Frankincense

What Is Frankincense?

Frankincense is the aromatic gum resin that weeps from the bark of Boswellia trees when they are cut. Indian frankincense, from Boswellia serrata, is the salai guggul of Ayurveda, used for joint pain and inflammation ^{6,34Reference 6Kumar B et al. · 2025RCTA Standardized Boswellia serrata Extract Improves Knee Joint Function and Cartilage Morphology in Human Volunteers with Mild to Moderate Osteoarthritis in a Randomized Placebo-Controlled Study — [randomized controlled trial]View study →Reference 34Orwa et al. · 2009Boswellia serrata — botanic description, biology, ecology, native range, resin yield and products — tree databaseView study →}.

Boswellia serrata is a deciduous tree of the dry hill forests of India and Pakistan, usually 9–15 m tall ^{34Reference 34Orwa et al. · 2009Boswellia serrata — botanic description, biology, ecology, native range, resin yield and products — tree databaseView study →}. Its resin has been used as medicine in India for over 2,000 years, and it is also burnt as incense ^{34,35Reference 34Orwa et al. · 2009Boswellia serrata — botanic description, biology, ecology, native range, resin yield and products — tree databaseView study →Reference 35FernFern, K. (n.d.). Boswellia serrata — habit, range, habitat, history of medicinal use and wild harvest — plant database. Useful Tropical Plants Database. https://tropical.theferns.info/viewtropical.php?id=Boswellia+serrataView study →}.

The resin’s anti-inflammatory activity is attributed to the boswellic acids, above all acetyl-11-keto-β-boswellic acid (AKBA), which blocks the enzyme 5-lipoxygenase ^{14Reference 14Sailer ER et al. · 1996In vitroAcetyl-11-keto-beta-boswellic acid (AKBA): structure requirements for binding and 5-lipoxygenase inhibitory activity — [in vitro enzyme study]View study →}. Several randomised trials of standardised extracts have found less pain and stiffness in knee osteoarthritis, and smaller trials have tested it in asthma and inflammatory bowel disease ^{1,2,3,4,5,6,7,8,9,10,11,12,13,19,20,21,22,23Reference 1Kimmatkar N et al. · 2003RCTEfficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee—a randomized double blind placebo controlled trial — [randomized double-blind placebo-controlled trial]View study →Reference 2Sengupta K et al. · 2008RCTA double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee — [randomized controlled trial]View study →Reference 3Vishal AA et al. · 2011RCTA double blind, randomized, placebo controlled clinical study evaluates the early efficacy of aflapin in subjects with osteoarthritis of knee — [randomized controlled trial]View study →Reference 4Sengupta K et al. · 2010RCTComparative efficacy and tolerability of 5-Loxin and AflapinAgainst osteoarthritis of the knee: a double blind, randomized, placebo controlled clinical study — [randomized controlled trial]View study →Reference 5Karlapudi V et al. · 2023RCTEfficacy and Safety of Aflapin®, a Novel Boswellia Serrata Extract, in the Treatment of Osteoarthritis of the Knee: A Short-Term 30-Day Randomized, Double-Blind, Placebo-Controlled Clinical Study — [randomized controlled trial]View study →Reference 6Kumar B et al. · 2025RCTA Standardized Boswellia serrata Extract Improves Knee Joint Function and Cartilage Morphology in Human Volunteers with Mild to Moderate Osteoarthritis in a Randomized Placebo-Controlled Study — [randomized controlled trial]View study →Reference 7Majeed M et al. · 2019RCTA pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee — [randomized controlled trial]View study →Reference 8Yu G et al. · 2020Meta-analysisEffectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis — [systematic review and meta-analysis]View study →Reference 9Bannuru RR et al. · 2018Meta-analysisEfficacy of curcumin and Boswellia for knee osteoarthritis: Systematic review and meta-analysis — [systematic review and meta-analysis]View study →Reference 10Liu X et al. · 2018Meta-analysisDietary supplements for treating osteoarthritis: a systematic review and meta-analysis — [systematic review and meta-analysis]View study →Reference 11Dubey V et al. · 2024Meta-analysisEfficacy evaluation of standardized Boswellia serrata extract (AflapinⓇ) in osteoarthritis: A systematic review and sub-group meta-analysis study — [systematic review and meta-analysis]View study →Reference 12Dalmonte T et al. · 2024Meta-analysisEfficacy of Extracts of Oleogum Resin of Boswellia in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis — [systematic review and meta-analysis]View study →Reference 13Inprasit C et al. · 2026Meta-analysisEvaluating the efficacy and safety of Curcuma longa, Boswellia serrata, and their mixed formulation in treating knee osteoarthritis: A systematic review and network meta-analysis — [systematic review and network meta-analysis]View study →Reference 19Gupta I et al. · 1997Clinical trialEffects of Boswellia serrata gum resin in patients with ulcerative colitis — [controlled clinical trial]View study →Reference 20Gerhardt H et al. · 2001RCTGerhardt H, Seifert F, Buvari P, Vogelsang H, & Repges R (2001). [Therapy of active Crohn disease with Boswellia serrata extract H 15] — [randomized controlled trial]. Z Gastroenterol, 39(1), 11-7. https://pubmed.ncbi.nlm.nih.gov/11215357/View study →Reference 21Holtmeier W et al. · 2011RCTRandomized, placebo-controlled, double-blind trial of Boswellia serrata in maintaining remission of Crohn’s disease: good safety profile but lack of efficacy — [randomized controlled trial]View study →Reference 22Madisch A et al. · 2007RCTBoswellia serrata extract for the treatment of collagenous colitisView study →Reference 23Gupta I et al. · 1998RCTEffects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study — [randomized controlled trial]View study →}.

Omani frankincense, the luban of the Arabian incense trade, comes from a different species, Boswellia sacra, which contains much more AKBA ^{29,31Reference 29Al-Saidi S et al. · 2012In vitroComposition and antibacterial activity of the essential oils of four commercial grades of Omani luban, the oleo-gum resin of Boswellia sacra FLUECK — [in vitro]View study →Reference 31Mannino G et al. · 2016Quantitative Determination of 3-O-Acetyl-11-Keto-βBoswellic Acid (AKBA) and Other Boswellic Acids in Boswellia sacra Flueck (synView study →}.

How Is Frankincense Used?

• Standardised extract — capsules or tablets of B. serrata extract enriched in AKBA, the form used in most modern trials.
• Powdered gum resin — taken as a tablet or capsule, the traditional internal form.
• Salve or liniment — the resin applied to wounds and inflamed joints.
• Essential oil and incense — the oil inhaled for the chest, and the resin burnt as incense.

Traditional Uses

Ayurvedic Medicine

In Ayurveda the resin of Boswellia serrata is salai guggul, also called shallaki (Sanskrit sallaki) ^{34Reference 34Orwa et al. · 2009Boswellia serrata — botanic description, biology, ecology, native range, resin yield and products — tree databaseView study →}. It is used both externally and internally.

Applied to the skin, it served as an astringent and anti-inflammatory for wounds and inflamed joints. Taken internally, it was a stimulant and expectorant.

Its documented indications include cough and lung complaints, rheumatism and joint pain, diarrhoea and dysentery, gonorrhoea and syphilis, painful periods, poor appetite and general weakness, and various liver conditions. Ayurvedic and Unani medicine also use it for asthma, skin and blood diseases, and fever ^{6Reference 6Kumar B et al. · 2025RCTA Standardized Boswellia serrata Extract Improves Knee Joint Function and Cartilage Morphology in Human Volunteers with Mild to Moderate Osteoarthritis in a Randomized Placebo-Controlled Study — [randomized controlled trial]View study →}.

Western Herbal Medicine

Western herbal practice took up frankincense from the Ayurvedic anti-inflammatory tradition and from its ancient role as an antiseptic and ceremonial incense. The resin is used chiefly for joint and inflammatory complaints, and applied to wounds.

Indications

• Knee osteoarthritis [standardised resin extract]
• Joint pain and rheumatism [gum resin; Ayurveda]
• Crohn’s disease [standardised extract] ⚠Caution: One trial found an extract as effective as mesalazine for active Crohn’s disease. A later 52-week trial found an extract no better than placebo for keeping the disease in remission, and it was stopped early ^20,21.
• Ulcerative colitis [gum resin]
• Collagenous colitis [standardised extract]
• Asthma [gum resin; Ayurveda]
• Cough and lung complaints [gum resin; Ayurveda]
• Brain swelling during radiotherapy for brain tumours [extract, alongside standard treatment]
• Blood sugar and cholesterol in type 2 diabetes [resin supplements]
• Diarrhoea and dysentery [gum resin; Ayurveda]
• Painful periods [gum resin; Ayurveda]
• Gonorrhoea and syphilis [gum resin; Ayurveda]
• Wounds [resin, applied to the skin; Ayurveda, Western herbal medicine]

Botany

Indian frankincense is a medium-sized to large deciduous tree in the Burseraceae, the same family as myrrh. It has a light, spreading crown and somewhat drooping branches, and usually grows 9–15 m tall. The trunk is often short, 3–5 m before it branches ^{34Reference 34Orwa et al. · 2009Boswellia serrata — botanic description, biology, ecology, native range, resin yield and products — tree databaseView study →}.

The bark is very thin and greyish-green, ashy or reddish. It peels away in thin, papery flakes to show a green layer beneath ^{34Reference 34Orwa et al. · 2009Boswellia serrata — botanic description, biology, ecology, native range, resin yield and products — tree databaseView study →}.

The leaves are pinnate, 20–45 cm long, and crowded towards the ends of the branches. The leaflets grow in opposite pairs and are lance-shaped, 2.5–8 cm long, with toothed edges. The species name serrata, from the Latin for “saw”, refers to these teeth ^{34Reference 34Orwa et al. · 2009Boswellia serrata — botanic description, biology, ecology, native range, resin yield and products — tree databaseView study →}.

The white flowers grow in stout clusters 10–20 cm long near the branch tips, from late January to April. The tree sheds nearly all its leaves by December and grows new ones in May or June ^{34Reference 34Orwa et al. · 2009Boswellia serrata — botanic description, biology, ecology, native range, resin yield and products — tree databaseView study →}.

The fruit is about 1.3 cm long and three-angled. It splits into three valves around three heart-shaped, one-seeded stones, and ripens in May and June ^{34Reference 34Orwa et al. · 2009Boswellia serrata — botanic description, biology, ecology, native range, resin yield and products — tree databaseView study →}.

When the bark is wounded it exudes a yellowish-green gum-oleoresin, which is collected as salai guggul. A mature tree yields about 1–1.5 kg of gum a year ^{34Reference 34Orwa et al. · 2009Boswellia serrata — botanic description, biology, ecology, native range, resin yield and products — tree databaseView study →}.

Distribution

Indian frankincense grows in India and Pakistan ^{34Reference 34Orwa et al. · 2009Boswellia serrata — botanic description, biology, ecology, native range, resin yield and products — tree databaseView study →}. It is a tree of tropical dry deciduous forest, found in very dry teak forest and dry mixed forest alongside Terminalia, Anogeissus latifolia and Acacia leucophloea. It grows on hill slopes and ridges and on flat ground, up to 1,150 m, where annual rainfall is 500–2,000 mm ^{34Reference 34Orwa et al. · 2009Boswellia serrata — botanic description, biology, ecology, native range, resin yield and products — tree databaseView study →}.

It thrives on the poorest and shallowest rocky soils, where the trees around it stay stunted. It resists drought, and survives fire better than most trees in its range ^{34Reference 34Orwa et al. · 2009Boswellia serrata — botanic description, biology, ecology, native range, resin yield and products — tree databaseView study →}. It is also planted as an avenue tree in India ^{34Reference 34Orwa et al. · 2009Boswellia serrata — botanic description, biology, ecology, native range, resin yield and products — tree databaseView study →}.

The resin and bark are wild-harvested and traded both locally and internationally ^{35Reference 35FernFern, K. (n.d.). Boswellia serrata — habit, range, habitat, history of medicinal use and wild harvest — plant database. Useful Tropical Plants Database. https://tropical.theferns.info/viewtropical.php?id=Boswellia+serrataView study →}. Boswellia serrata has not been assessed for the IUCN Red List ^{36Reference 36GBIF Secretariat (n.d.)Boswellia serrata RoxbView study →}.

Sourcing: the resin is collected by cutting the bark of wild trees. Suppliers who describe how the trees are tapped and rested between harvests are the ones to look for.

Growing Conditions

Cultivation snapshot for Frankincense

LifeperennialZoneUSDA 10–12

• Thrives in hot, seasonally dry tropical and subtropical climates (roughly USDA zones 10–12); it is not frost-tolerant.
• Wants full sun and well-drained, often rocky or poor hill soils — a tree of dry deciduous forest, not rich moist ground.
• Drought-adapted: it drops its leaves through the dry season and tolerates lean conditions.
• The medicinal resin is obtained by carefully tapping mature bark; over-tapping harms the tree, so sustainable harvest matters.

Grow it yourself

Farm Wiki is our cultivation-focused sister site, also run by Justin Cooke.

How to growComing soon

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Harvesting, Collection & Preparation

The resin dissolves only in strong alcohol, so it is usually taken as a tablet or capsule rather than as a tincture or liquid extract.

Pharmacology & Research

Frankincense has been tested in more human trials than most resins. A 2008 systematic review in the BMJ found seven randomised trials and judged the evidence encouraging but not compelling ^{30Reference 30Ernst E · 2008Systematic reviewFrankincense: systematic review — [systematic review]View study →}.

Most of the human evidence is on knee osteoarthritis, where several randomised trials and meta-analyses report less pain and stiffness ^{1,2,3,4,5,6,7,8,9,10,11,12,13Reference 1Kimmatkar N et al. · 2003RCTEfficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee—a randomized double blind placebo controlled trial — [randomized double-blind placebo-controlled trial]View study →Reference 2Sengupta K et al. · 2008RCTA double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee — [randomized controlled trial]View study →Reference 3Vishal AA et al. · 2011RCTA double blind, randomized, placebo controlled clinical study evaluates the early efficacy of aflapin in subjects with osteoarthritis of knee — [randomized controlled trial]View study →Reference 4Sengupta K et al. · 2010RCTComparative efficacy and tolerability of 5-Loxin and AflapinAgainst osteoarthritis of the knee: a double blind, randomized, placebo controlled clinical study — [randomized controlled trial]View study →Reference 5Karlapudi V et al. · 2023RCTEfficacy and Safety of Aflapin®, a Novel Boswellia Serrata Extract, in the Treatment of Osteoarthritis of the Knee: A Short-Term 30-Day Randomized, Double-Blind, Placebo-Controlled Clinical Study — [randomized controlled trial]View study →Reference 6Kumar B et al. · 2025RCTA Standardized Boswellia serrata Extract Improves Knee Joint Function and Cartilage Morphology in Human Volunteers with Mild to Moderate Osteoarthritis in a Randomized Placebo-Controlled Study — [randomized controlled trial]View study →Reference 7Majeed M et al. · 2019RCTA pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee — [randomized controlled trial]View study →Reference 8Yu G et al. · 2020Meta-analysisEffectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis — [systematic review and meta-analysis]View study →Reference 9Bannuru RR et al. · 2018Meta-analysisEfficacy of curcumin and Boswellia for knee osteoarthritis: Systematic review and meta-analysis — [systematic review and meta-analysis]View study →Reference 10Liu X et al. · 2018Meta-analysisDietary supplements for treating osteoarthritis: a systematic review and meta-analysis — [systematic review and meta-analysis]View study →Reference 11Dubey V et al. · 2024Meta-analysisEfficacy evaluation of standardized Boswellia serrata extract (AflapinⓇ) in osteoarthritis: A systematic review and sub-group meta-analysis study — [systematic review and meta-analysis]View study →Reference 12Dalmonte T et al. · 2024Meta-analysisEfficacy of Extracts of Oleogum Resin of Boswellia in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis — [systematic review and meta-analysis]View study →Reference 13Inprasit C et al. · 2026Meta-analysisEvaluating the efficacy and safety of Curcuma longa, Boswellia serrata, and their mixed formulation in treating knee osteoarthritis: A systematic review and network meta-analysis — [systematic review and network meta-analysis]View study →}. Single or small trials cover asthma, ulcerative colitis, Crohn’s disease, collagenous colitis and brain swelling during radiotherapy ^{19,20,21,22,23,24,25Reference 19Gupta I et al. · 1997Clinical trialEffects of Boswellia serrata gum resin in patients with ulcerative colitis — [controlled clinical trial]View study →Reference 20Gerhardt H et al. · 2001RCTGerhardt H, Seifert F, Buvari P, Vogelsang H, & Repges R (2001). [Therapy of active Crohn disease with Boswellia serrata extract H 15] — [randomized controlled trial]. Z Gastroenterol, 39(1), 11-7. https://pubmed.ncbi.nlm.nih.gov/11215357/View study →Reference 21Holtmeier W et al. · 2011RCTRandomized, placebo-controlled, double-blind trial of Boswellia serrata in maintaining remission of Crohn’s disease: good safety profile but lack of efficacy — [randomized controlled trial]View study →Reference 22Madisch A et al. · 2007RCTBoswellia serrata extract for the treatment of collagenous colitisView study →Reference 23Gupta I et al. · 1998RCTEffects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study — [randomized controlled trial]View study →Reference 24Clark CE et al. · 2010Meta-analysisHerbal interventions for chronic asthma in adults and children: a systematic review and meta-analysis — [systematic review and meta-analysis]View study →Reference 25Kirste S et al. · 2011RCTBoswellia serrata acts on cerebral edema in patients irradiated for brain tumors: a prospective, randomized, placebo-controlled, double-blind pilot trial — [randomized controlled trial]View study →}.

The preclinical research centres on the boswellic acids, especially acetyl-11-keto-β-boswellic acid (AKBA), a direct 5-lipoxygenase inhibitor ^{14Reference 14Sailer ER et al. · 1996In vitroAcetyl-11-keto-beta-boswellic acid (AKBA): structure requirements for binding and 5-lipoxygenase inhibitory activity — [in vitro enzyme study]View study →}.

1. Osteoarthritis

Knee osteoarthritis is the one indication where frankincense has been tested repeatedly in humans. The first trial was a small randomised, double-blind, placebo-controlled crossover study in 30 patients, with eight weeks on each treatment. The Boswellia serrata extract reduced knee pain and swelling and improved knee flexion and walking distance. X-rays did not change ^{1Reference 1Kimmatkar N et al. · 2003RCTEfficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee—a randomized double blind placebo controlled trial — [randomized double-blind placebo-controlled trial]View study →}.

A series of trials on AKBA-enriched extracts followed. 5-Loxin (30% AKBA), at 100 or 250 mg a day for 90 days in 75 patients, improved pain and function scores and lowered the cartilage-degrading enzyme MMP-3 in joint fluid ^{2Reference 2Sengupta K et al. · 2008RCTA double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee — [randomized controlled trial]View study →}. Aflapin at 100 mg a day improved pain and function within 5 days ^{3Reference 3Vishal AA et al. · 2011RCTA double blind, randomized, placebo controlled clinical study evaluates the early efficacy of aflapin in subjects with osteoarthritis of knee — [randomized controlled trial]View study →}, and both 5-Loxin and Aflapin at 100 mg a day beat placebo over 90 days ^{4Reference 4Sengupta K et al. · 2010RCTComparative efficacy and tolerability of 5-Loxin and AflapinAgainst osteoarthritis of the knee: a double blind, randomized, placebo controlled clinical study — [randomized controlled trial]View study →}.

More recent trials report the same direction of effect, with lower hs-CRP and MMP-3 ^{5,7Reference 5Karlapudi V et al. · 2023RCTEfficacy and Safety of Aflapin®, a Novel Boswellia Serrata Extract, in the Treatment of Osteoarthritis of the Knee: A Short-Term 30-Day Randomized, Double-Blind, Placebo-Controlled Clinical Study — [randomized controlled trial]View study →Reference 7Majeed M et al. · 2019RCTA pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee — [randomized controlled trial]View study →}. In a 180-day MRI study in 80 people, Aflapin increased cartilage volume, cartilage thickness and joint-space width alongside symptom relief ^{6Reference 6Kumar B et al. · 2025RCTA Standardized Boswellia serrata Extract Improves Knee Joint Function and Cartilage Morphology in Human Volunteers with Mild to Moderate Osteoarthritis in a Randomized Placebo-Controlled Study — [randomized controlled trial]View study →}. Several of these trials were run by staff of the extract manufacturers ^{2,4,7Reference 2Sengupta K et al. · 2008RCTA double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee — [randomized controlled trial]View study →Reference 4Sengupta K et al. · 2010RCTComparative efficacy and tolerability of 5-Loxin and AflapinAgainst osteoarthritis of the knee: a double blind, randomized, placebo controlled clinical study — [randomized controlled trial]View study →Reference 7Majeed M et al. · 2019RCTA pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee — [randomized controlled trial]View study →}.

Meta-analyses pool this into a consistent signal. Seven RCTs (n=545) favoured Boswellia for VAS pain and WOMAC scores ^{8Reference 8Yu G et al. · 2020Meta-analysisEffectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis — [systematic review and meta-analysis]View study →}. Eleven RCTs (n=1009) found both boswellia and curcumin better than placebo, but rated study quality low overall ^{9Reference 9Bannuru RR et al. · 2018Meta-analysisEfficacy of curcumin and Boswellia for knee osteoarthritis: Systematic review and meta-analysis — [systematic review and meta-analysis]View study →}. Nine RCTs (n=712) found benefit, with a larger effect for Aflapin than other extracts ^{11Reference 11Dubey V et al. · 2024Meta-analysisEfficacy evaluation of standardized Boswellia serrata extract (AflapinⓇ) in osteoarthritis: A systematic review and sub-group meta-analysis study — [systematic review and meta-analysis]View study →}. A British Journal of Sports Medicine review placed Boswellia serrata extract among the supplements with large short-term effects on osteoarthritis pain ^{10Reference 10Liu X et al. · 2018Meta-analysisDietary supplements for treating osteoarthritis: a systematic review and meta-analysis — [systematic review and meta-analysis]View study →}.

A 2024 meta-analysis of 13 studies found no significant effect overall because the studies differed so much, although a subgroup of placebo-controlled trials did show benefit ^{12Reference 12Dalmonte T et al. · 2024Meta-analysisEfficacy of Extracts of Oleogum Resin of Boswellia in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis — [systematic review and meta-analysis]View study →}. A 2026 network meta-analysis (20 RCTs, n=1633) found that modified B. serrata formulations improved WOMAC pain, stiffness and function ^{13Reference 13Inprasit C et al. · 2026Meta-analysisEvaluating the efficacy and safety of Curcuma longa, Boswellia serrata, and their mixed formulation in treating knee osteoarthritis: A systematic review and network meta-analysis — [systematic review and network meta-analysis]View study →}.

Gap: the evidence is low-quality and preparation-specific — it belongs to particular standardized extracts (5-Loxin, Aflapin, Boswellin), not to raw resin or a generic “boswellia,” and no trial has compared boswellia with standard anti-inflammatory drugs ^{9Reference 9Bannuru RR et al. · 2018Meta-analysisEfficacy of curcumin and Boswellia for knee osteoarthritis: Systematic review and meta-analysis — [systematic review and meta-analysis]View study →}.

2. Anti-Inflammatory

AKBA is a direct, non-redox, non-competitive inhibitor of 5-lipoxygenase (5-LOX), the enzyme that starts leukotriene synthesis. This differs from the cyclooxygenase (COX) inhibition of aspirin and other NSAIDs ^{14Reference 14Sailer ER et al. · 1996In vitroAcetyl-11-keto-beta-boswellic acid (AKBA): structure requirements for binding and 5-lipoxygenase inhibitory activity — [in vitro enzyme study]View study →}.

AKBA, β-boswellic acid and two acetylated boswellic acids also inhibit COX-1 at around 10 µM ^{16Reference 16Cao H et al. · 2010In vitroDiscovery of cyclooxygenase inhibitors from medicinal plants used to treat inflammation — [in vitro]View study →}. A compound isolated from B. serrata extract, 12-ursene-2-diketone, suppressed TNFα, IL-1β, nitric oxide and MAP-kinase signalling in human blood cells and mouse macrophages ^{15Reference 15Gayathri B et al. · 2007In vitroPure compound from Boswellia serrata extract exhibits anti-inflammatory property in human PBMCs and mouse macrophages through inhibition of TNFalpha, IL-1beta, NO and MAP kinases — [in vitro / animal model]View study →}.

A 2022 systematic review lists these targets (leukotriene synthesis, COX-1/2, oxidative stress and immune-cell regulation) as the shared basis of the resin’s anti-arthritic, digestive and anticancer effects ^{17Reference 17Efferth T et al. · 2022Systematic reviewAnti-inflammatory and anti-cancer activities of frankincense: Targets, treatments and toxicities — [systematic review]View study →}.

This is enzyme- and cell-level work on isolated compounds. The osteoarthritis and bowel trials are where the effect has been measured in people.

3. Glycemic & Lipid Control

A 2024 systematic review and meta-analysis pooled five randomised trials in type 2 diabetes, with 287 patients in total. Boswellia serrata lowered HbA1c (standardised mean difference −1.01), total cholesterol, triglycerides and LDL compared with placebo or control. The drop in fasting glucose was not significant, and HDL did not change ^{18Reference 18Karimi M et al. · 2024Meta-analysisEffect of boswellia (Boswellia serrata L.) supplementation on glycemic markers and lipid profile in type 2 diabetic patients: a systematic review and meta-analysis — [systematic review and meta-analysis]View study →}.

The trials are small, and there are no long-term or hard-outcome data and no established dose.

4. Inflammatory Bowel Disease

Leukotriene B4 helps sustain inflammation in the bowel lining, and boswellic acids block its synthesis.

In a 1997 controlled trial in ulcerative colitis (grade II–III), a gum-resin preparation at 350 mg three times daily for six weeks improved stool, histology and blood measures. 82% of patients went into remission, against 75% on sulfasalazine ^{19Reference 19Gupta I et al. · 1997Clinical trialEffects of Boswellia serrata gum resin in patients with ulcerative colitis — [controlled clinical trial]View study →}. A 2001 randomised trial of the extract H15 in 102 patients with active Crohn’s disease met its non-inferiority endpoint against mesalazine. The Crohn’s Disease Activity Index fell by a mean of 90 points with H15 and 53 with mesalazine ^{20Reference 20Gerhardt H et al. · 2001RCTGerhardt H, Seifert F, Buvari P, Vogelsang H, & Repges R (2001). [Therapy of active Crohn disease with Boswellia serrata extract H 15] — [randomized controlled trial]. Z Gastroenterol, 39(1), 11-7. https://pubmed.ncbi.nlm.nih.gov/11215357/View study →}.

A 2011 multicentre, 52-week trial tested an extract for keeping Crohn’s disease in remission. It was stopped early because the extract did not separate from placebo: 59.9% of treated patients and 55.3% on placebo stayed in remission. The extract was well tolerated ^{21Reference 21Holtmeier W et al. · 2011RCTRandomized, placebo-controlled, double-blind trial of Boswellia serrata in maintaining remission of Crohn’s disease: good safety profile but lack of efficacy — [randomized controlled trial]View study →}.

A 2007 trial in collagenous colitis gave 400 mg three times daily for six weeks. More patients reached remission on the extract than on placebo in the per-protocol analysis (63.6% vs 26.7%, p=0.04), but not in the intention-to-treat analysis (43.8% vs 26.7%). Histology did not change ^{22Reference 22Madisch A et al. · 2007RCTBoswellia serrata extract for the treatment of collagenous colitisView study →}.

Gap: the positive trials are small, old, and used different preparations; the one large, modern maintenance trial was null.

5. Bronchial Asthma

The asthma evidence is a single trial from 1998. Forty patients took Boswellia serrata gum resin, 300 mg three times daily for six weeks, and 40 took a lactose placebo. 70% of the treated patients improved, with fewer attacks, better lung function (FEV1, FVC, PEFR) and lower eosinophil counts, against 27% on placebo ^{23Reference 23Gupta I et al. · 1998RCTEffects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study — [randomized controlled trial]View study →}.

Leukotrienes drive bronchoconstriction, which is why leukotriene-blocking drugs are used in asthma. A 2010 systematic review of herbal asthma treatments listed the Boswellia trial among single studies with potential to improve lung function, and noted that most trials were small, short and methodologically poor ^{24Reference 24Clark CE et al. · 2010Meta-analysisHerbal interventions for chronic asthma in adults and children: a systematic review and meta-analysis — [systematic review and meta-analysis]View study →}.

Gap: one small trial from 1998, never replicated with contemporary methods or standardized extract — the mechanism is sound but the clinical evidence is a single data point.

6. Peritumoral Cerebral Edema

A 2011 randomised, placebo-controlled, double-blind pilot trial gave 44 patients having radiotherapy for brain tumours either Boswellia serrata 4,200 mg a day or placebo ^{25Reference 25Kirste S et al. · 2011RCTBoswellia serrata acts on cerebral edema in patients irradiated for brain tumors: a prospective, randomized, placebo-controlled, double-blind pilot trial — [randomized controlled trial]View study →}.

Swelling of the brain on MRI fell by more than 75% in 60% of the Boswellia group and 26% of the placebo group. Boswellic acids (AKBA and KBA) were detected in the patients’ blood. There were no serious side effects, and six patients on Boswellia reported mild stomach discomfort. The authors suggested it could reduce the need for dexamethasone ^{25Reference 25Kirste S et al. · 2011RCTBoswellia serrata acts on cerebral edema in patients irradiated for brain tumors: a prospective, randomized, placebo-controlled, double-blind pilot trial — [randomized controlled trial]View study →}.

It is one pilot trial in one setting.

7. Anticancer

The oncology research is entirely preclinical. AKBA induces cell death and cell-cycle arrest and inhibits NF-κB signalling across a range of cancer cell lines. In APC-Min mice, which develop intestinal polyps, AKBA prevented polyps more effectively than aspirin, without toxicity ^{17,26Reference 17Efferth T et al. · 2022Systematic reviewAnti-inflammatory and anti-cancer activities of frankincense: Targets, treatments and toxicities — [systematic review]View study →Reference 26Wang R et al. · 2014AnimalThe comparative study of acetyl-11-keto-beta-boswellic acid (AKBA) and aspirin in the prevention of intestinal adenomatous polyposis in APC(Min/+) mice — [animal model]View study →}.

A 2022 systematic review maps these targets across several boswellic acids and tumour types. It notes that frankincense reduced brain-tumour swelling in trials but did not shrink gliomas ^{17Reference 17Efferth T et al. · 2022Systematic reviewAnti-inflammatory and anti-cancer activities of frankincense: Targets, treatments and toxicities — [systematic review]View study →}.

Gap: no human anticancer data at all; effective preclinical doses are not achievable by ingesting the resin.

8. Neuroprotective & Cognitive

In APPswe/PS1dE9 mice, a model of Alzheimer’s disease, AKBA improved learning and memory, lowered amyloid-β and plaque burden, and reduced oxidative stress and inflammation, acting through the Nrf2/HO-1 pathway ^{27Reference 27Wei C et al. · 2020AnimalAcetyl-11-keto-β-boswellic acid ameliorates cognitive deficits and reduces amyloid-β levels in APPswe/PS1dE9 mice through antioxidant and anti-inflammatory pathways — [animal model]View study →}.

In rats with sciatic nerve injury, AKBA activated the same Nrf2/HO-1 pathway in Schwann cells, reduced oxidative damage and helped the nerve regrow its myelin ^{28Reference 28Zhou C et al. · 2023AnimalAcetyl-11-Keto-Beta-Boswellic Acid Activates the Nrf2/HO-1 Signaling Pathway in Schwann Cells to Reduce Oxidative Stress and Promote Sciatic Nerve Injury Repair — [animal model]View study →}.

There is no human cognitive or neurodegenerative trial.

9. Antimicrobial

The traditional use of frankincense as an antiseptic dressing and purifying incense relates to its essential oil. The oil study behind it was done on Omani luban, the resin of Boswellia sacra, a different species. Oils from four commercial grades all showed marked antibacterial activity, and α-pinene was the main component of every oil ^{29Reference 29Al-Saidi S et al. · 2012In vitroComposition and antibacterial activity of the essential oils of four commercial grades of Omani luban, the oleo-gum resin of Boswellia sacra FLUECK — [in vitro]View study →}.

No antibacterial study of B. serrata oil was located, and there is no controlled study of frankincense treating an infection in people.

10. Antioxidant

AKBA activates the Nrf2/HO-1 pathway, the cell’s main antioxidant response, and lowers markers of oxidative stress in rodent models of nerve injury and Alzheimer’s disease ^{27,28Reference 27Wei C et al. · 2020AnimalAcetyl-11-keto-β-boswellic acid ameliorates cognitive deficits and reduces amyloid-β levels in APPswe/PS1dE9 mice through antioxidant and anti-inflammatory pathways — [animal model]View study →Reference 28Zhou C et al. · 2023AnimalAcetyl-11-Keto-Beta-Boswellic Acid Activates the Nrf2/HO-1 Signaling Pathway in Schwann Cells to Reduce Oxidative Stress and Promote Sciatic Nerve Injury Repair — [animal model]View study →}. This raises the body’s own antioxidant enzymes rather than scavenging free radicals directly.

Gap: no human antioxidant-endpoint data; the effect is an isolated-AKBA, Nrf2-mediated action in rodents, and AKBA also induced oxidative-stress-linked developmental and heart toxicity in zebrafish embryos ^{33Reference 33Han L et al. · 2022In vitroInduction of developmental toxicity and cardiotoxicity in zebrafish embryos/larvae by acetyl-11-keto-β-boswellic acid (AKBA) through oxidative stress — [in vitro / zebrafish developmental toxicity]View study →}.

Mechanisms

The boswellic acids, especially AKBA, inhibit 5-lipoxygenase directly and cut leukotriene production. Several also inhibit COX-1, and AKBA suppresses NF-κB signalling. These actions have been studied as the basis of the osteoarthritis, bowel, asthma and brain-swelling findings.

AKBA also activates the Nrf2/HO-1 antioxidant pathway, which has been studied in animal models of nerve injury and Alzheimer’s disease. The essential oil, rich in α-pinene, has been studied separately for antibacterial activity.

Clinical Trials

Most human trials are in knee osteoarthritis. Single trials cover asthma, ulcerative colitis, Crohn’s disease, collagenous colitis and brain swelling during radiotherapy, and the largest Crohn’s disease trial was stopped early for lack of effect.

Last checked: July 2026.

Phytochemistry

Frankincense gum resin has two parts: a non-volatile resin rich in triterpenes, and a fragrant essential oil.

The main medicinal compounds are the pentacyclic boswellic acids. Acetyl-11-keto-β-boswellic acid (AKBA) is the most potent 5-lipoxygenase inhibitor among them ^{14Reference 14Sailer ER et al. · 1996In vitroAcetyl-11-keto-beta-boswellic acid (AKBA): structure requirements for binding and 5-lipoxygenase inhibitory activity — [in vitro enzyme study]View study →}. In one analysis, boswellic acids made up about 16% of B. serrata gum resin, and AKBA about 0.7% ^{31Reference 31Mannino G et al. · 2016Quantitative Determination of 3-O-Acetyl-11-Keto-βBoswellic Acid (AKBA) and Other Boswellic Acids in Boswellia sacra Flueck (synView study →}.

The same analysis found far more in Boswellia sacra: about 29% boswellic acids and 7% AKBA. Its authors concluded that claims of 30% AKBA in raw resin are unrealistic ^{31Reference 31Mannino G et al. · 2016Quantitative Determination of 3-O-Acetyl-11-Keto-βBoswellic Acid (AKBA) and Other Boswellic Acids in Boswellia sacra Flueck (synView study →}. Extracts reach that level only by concentration, as in 5-Loxin ^{2Reference 2Sengupta K et al. · 2008RCTA double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee — [randomized controlled trial]View study →}.

The volatile fraction contains α-pinene and octyl acetate. Across ten batches of B. serrata, α-pinene measured 0.02–0.15 mg per gram of resin and octyl acetate 2.5–9.1 mg per gram ^{32Reference 32Song Z et al. · 2012Song Z, Xia L, Wei Z, Cao Y, Zhang L, & Liu Z (2012). [Determination of alpha-pinene and octyl acetate contents in Boswellia serrata] — [analytical chemistry study]. Zhongguo Zhong Yao Za Zhi, 37(10), 1431-3. https://pubmed.ncbi.nlm.nih.gov/22860456/View study →}. The monoterpene alpha-thujene is also reported.

Constituent Summary

Boswellic-acid figures are a share of the gum resin; α-pinene is per gram of resin.

Dosage

Most trials gave a standardised extract with a set AKBA content, not raw gum resin. The osteoarthritis trials used small doses of high-AKBA extracts, while the asthma, ulcerative colitis and brain-swelling trials used gram-scale doses.

Crude resin contains under 1% AKBA ^{31Reference 31Mannino G et al. · 2016Quantitative Determination of 3-O-Acetyl-11-Keto-βBoswellic Acid (AKBA) and Other Boswellic Acids in Boswellia sacra Flueck (synView study →}, so a small dose of an AKBA-enriched extract corresponds to much more whole resin.

Traditional Dosage

Traditional practice uses the whole gum resin, most often as a powder, tablet or capsule.

Safety & Pregnancy

Frankincense extract is well tolerated in trials. Mild digestive upset is the main complaint, and no serious side effects have been reported in trials lasting up to a year ^{7,21,25Reference 7Majeed M et al. · 2019RCTA pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee — [randomized controlled trial]View study →Reference 21Holtmeier W et al. · 2011RCTRandomized, placebo-controlled, double-blind trial of Boswellia serrata in maintaining remission of Crohn’s disease: good safety profile but lack of efficacy — [randomized controlled trial]View study →Reference 25Kirste S et al. · 2011RCTBoswellia serrata acts on cerebral edema in patients irradiated for brain tumors: a prospective, randomized, placebo-controlled, double-blind pilot trial — [randomized controlled trial]View study →}.

Full Safety & Interactions Detail

Tolerability. Across the osteoarthritis and bowel trials, side effects were mild and mostly digestive. The 52-week Crohn’s disease trial found a good safety profile ^{21Reference 21Holtmeier W et al. · 2011RCTRandomized, placebo-controlled, double-blind trial of Boswellia serrata in maintaining remission of Crohn’s disease: good safety profile but lack of efficacy — [randomized controlled trial]View study →}, and trials of up to 180 days found no serious adverse events or changes in blood chemistry, liver or kidney measures ^{5,6,7Reference 5Karlapudi V et al. · 2023RCTEfficacy and Safety of Aflapin®, a Novel Boswellia Serrata Extract, in the Treatment of Osteoarthritis of the Knee: A Short-Term 30-Day Randomized, Double-Blind, Placebo-Controlled Clinical Study — [randomized controlled trial]View study →Reference 6Kumar B et al. · 2025RCTA Standardized Boswellia serrata Extract Improves Knee Joint Function and Cartilage Morphology in Human Volunteers with Mild to Moderate Osteoarthritis in a Randomized Placebo-Controlled Study — [randomized controlled trial]View study →Reference 7Majeed M et al. · 2019RCTA pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee — [randomized controlled trial]View study →}.

Drug interactions. In laboratory tests, resin extracts of four Boswellia species, B. serrata among them, inhibited all the main drug-metabolising liver enzymes: CYP1A2, 2C8, 2C9, 2C19, 2D6 and 3A4. The boswellic acids inhibited them too, but were not the main source of the effect ^{37Reference 37Frank A et al. · 2006In vitroAnalysis of frankincense from various Boswellia species with inhibitory activity on human drug metabolising cytochrome P450 enzymes using liquid chromatography mass spectrometry after automated on-line extraction — [in vitro enzyme study]View study →}.

In cell tests, Boswellia serrata extract and its keto-boswellic acids also inhibited P-glycoprotein, a pump that moves many drugs out of the gut wall ^{38Reference 38Weber CC et al. · 2006In vitroModulation of Pgp function by boswellic acids — [in vitro]View study →}. No human drug-interaction study has been done, so care is sensible with medicines that have a narrow safety margin.

References

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