Recent research has led to recommendations for increased use in inflammatory disease, especially in arthritis. This recommendation relies on the iridoid glycoside content. Iridoids are found in many Scrophularia species and an iridoid of special interest in Scrophularia species is harpagoside. This is amongst the active constituents of devil’s claw Harpagophytum procumbens, widely used in arthritis to reduce pain and inflammation. The use of Harpagophytum procumbens is of conservation concern because it is collected in the wild in the Namibian desert. Sesterhenn et al (2007) propose that Scrophularia nodosa could be a useful substitute as they found that the concentration of harpagoside in the leaves is similar to that in tubers of Harpagophytum procumbens. Faivre (2007) argues that the high concentration of harpagoside in a standardized fluid extract prepared from fresh plant material alongside the aucubin found in Scrophularia species but not in Harpagophytum procumbens, and the associated phenolic acids such as ver-bascoside, make Scrophularia nodosa a significant herb in the treatment of functional and arthritic joint disease. Faivre (2007) claims that it is very well tolerated and particularly useful in exacerbations of painful joint pain in, for example, the shoulder. This suggests that it could be particularly useful in psoriatic arthritis and thus of use as an alterative alongside other herbs in treatment of this condition. Patients with this condition often take disease-modifying antirheumatic drugs so that extra caution is needed in the choice of appropriate and supportive treatment. Harpagoside has been identified in other Scrophularia species such as Scrophularia scorodonia, where levels were highest in the leaves in July and Scrophularia ningpoensis. Extraction of iridoid glycosides is most efficient in hot water.
• The British Herbal Pharmacopoeia recommends figwort in chronic skin disease, eczema, psoriasis and pruritus, and this agrees with the consistent recommendations by the authors for skin conditions. In addition, there is a consistent recommendation from the authors for use in wounds and ulcers that are or might become infected. External and internal usage together is often recommended. Figwort could be particularly useful in patients who are vulnerable to exacerbations of eczema caused by bacterial infections, and in patients with diabetes who are subject to poor wound healing and chronic skin infections.
• Figwort could be the alterative of choice in a prescription for psoriasis and in psoriatic arthritis.
• Usage for chronic infection with lymphadenitis must be recommended as long as the diagnosis is clear. Figwort could be the alterative of choice alongside available orthodox treatment where the patient has either primary or secondary tumours in the lymph nodes.
• The authors consistently recommend use of the root, mainly externally, for swollen and inflamed haemorrhoids.
• Dosage: the British Herbal Pharmacopoeia recommends 2-8 g three times a day of dried herb.