***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In a double-blind , r and omized , multicentre clinical study , the efficacy and tolerance of a herbal medicine product , Harpadol ( 6 capsules/day , each containing 435 mg of powdered cryoground powder Harpagophytum procumbens ) , was compared with diacerhein 100 mg/day in the treatment , for 4 months , of 122 patients suffering from osteoarthritis of the knee and hip . Assessment s of pain and functional disability were made on a 10 cm horizontal visual analogue scale ; severity of osteoarthritis was evaluated by Lequesne 's index . Spontaneous pain showed a significant improvement during the course of the study and there was no difference in the efficacy of the two treatments . Similarly , there was a progressive and significant reduction in the Lequesne functional index and no statistical difference was found between Harpadol and diacerhein . At completion of the study , patients taking Harpadol  were using significantly less NSAIDs and antalgic drugs . The frequency of adverse events was significantly lower in the  Harpadol group . The most frequent event reported was diarrhea , occurring in 8.1 % and 26.7 % of Harpadol and diacerhein patients respectively . The global tolerance assessment by patients at the end of treatment favoured Harpadol . The results of this study demonstrate that Harpadol is comparable in efficacy and superior in safety to diacerhein Aflapin ® is a novel synergistic composition derived from Boswellia serrata gum resin ( Indian Patent Application No. 2229/CHE/2008 ) . Aflapin is significantly better as an anti-inflammatory agent compared to the Boswellia extracts presently available in the market . A 90-day , double-blind , r and omized , placebo-controlled study was conducted to evaluate the comparative efficacy and tolerability of 5-Loxin ® and Aflapin ® in the treatment of osteoarthritis ( OA ) of the knee ( Clinical trial registration number : IS RCT N80793440 ) . Sixty OA subjects were included in the study . The subjects received either 100 mg ( n=20 ) of 5-Loxin ® or 100 mg ( n=20 ) of Aflapin ® or a placebo ( n=20 ) daily for 90 days . Each patient was evaluated for pain and physical functions by using the st and ard tools ( visual analog scale , Lequesne 's Functional Index , and Western Ontario and McMaster Universities Osteoarthritis Index ) at the baseline ( day 0 ) , and at days 7 , 30 , 60 and 90 . A battery of biochemical parameters in serum , urine and hematological parameters in citrated whole blood were performed to assess the safety of 5-Loxin ® and Aflapin ® in OA subjects . Fifty seven subjects completed the study . At the end of the study , both 5-Loxin ® and Aflapin conferred clinical ly and statistically significant improvements in pain scores and physical function scores in OA subjects . Interestingly , significant improvements in pain score and functional ability were recorded as early as 7 days after initiation of the study in the treatment group supplemented with 100 mg Aflapin . Corroborating the improvements in pain scores in treatment groups , our in vitro studies provide evidence s that Aflapin ® is capable of inhibiting cartilage degrading enzyme MMP-3 and has the potential to regulate the inflammatory response by inhibiting ICAM-1 . Aflapin ® and 5-Loxin ® reduce pain and improve physical functions significantly in OA subjects . Aflapin exhibited better efficacy compared to 5-Loxin ® . In comparison with placebo , the safety parameters were almost unchanged in the treatment groups . Hence both 5-Loxin ® and Aflapin ® are safe for human consumption In a study that indicates more definitive investigation is needed , 118 patients with chronic back problems seeking treatment for acute attacks of pain were included in a 4-week r and omised double-blinded study on the safety and effectiveness of an extract of Harpagophytum procumbens . Both , the treatment and the placebo were administered in the form of two tablets taken three times per day ; the treatment group had a daily consumption equal to 6,000 mg of crude preparation ( 50 mg harpagoside , the putative active ingredient ) . The treatment and placebo groups were well matched in physical characteristics ; in the severity , duration , nature and accompaniments of their pain ; and in laboratory indices of organ system function . 109 patients completed the study . The study was originally design ed to measure Harpagophytum 's effectiveness by measuring the use of supplementary pain-killer Tramadol over its final 3 weeks . However , this did not differ between the Harpagophytum and placebo groups nor was the consumption closely related to the amount of pain . Further analysis , though , revealed that 9 out of 51 patients who received the extract were pain free at the end of treatment compared to only 1 out of 54 patients who received placebo . A modification of the Arhus index was used as an additional measure , covering the more global impact . The percentage change was greater in those patients who received Harpagophytum extract than in those who received placebo , but inferential testing ( Mann Whitney ) allowed only 94 % degree of confidence that this had not arisen by chance . The Arhus index reduction was based on improvement in pain . This indication of effectiveness , and the absence of demonstrable adverse effects show that more definite clinical studies of Harpagophytum extract will be worthwhile Osteoarthritis is a common , chronic , progressive , skeletal , degenerative disorder , which commonly affects the knee joint . Boswellia serrata tree is commonly found in India . The therapeutic value of its gum ( guggulu ) has been known . It posses good anti-inflammatory , anti-arthritic and analgesic activity . A r and omized double blind placebo controlled crossover study was conducted to assess the efficacy , safety and tolerability of Boswellia serrata Extract ( BSE ) in 30 patients of osteoarthritis of knee , 15 each receiving active drug or placebo for eight weeks . After the first intervention , washout was given and then the groups were crossed over to receive the opposite intervention for eight weeks . All patients receiving drug treatment reported decrease in knee pain , increased knee flexion and increased walking distance . The frequency of swelling in the knee joint was decreased . Radiologically there was no change . The observed differences between drug treated and placebo being statistically significant , are clinical ly relevant . BSE was well tolerated by the subjects except for minor gastrointestinal ADRs . BSE is recommended in the patients of osteoarthritis of the knee with possible therapeutic use in other arthritis BACKGROUND & AIMS Curcumin is a biologically active phytochemical substance present in turmeric and has pharmacologic actions that might benefit patients with ulcerative colitis ( UC ) . The aim in this trial was to assess the efficacy of curcumin as maintenance therapy in patients with quiescent ulcerative colitis ( UC ) . METHODS Eighty-nine patients with quiescent UC were recruited for this r and omized , double-blind , multicenter trial of curcumin in the prevention of relapse . Forty-five patients received curcumin , 1 g after breakfast and 1 g after the evening meal , plus sulfasalazine ( SZ ) or mesalamine , and 44 patients received placebo plus SZ or mesalamine for 6 months .  Clinical activity index ( CAI ) and endoscopic index ( EI ) were determined at entry , every 2 months ( CAI ) , at the conclusion of 6-month trial , and at the end of 6-month follow-up . RESULTS Seven patients were protocol violators . Of 43 patients who received curcumin , 2 relapsed during 6 months of therapy ( 4.65 % ) , whereas 8 of 39 patients ( 20.51 % ) in the placebo group relapsed ( P=.040 ) . Recurrence rates evaluated on the basis of intention to treat showed significant difference between curcumin and placebo ( P=.049 ) . Furthermore , curcumin improved both CAI ( P=.038 ) and EI ( P=.0001 ) , thus suppressing the morbidity associated with UC . A 6-month follow-up was done during which patients in both groups were on SZ or mesalamine . Eight additional patients in the curcumin group and 6 patients in the placebo group relapsed . CONCLUSIONS Curcumin seems to be a promising and safe medication for maintaining remission in patients with quiescent UC . Further studies on curcumin should strengthen our findings Although practitioner-prescribed ` western ' herbal medicine ( phytotherapy ) is a popular complementary therapy in the UK , no clinical studies have been reported on patient-orientated outcomes . The objective of this pilot study was to investigate the effects of phytotherapy on symptoms of osteoarthritis of the knee .  A previous study of Chinese herbal medicine for the treatment of irritable bowel syndrome , published in the Journal of the American Medical Association,1 acted as a model in the development of the protocol of this investigation . Twenty adults , previously diagnosed with osteoarthritis of the knee , were recruited from two Inner London GP practice s into this r and omized , double-blind , placebo-controlled , pilot study carried out in a primary -care setting . All subjects were seen in consultation three times by a herbal practitioner who was blinded to the r and omization coding . Each subject was prescribed treatment and given lifestyle advice according to usual practice : continuation of conventional medication where applicable , healthy-eating advice and nutrient supplementation . Individualized herbal medicine was prescribed for each patient , but only dispensed for those r and omized to active treatment — the remainder were supplied with a placebo . At baseline and outcome ( after ten weeks of treatment ) , subjects completed a food frequency question naire and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) knee health and Measure Yourself Outcome Profile ( MYMOP ) wellbeing question naires . Subjects completing the study per protocol ( n = 14 ) reported an increased intake of wholegrain foods ( p = 0.045 ) and oily fish ( p = 0.039 ) compared to baseline , but no increase in fruit and vegetables and dairy products intakes . There was no difference in the primary outcome measure of knee health assessed as the difference in the mean response ( baseline-week 10 ) in WOMAC score between the two treatment groups . However , there was , compared with baseline , improvement in the active group ( n = 9 ) for the mean WOMAC stiffness sub-score at week 5 ( p = 0.035 ) and week 10 ( p = 0.060 ) but not in the placebo group ( n = 5 ) . Furthermore , for the active , but not the placebo group , the mean WOMAC total and sub-scores all showed clinical ly significant improvement ( ≥ 20 % ) in knee symptoms at weeks 5 and 10 compared with baseline . Moreover , the mean MYMOP symptom 2 sub-score , mostly relating to osteoarthritis ( OA ) , showed significant improvement at week 5 ( p = 0.02 ) and week 10 ( p = 0.008 ) compared with baseline for the active , but not for the placebo group . This pilot study showed that herbal medicine prescribed for the individual by a herbal practitioner result ed in improvement of symptoms of OA of the knee Forty individuals suffering from an acute arthritis took part in an open r and omized study comparing the effects of 50 mg diclofenac plus stewed Herba Urticae dioicae ( stinging nettles ) with 200 mg diclofenac .  Thirty-seven patients completed the study . Assessment was based on the decrease of the elevated acute phase protein CRP and the clinical signs of acute arthritis ( physical impairment , subjective pain and pressure pain ( patient assessment ) and stiffness ( physician assessment ) . All assessment s were done on a verbal rating scale from 0 to 4 . In both groups median scores improved by about 70 % relative to the initial value . Only minor adverse effects occurred during treatment . The authors conclude , that stewed Herba Urticae dioicae may enhance the NSAID antirheumatic effectiveness Patients studied here suffered from chronic colitis characterized by vague lower abdominal pain , bleeding per rectum with diarrhoea and palpable tender descending and sigmoid colon . The inflammatory process in colitis is associated with increased formation of leukotrienes causing chemotaxis , chemokinesis , synthesis of superoxide radicals and release of lysosomal enzymes by phagocytes . The key enzyme for leukotriene bio synthesis is 5-lipoxygenase . Boswellic acids were found to be non-redox , non-competitive specific inhibitors of the enzyme 5-lipoxygenase . We studied the gum resin of Boswellia serrata for the treatment of this disease . Thirty patients , 17 males and 13 females in the age range of 18 to 48 years with chronic colitis were included in this study . Twenty patients were given a preparation of the gum resin of Boswellia serrata ( 900 mg daily divided in three doses for 6 weeks ) and ten patients were given sulfasalazine ( 3 gm daily divided in three doses for 6 weeks ) and served as controls . Out of 20 patients treated with Boswellia gum resin 18 patients showed an improvement in one or more of the parameters : including stool properties , histopathology as well as scanning electron microscopy , besides haemoglobin , serum iron , calcium , phosphorus , proteins , total leukocytes and eosinophils . In the control group 6 out of 10 patients showed similar results with the same parameters . Out of 20 patients treated with Boswellia gum resin 14 went into remission while in case of sulfasalazine 
    Output:
    
The bibliographic search found no paper regarding the anti-inflammatory effects of Calendula officinalis L. and Symphytum officinalis L. by oral use .
Boswellia serrata Roxb .
was found to be the most promising , since it shows the best efficacy for the treatment of pain/inflammatory conditions .