Althea Medical Journal. 2016;3(3)
421
Role of Kletik oil, Ginger and Garlic Extracts towards Soft Tissue Injury
Benjamin Yong Qing Nan,1 Yoyos Dias Ismiarto,2 Adhi Kristianto Sugianli3
1Faculty of Medicine Universitas Padjadjaran, 2Department of Orthopedic and Traumatology
Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung,
3Department of Clinical Pathology Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin
General Hospital, Bandung
Abstract
Background: There is an increased consumption of herbal medicines throughout the world as an alternative
treatment for curing health problems. Several herbal medicines are believed to contain anti-inflammatory
properties that could trigger healing process. But little is known about the combination effect of herbal
medicines. Therefore, the objective of the study was to determine the effects of garlic, ginger and coconut oil
(kletik oil) on soft tissue injury (swelling).
Methods: The study was held in the research laboratory of Faculty of Medicine Universitas Padjadjaran, from
24th September until 1st October 2014. This experimental study used 7 healthy rabbits (Lepus curpaeums,
±2.5kg) as animal models for each control and intervention group with induced soft tissue injury in the
dorsal ear to mimic swelling (inflammation). The mixture of herbs was applied on the injured site in the trial
group, while the healing process was denoted by the thickness of edema and time of observation. The data
was analyzed using Wilcoxon test.
Results: The study results showed that after observation time of 0.5 hour, 2 hours, and 5 hours, edema
thickness was unvaried. Onset of action of the herbal mixture began 24 hours after induced injury, with
significant difference of edema thickness on both groups; hence the p-value 0.019 (p<0.05).
Conclusions: The herbal mixture of ginger, garlic, and coconut oil (kletik oil) contains anti-inflammatory
properties to enhance the healing process of soft tissue injury. [AMJ.2016;3(3):421–4]
Keywords: Ginger, herbal medicine, inflammation, kletik oil, soft tissue injury
Correspondence: Benjamin Yong Qing Nan, Faculty of Medicine, Universitas Padjadjaran, Jalan Raya Bandung-
Sumedang Km.21, Jatinangor, Sumedang, Indonesia, Phone: +6287822004705 Email: poornoob159@gmail.com
Introduction
There is an increased consumption of
herbal medicines throughout the world as
an alternative treatment for curing health
problems such as heart diseases, diabetes,
high blood pressure and certain types of
cancer.1Herbs such as garlic, ginger and
coconut oil (topical) are chosen because these
herbs are able to alleviate and provides anti-
inflammatory effect towards cell injury.2−4
Furthermore, garlic (Allium sativum)
contains a sulfur natural compound, allicin,
a substance that have effect as antibacterial,
antiviral and antifungal properties.5 Ginger
(Zingiber officinale) has been used in traditional
medicine for its therapeutic properties.
According to the results in vitro studies,
the rhizome of ginger contains gingerols,
which inhibits synthesis of pro-inflammatory
cytokines, IL-1, TNF-α, IL-8, prostaglandin
(PG) and leukotriene (LT), and also inhibits
the inducible enzyme cyclo-oxygenase-2 (COX-
2).6 Moreover, coconut (Cocos nucifera L), is
capable of increasing antioxidant enzymes,
reduces lipid peroxidation content and also has
antithrombotic effect. It is reported that it also
has anti-nociceptive and anti-inflammatory
properties.3
The skin is part of soft tissue composed
of epidermis, and dermis.7 In acute soft tissue
injury, sign and symptoms occur rapidly and
occur from a known or unknown incident.8
In this study, it has never been proven that
these three topical herbs mixture will provide
an anti-inflammatory effect towards soft tissue
injury. So from these three different types
of herb, coconut oil will be used as a topical
cream that is able to refine and moisturize
skin conditions, whereas garlic will be added
to act as emulsifier for the fat inside the
coconut oil, with generation of heat to provide
Althea Medical Journal. 2016;3(3)
422 AMJ September 2016
optimal vasodilation, ginger is added. Due to
their individual anti-inflammatory properties,
when mixed together, these topical agents will
have enhanced anti-inflammatory properties
in treating soft tissue injuries.3,4,9,10
Therefore, the objective of the study was
to determine the effects of garlic, ginger and
coconut oil (kletik oil) on soft tissue injury
(swelling).
Methods
The research was conducted from September
until October 2014 at the research laboratory
Faculty of Medicine, Universitas Padjadjaran.
This study was an experimental study on 7
healthy rabbits (Lepus curpaeums ±2.5kg).
The herbal mixture was prepared from 15ml of
coconut oil, 5g of crushed garlic, 5g of crushed
ginger. Next, it was mixed together into a
container, then stored in the refrigerator for
24 hours. In both two groups: the control and
intervention group, the rabbits were induced
soft tissue injury (edema) by using a soft tissue
clamp onto the rabbit’s ear to mimic injury of
the human body. The injury’s site (rabbit’s
ears) was left to undergo swelling (sign of
inflammation). There were 6 consecutive
periods to observe the swelling: 0.5 hours, 2
hours, 5 hours, 24 hours, 120 hours and 168
hours. On the intervention group, the topical
herbal mixture of ginger, garlic and coconut
oil was applied onto the animal models and
left for the healing process observation.
The reapplication of the herbal mixture was
designated on each observation period. The
healing process was identified and measured
with a measuring caliper (mm) through the
thickness of edema and time of observation
(hours).
The result was expressed as mean ± SD
and was denoted by the thickness of edema
caused by inflammation reaction. The groups
were compared using the Wilcoxon statistical
testing. The data collected will be plot into a
graph.11
During the observation time, all animal
models were placed in a secure and hygienic
animal rabbit cage where sustenance was
provided. This study was approved by the
Health Research Ethics Committee, Faculty of
Medicine, Universitas Padjadjaran.
Results
The result of experiments on 7 rabbits
during the 168 hours showed the comparison
result between control group and intervention
group based on the thickness of edema
and time of observation. In both control
and intervention group, it was found that
during 0.5 hours up to 5 hours, there was no
difference in the edema thickness, whereas,
the differences only occured from 24 hours up
to 168 hours; the biggest difference occurred
on the 168 hours during observation time. The
thickness of edema in the control group was
higher (0.134 mm) than in the intervention
group (0.121 mm) (Figure 1).
The observation time was compared
Figure 1 Comparison of the Thickness of Edema and Time of Observation between Two
Groups: Control and Intervention
Althea Medical Journal. 2016;3(3)
423Benjamin Yong Qing Nan, Yoyos Dias Ismiarto, Adhi Kristianto Sugianli: Role of Kletik oil, Ginger and Garlic
Extracts towards Soft Tissue Injury
between the control and intervention animal
models, and the statistical analysis showed
the p-value of the intervention group was
0.019 (p<0.05). This result indicated that
there was a difference between the control
group and intervention group during the
observation time, and this happened as the
effect of applying the herbal mixture onto the
intervention group.
Discussion
In this study, it was found that the herbal mixture
could significantly prevent the deterioration
of injury and decrease the edema formation
in rabbit ears. The results suggested that the
herbal mixture of ginger, garlic and coconut
oil (kletik oil) had active medical ingredients
for activating the blood and removing stasis,
hence promoting wound healing. Wound
healing of the skin can be divided into 3
phases: inflammatory, proliferative and
remodeling phase. The inflammatory phase is
the initial phase which ranges from 2−6 days.
The observation time started at 0.5 hours up to
5 hours, and showed there was no difference
in the thickness of edema between the two
groups. Beginning from 24 hours until 168
hours, the difference of thickness of edema was
shown between the two groups. Meanwhile,
the intervention group showed less edema
formation. This explained that the mixture
of garlic, ginger and coconut oil (kletik oil)
had anti-inflammatory properties that could
decrease the inflammation reaction hence
decreased edema formation. A previous study
suggested that other types of herbal mixtures
had also proved to decrease the thickness of
inflammatory reaction (edema) on soft tissue
injury.11 Furthermore, other herbal mixtures
(four China’s Tibetan medical herbs, including
Lamiophlomis rotata, Oxytropis falcate Bunge,
Curcuma longa Linn, and Myricaria bracteata.)
applied onto test rabbits showed the onset of
action for these herbal mixtures was on the 24
hours as well. Moreover, the effect on inhibition
of TNF-α production by the ginger extract was
earlier reported because ginger is known
to have a moderate effect on osteoarthritis
in vivo, and it also has a promising effect of
ginger extract in experimental arthritis in rats.
Additionally, another previous study stated
that, ginger extract EV77/15 is as effective an
anti-inflammatory agent as betamethasone in
this in vitro cell model of cultured fibroblast-
like synoviocytes.10,11
In this study, it was found that ginger
and its main components, gingerols, can
inhibit synthesis of several pro-inflammatory
cytokines including IL-1, TNF-α and IL-8
along with inhibiting prostaglandin (PG)
and leukotriene (LT) synthesis enzymes.
Furthermore, ginger also exerted effect on
several genes encoding cytokines, chemokines
and the inducible enzyme cyclo-oxygenase-2
(COX-2).6
Kletik oil (coconut oil) is rich in fatty acids
of medium chain length (6–12 C) of which the
major fatty acid is lauric-acid (12 C). Fatty
acids are bioactive molecules, which have been
proved to modulate cellular proliferation, cell
signaling and growth factor activities. Kletik
oil contains higher amounts of antioxidant
polyphones, catechins, ferulic acid, p-coumaric
acid, caffeic acid, and unidentified phenolic
acid and unidentified flavonoids. Hence, the
cumulative effect of these compounds may
fasten and prove to be beneficial to the wound
healing process which was able to decrease
the swelling in this study.3
Lastly, garlic that contains a reactive
compound (allicin), inhibited the migration of
neutrophilic granulocytes into epithelia, which
was a crucial process during inflammation
and also inhibited TNFα-dependent pro-
inflammatory cytokines. Furthermore, allicin
also acted on T-cell lymphocytes by inhibition
of the SDF1α-chemokine-induced chemotaxis
and this effect was correlated with an impaired
dynamic of the actin-cytoskeleton.5
In conclusion, the usage of herbal mixture
consisting of ginger, garlic, and coconut
oil (kletik oil) somehow possesses anti-
inflammatory properties which can help the
healing process in soft tissue injury.
This was an animal model experiment,
which could differ when applied onto human’s
soft tissue injury. It is important to perform
further studies on humans.
References
1. Kaur J, Kaur S, Mahajan A. Herbal
medicines: possible risks and benefits.
AJPCT. 2013;2:226–39.
2. Fraenkel L, Bogardus ST, Concato J,
Wittink DR. Treatment options in knee
osteoarthritis ( The patient’s perspective ).
Arch Intern Med. 2004;164:1299–304.
3. Rajamohan T, Nevin KG. Effect of topical
application of virgin coconut oil on skin
components and antioxidant status during
dermal wound healing in young rats. Skin
Pharmacol Physiol. 2010;23:290–7.
4. Zar C, Das S. Potential effect of herbs
on diabetic hypertension: alternative
Althea Medical Journal. 2016;3(3)
424 AMJ September 2016
medicine treatment modalities. La Clinica
terapeutica. 2013;164(6):529–35.
5. Borlinghaus J, Albrecht F, Gruhlke MCH,
Nwachukwu ID, Slusarenko AJ. Allicin
: chemical and biological properties.
Molecules. 2014;19:12591–618.
6. Mahluji S, Ostadrahimi A, Mobasseri M,
Ebrahimzade Attari V, Payahoo L. Anti-
inflammatory effects of zingiber officinale
in type 2 diabetic patients. Adv Pharm
Bull. 2013;3(2):273-6.
7. Mescher AL., editor, Skin,. 2010 Junqueira
basic histology text and atlas. 12th ed.
Bloomington: McGraw-Hill Education;
2010. p. 316–23.
8. Kumar V, Abbas AK, Fausto N, Aster JC.
General Pathology. In: Abbas AK, editor.
2010 Robbins and Cotran: Pathologic basis
of disease. 8th ed. Philadelphia: Elsevier-
Health Science Division; 2010. p. 3–43.
9. Nieman DC, Shanely RA, Luo B, Dew D,
Meaney MP, Sha W, et al. A commercialized
dietary supplement alleviates joint pain
in community adults: a double-blind,
placebo-controlled community trial. Nutr
J. 2013;12(1):1–9.
10. Ribel-Madsen S, Bartels EM, Stockmarr
A, Borgwardt A, Cornett C, Danneskiold-
Samsoe B, et al. A synoviocyte model for
osteoarthritis and rheumatoid arthritis:
response to ibuprofen, betamethasone,
and ginger extract-a cross-sectional in
vitro study. Arthritis. 2012;2012:1-9.
11. Wang YZ, Guo CY, Zhong HG, WN. Z, Wang
DL, Wang X, et al. In vivo effects of pain
relieving plaster on closed soft tissue
injury in rabbit ears. BMC Complement
Altern Med. 2008;8:1-7.