Sumbulus moschatus or Ferula Sumbul (Musk-root) is a partially proved remedy, used since antiquity in cardiac disorders. The root has long been used in India as an incense. Its proving is found in Allen’s Encyclopedia of Pure Materia Medica and Hering’s Guiding Symptoms. Apart from these works, there is little in our literature about this drug. It is close to Medhorinum, Moschus & Asafoetida in its proving.
In its proving, we observed the following CVS symptoms. Palpitation in cardiophobics; oppression in chest. Sensation of stretched feeling across the left precordium < inspiration & stooping.Hot flushes from back. Left arm numb with shooting pain in fingers (Ulnar side); Pulse: soft, irregular, missed beats. Apex impulse forceful < exertion or post meal. Soft systolic murmur at apex..ECG -Ventricular Premature beats.
Until recently, atherosclerosis was thought of as a degenerative disease, affecting the elderly and causing symptoms by its mechanical effects on blood flow, in the small caliber arteries supplying the myocardium. Thus, the treatment approach has traditionally been surgical. However, recent research has shown that it is a dynamic, inflammatory process that is modifiable by medicines. Often, homoeopaths are questioned about the mode of action of our drugs on the cellular plane. After proving Sumbul, we can propose a hypothesis of its action in atherosclerotic plaque remodeling at the cellular level as follows-
1. Endothelial function - It is the cuboidal cell lining, forming the inner coat of blood vessels. Within it, certain cells release hormones that modulates the vascular tone. Endothelial Dysfunction is the first step of atherosclerosis. Central to it is the deregulation of endothelial derived Nitric Oxide. The latter plays a major role in vessel dilatation, reaction of the sub-endothelium with monocytes and proliferation of smooth muscle in the subendothelium. Sumbul increases the bioavailability of nitric oxide. The reversal of endothelial dysfunction in persons of Tubercular miasmatic state who are prone to atherogentic tendency, can be a vital mechanism for its action at the molecular level.
2. Inflammation - The role of inflammation & immunity in the chain of atherosclerosis is well known. Cytokines secreted by macrophages modify endothelial function, cause smooth muscle proliferation, collagen degradation and promote thrombosis. Inflammatory processes are early signs of atherosclerosis.Sumbul possibly inhibits local inflammation.
3. Plaque stability - Atheroma is the end result of atherogenesis. It begins as a subendothelial accumulation of lipid laden foam cells which later forms a fatty streak. With progression, the lesions form an acellular core of cholesterol esters bounded by a fibrous cap, macrophages, new blood vessels and calcium hydroxyapatite. Thus atheromas are complex. The dynamic interaction between different components of the plaque dictates outcome of the disease. Its rupture leads to an acute coronary syndrome. Sumbul helps in stabilizing this plaque by modifying its lipid contents.
4. Smooth Muscle Cell Proliferation - It is vital in plaque development in post -angioplasty restenosis and venous graft occlusion. Our studies at the Academy suggest that by controlling smooth muscle proliferation, Sumbul may modulate the cellularity of the arterial wall in the proliferative psoro-sycotic atherosclerotic lesions.
5. Vasculogenesis - It promotes vasculogenesis reducing recurrence of coronary events.
Conclusion: Thus we can effectively conclude that Sumbul has a pleiotrophic effect that may largely account for the clinical benefits observed. The clinical relevance of these effects is now a reality.
