Wound Healing

Gotu kola is the best-evidenced herbal vulnerary. A 2022 systematic review of four clinical trials found Centella asiatica improved wound contraction, granulation and re-epithelialisation by stimulating collagen I, FGF and VEGF while suppressing IL-1β, IL-6, TNF-α and COX-2 ^{22Reference 22Arribas-López et al. · 2022Systematic reviewA systematic review of the effect of Centella asiatica on wound healingView study →}, and a 2023 multicentre RCT (n=60) of a standardised triterpene spray-film improved healing of clean-contaminated acute wounds ^{23Reference 23Changsan et al. · 2023RCTWound healing efficacy of a polymeric spray film containing Centella asiatica leaf extract — multicentre randomised controlled trialView study →}.

Animal work adds antioxidant and collagen (hydroxyproline) gains from asiaticoside and madecassoside ^{24,25Reference 24Shukla et al. · 1999AnimalAsiaticoside-induced elevation of antioxidant levels in healing wounds — animal (rat) modelView study →Reference 25Liu et al. · 2008AnimalMadecassoside isolated from Centella asiatica facilitates burn wound healing in mice — animal modelView study →}.

Effects are documented for standardised topical preparations (defined triterpene fractions), not tea or raw powder, and oral whole-herb wound data are thin.

Calendula’s support as a vulnerary is mixed, and strongest in the early inflammation/granulation phase. Animal and fibroblast-proliferation (PI3K/Akt) studies back it ^{4,5Reference 4Givol O et al. · 2019Systematic reviewA systematic review of Calendula officinalis extract for wound healing — [systematic review]View study →Reference 5Dinda M et al. · 2015In vitroPI3K-mediated proliferation of fibroblasts by Calendula officinalis tincture: implication in wound healing — [in vitro study]View study →}, venous-leg- and diabetic-foot-ulcer work reported reduced area and high closure ^{6,7Reference 6Kundaković T et al. · 2012RCTTreatment of venous ulcers with the herbal-based ointment Herbadermal®: a prospective non-randomized pilot study — [non-randomised clinical trial]View study →Reference 7Buzzi M et al. · 2016Clinical trialA Prospective, Descriptive Study to Assess the Clinical Benefits of Using Calendula officinalis Hydroglycolic Extract for the Topical Treatment of Diabetic Foot Ulcers — [prospective clinical study]View study →}, and post-surgical trials are consistently positive on the REEDA scale ^{8,9,10Reference 8De Angelis C et al. · 2022RCTUse of calendula ointment after episiotomy: a randomized clinical trial — [randomised controlled trial]View study →Reference 9Jahdi F et al. · 2018RCTThe impact of calendula ointment on cesarean wound healing: A randomized controlled clinical trial — [randomised controlled trial]View study →Reference 10Eghdampour F et al. · 2013RCTThe Impact of Aloe vera and Calendula on Perineal Healing after Episiotomy in Primiparous Women: A Randomized Clinical Trial — [randomised controlled trial]View study →}.

A randomised diabetic-leg-ulcer trial ^{11Reference 11Carvalho AF et al. · 2016RCTLow-level laser therapy and Calendula officinalis in repairing diabetic foot ulcers — [randomised controlled trial]View study →} and a burns RCT found no benefit, almost no trial is placebo-controlled or blinded, and ‘calendula’ spans many extract types; benefit is topical. (Asteraceae contact-allergy caveat.)

Two randomised double-blind trials support comfrey for fresh abrasions — a 10% aerial-part cream reached 50% healing ~0.9 days sooner than a 1% control in children (n=108) ^{17Reference 17Barna et al. · 2012RCTWound-healing effects of a Symphytum herb extract cream in children — randomised, controlled, double-blindView study →} and cut wound size faster in adults (n=278) ^{18Reference 18Barna et al. · 2007RCTWound-healing effects of a Symphytum herb extract cream — randomised, controlled, double-blindView study →} — with rat and in-vitro data showing faster re-epithelialisation and collagen deposition ^{19,20,21Reference 19Dähnhardt et al. · 2020In vitroEpidermal regeneration induced by comfrey extract — in vitro (light and electron microscopy)View study →Reference 20Mârza et al. · 2024AnimalHealing of skin wounds in rats using creams based on Symphytum officinale extract — animal modelView study →Reference 21Araújo et al. · 2012AnimalIn vivo wound-healing effects of Symphytum officinale leaves extract — animal modelView study →}, driven by allantoin and rosmarinic acid.

Two caveats: trials were reference- not placebo-controlled (10% vs 1%), and comfrey is for intact skin and clean superficial grazes only — never open, deep or dirty wounds (rapid surface proliferation can trap infection) and never internally (hepatotoxic pyrrolizidine alkaloids).

A double-blind placebo-controlled RCT applied a 3% Equisetum arvense ointment to episiotomy wounds in 108 women and found significantly better REEDA healing scores and less pain at days 5 and 10, with fewer analgesics ^{29Reference 29Asgharikhatooni et al. · 2015RCTThe effect of Equisetum arvense (horsetail) ointment on wound healing and pain intensity after episiotomy — randomised placebo-controlled trialView study →}; two diabetic and dermal rat models support the direction ^{30,31Reference 30Ozay et al. · 2013AnimalEffects of Equisetum arvense ointment on diabetic wound healing in rats — animal modelView study →Reference 31Ozay et al. · 2010AnimalEffects of Equisetum arvense ointment on dermal wound healing in rats — animal modelView study →}, the silica and phenolic content the proposed mechanism.

All evidence is topical and the human trial is single-centre and episiotomy-specific; none of it supports oral use for wounds.

The clearest human evidence for anything ‘manuka’ is topical manuka honey, a distinct product from the leaf or essential oil: a Cochrane review found honey may shorten healing of infected post-operative wounds versus some comparators, with low-certainty evidence for other wound types ^{32Reference 32Jull et al. · 2015Systematic reviewHoney as a topical treatment for wounds [systematic review]View study →}, and a second Cochrane review rated honey among better-supported antiseptic options ^{33Reference 33Norman et al. · 2017Systematic reviewAntiseptics for burns [systematic review]View study →}, the mechanism combining osmotic drawing, low pH and methylglyoxal action ^{34Reference 34Nolan et al. · 2020Systematic reviewClinical significance of manuka and medical-grade honey for antibiotic-resistant infections: a systematic review [systematic review]View study →}.

Certainty is low, trials heterogeneous, and null results exist. The product tested is medical-grade honey, not the herb; the leaf and oil have no completed human wound trials.

Myrrh’s best-documented modern use is topical/mucosal repair: a 2026 systematic review and meta-analysis (15 studies, eight RCTs) found myrrh improves gingival and plaque indices and reduces post-surgical swelling as an adjunct ^{38Reference 38Alnakhli RA et al. · 2026Meta-analysisMyrrh in the management of periodontal disease and gingival healing — systematic review and meta-analysisView study →}, a 0.5% mucoadhesive gel led pain reduction in recurrent aphthous stomatitis ^{39Reference 39Mansour et al. · 2014RCTClinical efficacy of aloe vera- and myrrh-based oral mucoadhesive gels in minor recurrent aphthous stomatitis — randomised, double-blind, vehicle-controlled trialView study →}, mouthwash sped healing after tooth extraction ^{40Reference 40Eid RAA · 2021Clinical trialEfficacy of myrrh mouthwash on wound healing after tooth extraction — controlled clinical trialView study →}, and a sitz-bath outperformed comparators for episiotomy healing ^{41Reference 41Faraji A et al. · 2021RCTEpisiotomy wound healing by Commiphora myrrha and Boswellia carteri in primiparous women — randomised controlled trialView study →}.

Evidence is concentrated in oral/gingival and perineal/post-surgical wounds, certainty is low-to-moderate, preparations heterogeneous; one hemorrhoidectomy cohort healed faster but recorded more complications ^{42Reference 42Haffor AS · 2010AnimalEffect of myrrh (Commiphora molmol) on leukocyte levels during healing from gastric ulcer or skin injury — rat modelView study →}.

Plantain leaf is a classic drawing/soothing vulnerary with several small topical RCTs: a triple-blind trial improved stage-1 pressure-ulcer resolution with a quercetin-standardised P. major gel ^{43Reference 43Ghiasian M et al. · 2021RCTClinical and phytochemical studies of Plantago major in pressure ulcer treatment: A randomized controlled trialView study →}, an open-label RCT found a 10% hydroalcoholic gel accelerated diabetic-foot and pressure-ulcer closure ^{44Reference 44Ghanadian M et al. · 2024RCTThe effect of Plantago major hydroalcoholic extract on the healing of diabetic foot and pressure ulcers — randomised controlled trialView study →}, and an Aloe vera/P. major gel beat placebo in diabetic-foot ulcers ^{45Reference 45Najafian Y et al. · 2019RCTEfficacy of Aloe vera/Plantago major gel in diabetic foot ulcer: a randomized double-blind clinical trialView study →}; rat stereology and fibroblast studies show increased collagen and scratch-wound closure ^{46,47Reference 46Ashkani-Esfahani S et al. · 2019AnimalThe healing effect of Plantago major and Aloe vera mixture in excisional full-thickness skin wounds: stereological study — rat, in vivoView study →Reference 47Bâldea I et al. · 2023In vitroAntioxidant, anti-inflammatory effects and ability to stimulate wound healing of a common-plantain extract in alginate gel formulations — in vitroView study →}.

Trials are small, several open-label or combination, a systematic review of animal studies judged them high-risk-of-bias ^{48Reference 48Cardoso FCI et al. · 2021Systematic reviewThe effect of Plantago major on wound healing in preclinical studies: a systematic review — animal models, insufficient evidence, all at high risk of biasView study →}; benefit is topical, and leaf medicine must not be conflated with psyllium seed.

A distinct traditional use of the infused oil, not the oral antidepressant extract: a randomised double-blind trial in 144 women found a topical Hypericum perforatum ointment (3×/day) accelerated cesarean wound healing and reduced scar formation versus placebo ^{51Reference 51Samadi et al. · 2010RCTThe effect of Hypericum perforatum on the wound healing and scar of caesarean — randomised, double-blind trialView study →}, plausibly via anti-inflammatory flavonoids and hyperforin’s antibacterial action.

The signal is not uniform — a 2025 RCT on stage 1–2 pressure injuries found no difference from saline ^{52Reference 52Yıldırım et al. · 2025RCTThe Effects of StView study →} — so results are wound-type- and formulation-specific and say nothing about oral use. (Topical hypericum is photosensitising.)

Witch hazel’s human wound data are broad but weak. The largest human dataset is an uncontrolled observational study of 309 children with minor injuries, diaper dermatitis or localised inflammation, in which hamamelis ointment gave symptom reduction comparable to dexpanthenol with excellent tolerability ^{53Reference 53Wolff HH · 2007ObservationalHamamelis in children with skin disorders and skin injuries: results of an observational study — observational/cohortView study →}, though a systematic review rated the underlying evidence low-quality ^{54Reference 54Kloter E et al. · 2023Systematic reviewPhytotherapy in paediatric skin disorders — a systematic literature review — systematic reviewView study →}.

Everything else is preclinical, and a striking rat wound-closure figure came from an engineered dressing that also contained diclofenac. The astringent tannins are largely absent from steam-distilled ‘witch hazel water’.

Yarrow’s flagship traditional role is styptic and vulnerary (‘Soldier’s Woundwort’), and it has one human trial: a double-blind study in 140 primiparous women found an A. millefolium ointment reduced episiotomy pain, redness, oedema and ecchymosis versus placebo, though it did not change discharge or dehiscence ^{55Reference 55Hajhashemi M et al. · 2018RCTThe effect of Achillea millefolium and Hypericum perforatum ointments on episiotomy wound healing in primiparous women — [double-blind randomised]View study →}. In vitro, extracts promote fibroblast activity and wound closure ^{56,57Reference 56Agar OT et al. · 2015In vitroComparative studies on phenolic composition, antioxidant, wound healing and cytotoxic activities of selected Achillea L. species growing in Turkey — [in vitro]View study →Reference 57Pain S et al. · 2011RCTSurface rejuvenating effect of Achillea millefolium extract — [randomised placebo-controlled]View study →}.

The single RCT combined yarrow with a standard base (and St John’s wort), most positive genus data are on other Achillea species, and the classic hemostatic claim itself remains untested in controlled human settings.

Aloe gel is a classic vulnerary (its mucilage carries antiseptic, anti-inflammatory and wound-healing action) with supportive animal data: oral and topical activity on wound healing ^{1Reference 1Huseini et al. · 2012RCTAnti-hyperglycemic and anti-hypercholesterolemic effects of Aloe vera leaf gel in hyperlipidemic type 2 diabetic patients — randomized double-blind placebo-controlled clinical trialView study →}, accelerated closure in rat skin wounds ^{2Reference 2Alinejad-Mofrad et al. · 2015RCTImprovement of glucose and lipid profile status with Aloe vera in pre-diabetic subjects — randomized controlled trialView study →}, and improved dermal-wound healing in diabetic rats ^{3Reference 3Huang et al. · 2024Meta-analysisEffects of Aloe vera on burn injuries — systematic review and meta-analysis of randomized controlled trialsView study →}, with acemannan the marker polysaccharide credited for repair.

Human evidence is old and thin, with no dedicated wound-healing study. Aloe’s strongest skin data are in burns; for general wounds its use rests on tradition and preclinical work, chiefly topical.

A 2024 study tested the plant’s oldest documented use: a Galium aparine extract accelerated scratch-wound closure in human dermal-fibroblast and endothelial monolayers without cytotoxicity, alongside anti-S. aureus activity and ascorbic-acid-comparable antioxidant capacity ^{15Reference 15Beirami et al. · 2024In vitroBringing back Galium aparine L. from forgotten corners of traditional wound treatment procedures: an antimicrobial, antioxidant, and in-vitro wound healing assay — in vitro studyView study →}, echoing an 1883 clinical note on cleavers for chronic ulcers ^{16Reference 16Quinlan FJ · 1883Galium Aparine as a Remedy for Chronic Ulcers — historical clinical noteView study →}.

This is an in-vitro scratch assay, not a healing-wound animal or human model — whether topical cleavers speeds real wound closure is untested, and no human trial of cleavers has ever been published.

Topical flower extracts support the traditional vulnerary use in rodents only: an aqueous flower extract accelerated wound contraction, epithelialisation and tensile strength in rats ^{26Reference 26Nayak et al. · 2007AnimalWound-healing activity of Hibiscus rosa-sinensis flower extract in rats — in vivoView study →}, an ethanolic extract improved breaking strength and collagen across excision, incision and dead-space models ^{27Reference 27Bhaskar et al. · 2012AnimalWound-healing activity of ethanolic Hibiscus rosa-sinensis flower extract in rats (excision/incision/dead-space) — in vivoView study →}, and an n-butanol fraction enhanced excisional healing ^{28Reference 28Shen et al. · 2017AnimalN-butanol fraction of Hibiscus rosa-sinensis flowers enhances excisional wound healing in rats — in vivoView study →}.

The evidence is a small cluster of animal studies, with no human wound-care data. The species tested is the ornamental H. rosa-sinensis, not the roselle tea species.

Two rat studies support topical use: 5% and 10% marshmallow gels increased fibroblast populations, vessel diameter and (at 10%) collagen synthesis ^{35Reference 35Mohsenikia et al. · 2020AnimalAlthaea officinalis improves wound healing in rats: a stereological study — animal (rat)View study →}, and a hydroalcoholic leaf extract sped excision-wound closure, partly through gram-positive antibacterial activity ^{36Reference 36Rezaei et al. · 2015In vitroEvaluation of the antibacterial activity of the Althaea officinalis L. leaf extract and its wound healing potency in the rat model of excision wound — animal/in vitroView study →}; human-cell work showed the root extract cut IL-6 and improved endothelial wound-closure ^{37Reference 37Bonaterra et al. · 2022In vitroPhytohustil and root extract of Althaea officinalis L. exert anti-inflammatory and anti-oxidative properties and improve migratory capacity of endothelial cells — in vitroView study →}.

Rodent-only, topical and small, with no controlled human wound trial — and its antibacterial effect is confined to gram-positive organisms while secondary wound infection is often gram-negative, so it is best combined for antisepsis.

A crushed-leaf poultice or wash of chilca is traditionally applied as a vulnerary to clean and close wounds. The only adjacent pharmacology is the leaf essential oil’s in-vitro antifungal activity against dermatophytes (Trichophyton) and Aspergillus ^{14Reference 14Zapata B et al. · 2010Antifungal activity, cytotoxicity and composition of essential oils from the Asteraceae plant familyView study →} — relevant to skin infection, not wound repair as such. No wound-healing pharmacology exists for the herb; the use rests on consistently documented tradition.

German chamomile is a long-standing topical vulnerary, its essential-oil actives α-bisabolol and chamazulene providing a plausible anti-inflammatory basis for soothing damaged skin. But its controlled skin trials are not wound-closure studies — a chamomile liposomal gel was null on its primary radiation-dermatitis outcome ^{12Reference 12Meneses AG et al. · 2025RCTComparison of liposomal gel with and without chamomile to prevent radiation dermatitis in breast cancer patients: a randomized controlled trialView study →} and a positive 2025 trial was in diabetic neuropathy, not wound healing ^{13Reference 13Amiri M et al. · 2025RCTTopical chamomile oil as a novel therapeutic intervention for diabetic neuropathy: a randomized double-blind controlled clinical trialView study →}. Its wound-healing use rests on tradition and mechanism rather than trial evidence, and is topical.

Slippery elm bark powder was a classic Civil War-era poultice for wounds, boils and inflamed skin, and the rationale is its mucilage: a hydrated gel forms a moist protective barrier over damaged tissue ^{49,50Reference 49Tamayo et al. · 2000ReviewThe chemistry and biological activity of herbs used in Flor-Essence herbal tonic and Essiac — reviewView study →Reference 50Zick et al. · 2006ObservationalTrial of Essiac to ascertain its effect in women with breast cancer (TEA-BC) — observational studyView study →}. Direct experimental wound-healing evidence, however, comes from related elm species (U. parvifolia, U. davidiana) that accelerated closure in mouse models — findings that do not transfer to U. rubra, which has never itself been tested. The topical case rests on mechanism and tradition, not on any study of slippery elm.