India but to the North does not go beyond Central Europe, unless specially cultivated. The daisy family (Compositae) is outstanding in having flower communities of a higher order, a kind of "super flower". They include many medicinal plants, several of which, e.g. Arnica, Bellis and Echinacea, are able to restore order after injury. The brilliant yellow or orange color of the marigold flower appeals to us; yet it is not noble like the red of a cultivated rose nor delicate and pure like the pink of a dog rose, but rather sturdy, cheerful and unbelievably vital. Numerous small insects are always found in the inner part of the flower, and the plant clearly knows how to live with these creatures, some of them parasitic.
The scent of the flower does not suggest purity either; it is musty, fusty, faintly reminiscent of decomposition, which is probably why one of its old German names is "flower of death".
Growth is not on the disorderly side, lacking a clear central axis between earth and heaven, nor do the leaves show differentiation as they come closer to the flower; they remain simple and undivided. Flowering does not mark the end of the vegetative period for side shoots appear immediately, and this makes the general habit appear lacking in system and proliferative.

The plant, which makes few demands on the soil, shows marked vitality. One may be able to sense why this plant is able to help in areas where inadequate etheric vitalization creates problems with wound healing, providing a milieu for pathogens. It will sometimes be necessary to provide an ordering impulse by following Calendula with another substance, e.g. Quartz, once the wound has cleansed and granulation has started.

Numerous in-vitro studies demonstrate individual pharmacological actions of Calendula (for a review, see Isaac, 1992; for most recent findings, della Loggia, 1994), though on their own these do not reflect its clinical importance. According to Weiss,1988, Calendula is a gentle herbal medicine, but it will certainly also serve in the treatment of serious conditions that will hardly respond to the usual medication or where the latter carry serious risks. Extensive investigations (Isaac, 1992), as welll as long-term practical experience with the use of this plant in humans confirm the absence of toxic and mutagenic risks. Another important point is that the plant is not an allergen (Schneider et al., 1991), for unlike some other members of the family it does not contain sesquiterpene lactones.

Two case reports may serve as examples. Controlled clinical (double blind) trials are often considered the only acceptable proof of efficacy, but serious criticism has been made of these, with good reason, e.g. Kiene, 1994. In the final instance, our clinical work as physicians is determined to a high degree by individual, personal experience; every patient comes to us as an individual and cannot be adequately described by statistical means. Partly basing our work on critically-assessed, empirical data also has inner justification. Here, reference may be made to the impressive report of constructive anthroposophical care given to a patient with severe wound healing disorder published in this Journal (Glaser, 1995):

Mrs. E. N., age 79, was treated by us for left-sided hemiparesis following a first grand mal seizure. Her right breast had been removed and irradiated for cancer about 20 years earlier. Severe radiation burns required repeated skin grafts - partly with muscle tissue. At the time of admission, it could no longer be established if paresis of the brachial plexus was due to primary radiation damage or the result of numerous operations.
Six months prior to admission, a right subclavicular fistula had developed in the radiation-damaged skin area. "Local and systemic antibiotics" had been given for a month at another hospital. This reduced the inflammatory reaction, but granulation did not develop. A type IIb diabetes requiring insulin treatment may have been an additional factor in reducing healing potential.

On admission, examination showed extensive skin atrophy and teleangiectases over the whole of the thorax, with the subclavicular region most seriously affected. Here was also the fistula, its orifice about 4 mm in diameter and below it a wound cavity that could be probed to a depth of about 2 cm. Radiology, using a contrast medium, showed an irregular cavity of 2 x 1.5 cm. Necrotic material was discharged on pressure. A smear showed masses of enterococci, with a small biopsy giving no indication of malignity.
The patient had been treated with framycetin (Leukase N, Kegel) for 4 weeks; this could not be continued (treatment is normally limited to 14 days because of potential ototoxicity) and also had not resulted in granulation. We therefore started treatment with daily lavage using Wala Calendula essence (diluted 1:10 with physiological saline). The cavity was soon cleansed and getting progressively smaller. Microbiologically, only Streptococcus epidermidis was detected.

After 5 weeks of inpatient treatment, the patient was discharged, and her daughter continued the treatment at home. It needed 6 months for the wound to heal completely. No undesirable side effects were noted (as with other patients given the same treatment).
About 18 months later, the patient had to be readmitted following a fall down some stairs (probably due to hypoglycemia); she had severe concussion, a fractured skull and serial rib fractures. The thoracotomy wound became purulent, with an ulcer about 3 cm in diameter. This healed without complications with the same treatment as above.
Late sequels of radiation skin damage are notoriously difficult. In view of this, complete healing of the fistula in an area of severe skin damage must be rated a success despite the long period of treatment required. This is all the more so as previous local and even systemic treatment with antibiotics, which do have side effects, had not given the desired result.

Another case report may serve to show that Calendula also promotes the healing of problematical superinfected wounds if given in potentized form.
Mr. F. R., age 64, was transferred to us after a right hemicolectomy to remove an adenocarcinoma of the ascending colon (pT3, pNO, G2, LI, RO). Prior to the diagnosis he had had thrombosis of the right lower leg with recurrent lung embolism. A screen had been implanted in the vena cava after fibrinolysis. Hemicolectomy had been followed by gangrene of the small intestine with cholecystitis, requiring extensive surgery, including cholecystectomy. He had a 21-day lavage program to treat purulent peritonitis and was on a ventilator for 35 days because of respiratory failure due to chronic obstructive lung disease. Cardioversion was applied four times during this time to treat electrical dysfunction.

On transfer to our geriatric unit, the most serious problems were general weakness and two large, superinfected laparotomy wounds, gaping widely because of inadequate suturing. A fibrin-covered wound, 4-5 cm wide, with the fascia of the abdominal wall exposed, extended from xiphoid almost to symphysis. The subcutis, about 5 cm thick in the adipose patient, was held together with 6 sutures. The undermined wound margins could be probed to a depth of 1.5-2 cm. The other laparotomy wound was on the right side, c. 20 cm long, up to 7 cm wide and shallower. This was granulating at the base but was also thickly coated with fibrin. Microbiological smears from both wounds showed dense populations of a Staphylococcus album strain sensitive only to vancomycin.

Local treatment with a streptokinase/streptodomase gel (Varidase Gel, Lederle) soon cleared the wounds. Plans were made to cover the wound areas with grafts to shorten a healing period estimated to take months, s.c. injections of Calendula ferm. 3x (Wala) soon resulted in clean granulation tissue developing, with the pockets disappearing. The granulation tissue quickly reached skin level, with epithelization regular.
As healing progressed, the patient became mobile and independent with care designed to treat and activate him, achieving a Barthel ADL score of 100, which means complete independence in all activities of daily life.

After a brief reverse due to hemorrhoidal bleeding affecting Hb levels (recurrence of the original problem was excluded by coloscopy and gastros-copy), we were able to discharge Mr. R. after 5 weeks of inpatient treatment. The patient, who has been so severely ill before, now looks after himself at home, with occasional help from his daughter, and is in a good state of health. Marcumar anticoagulation continues, with the screen still in situ in the vena cava.

The evolution of this dramatic case history shows that good cooperation among surgeons, anesthetists and intensive care unit on one hand and geriatric rehabilitation on the other can restore stable independence even after serious illness with numerous complications. Giving Calendula 3x in addition did, in our opinion, help to shorten the inpatient period and avoid further surgery or the use of an antibiotic with its many possible side effects. Clinical geriatrics, aiming above all to develop patients' capacities and powers of self-healing, can gain much from approaches to treatment where this is the primary goal.
The observations were made at the Center for Acute Geriatrics and Early Rehabilitation at Neuperlach Hospital (Medical Director, Prof. R. Heinrich).

Brockhaus Konversationslexikon Bd 3. Berlin 1892.
Clarke JH. A Dictionary of Practical Materia Medica. New Delhi 1993.
Glaser H. Wound care in anthroposophically-extended nursing. A case history. Tr. A. R. Meuss.
JAM 1995; 12:4/70-80. Isaac 0. Die Ringelblume. Stuttgart 1992. Kiene H. Komplementxrmedizin - Schulmedizin. Dei Wissenschaftsstreit am Ende des 20. Jahrhunderts. Stuttgart 1994.
Schneider E, Hoelzl J, Eckes B, Mauch C, Schirren CG. Planta Med. 57,60. 
Weiss RF. Herbal Medicine Tr. A. R. M22