An Ancient Siddha Answer to Modern Pain Management
A Comprehensive Review of Ettikottai Mathirai (EM): A Siddha Polyherbal Formulation
In an era where synthetic drugs often come with unwanted side effects, the search for effective natural alternatives has never been more pressing.
Enter Ettikottai Mathirai (EM), a traditional Siddha polyherbal formulation that has been used for centuries in South India to manage various types of pain. Recent scientific investigation has begun to validate what traditional healers have long known—this complex herbal blend possesses significant analgesic and anti-inflammatory properties 2 .
Siddha medicine operates on the fundamental principle of maintaining balance between three vital humors: vatham, pitham, and kabam. According to this philosophy, illness arises from disruptions in this delicate equilibrium. EM represents a classic example of Siddha's holistic approach 2 .
Specifically mentioned in the Siddha text "Nam Nattu Vaithiyam," this formulation is traditionally indicated for 18 types of soolai (pain), including lumbar and cervical pain 2 .
Siddha medicine is more than just a collection of herbal remedies—it's a comprehensive holistic healing system that emphasizes preventive care, health promotion, and rejuvenation. This traditional Indian system, primarily practiced in South India, considers the interconnectedness of mind, body, and spirit in both health and disease 2 .
The system categorizes medicines into internal and external applications, with mathirai (pills) representing one of the primary forms of internal medicine with a typical shelf life of one year 2 .
The preparation of Siddha formulations is considered a sacred art, with specific purification processes (known as "suthimurai") employed to enhance the therapeutic properties while reducing potential toxicity of certain ingredients 2 .
Conventional medicine typically addresses pain through pharmaceutical compounds such as non-steroidal anti-inflammatory drugs (NSAIDs), which, while effective, often cause significant side effects including gastric ulcers with long-term use 2 .
The International Association for the Study of Pain (IASP) defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage"—acknowledging both physical and psychological dimensions that require comprehensive treatment approaches 2 .
Modern research has begun to explore how traditional formulations like EM interact with pain pathways, with studies suggesting that polyherbal combinations may target multiple mechanisms simultaneously 2 .
EM comprises five primary herbal components, each contributing unique therapeutic properties to the formulation. The traditional preparation involves specific purification processes for each ingredient, followed by roasting and grinding into a fine powder. This powder is then pestled with lemon juice until it reaches a consistency suitable for forming pills 2 .
| S. No. | Ingredient Name | Common Name | Part Used | Quantity |
|---|---|---|---|---|
| 1. | Milagu | Pepper | Fruit | 80 g |
| 2. | Chukku | Dry ginger | Rhizome | 80 g |
| 3. | Ettikottai | Strychnos nux-vomica | Seed | 80 g |
| 4. | Kirampu | Clove | Flower bud | 20 g |
| 5. | Elumichai | Lemon | Fruit juice | Q.S. |
Table: Complete Composition of Ettikottai Mathirai (EM) 3
Soaked in limestone water for 3 hours, dried, and the outer layer peeled off 3
Soaked in sour buttermilk for 1-1.25 hours and then fried 3
Buds of the flowers are removed and fried 3
The outer skin and cotyledons are removed and deep-fried in ghee 3
The completed formulation is typically administered at a dosage of 65-130 mg, twice daily, with warm water or buttermilk as adjuvants 2 3 .
| S. No. | Plant Name | Chemical Constituents | Pharmacological Activities |
|---|---|---|---|
| 1. | Chukku (Zingiber officinale) | Monoterpenoids, sesquiterpenoids, zingiberol 2 | Antioxidant, anticancer, anti-inflammatory, anti-apoptotic 2 |
| 2. | Milagu (Piper nigrum) | Piperine, piperanine, piperettine, flavonoids, alkaloids 2 | Antioxidant, anti-obesity, antitumor, antipyretic, anticonvulsant 2 |
| 3. | Kirampu (Syzygium aromaticum) | Eugenol acetate, caryophyllene 2 | Antimicrobial, antipyretic, appetizer, hypnotic, anxiolytic 2 |
| 4. | Ettikottai (Strychnos nux-vomica) | Strychnine, brucine, pseudo-strychnine 2 | Impacts on nervous system, analgesic, anti-inflammatory, anticancer 2 |
| 5. | Elumichai (Citrus limon) | Limonene, α-pinene, α-terpineol 2 | Anti-inflammatory, antimicrobial, anticancer, antiparasitic 2 |
Table: Pharmacological Properties of EM Components 2
Ettikottai (Strychnos nux-vomica) deserves special attention as the namesake and potentially most therapeutically significant component of EM. This evergreen tree, native to India and Southeast Asia, contains powerful alkaloids, primarily strychnine and brucine. In their raw form, these compounds are highly toxic, with strychnine estimated to have a lethal dosage between 30 mg and 120 mg in humans 2 .
However, the Siddha purification process ("suthimurai") transforms this potentially toxic ingredient into a therapeutically valuable medicine 2 .
While EM has been traditionally used primarily for pain management, recent scientific investigations have explored its potential wound healing properties. A 2025 study conducted by researchers at the National Institute of Siddha employed modern laboratory techniques to evaluate EM's effects on wound repair using the KB cell line 3 .
KB cells were seeded in 96-well plates at a density of 1 × 10⁵ cells/mL and incubated for 24 hours. The cells were then treated with different concentrations of EM and incubated for an additional 24 hours 3 .
After adding MTT solution, the resulting formazan crystals were dissolved in DMSO, and absorbance was measured at 595 nm to determine the percentage of growth inhibition 3 .
| Assay Type | Parameter Measured | Key Finding | Interpretation |
|---|---|---|---|
| MTT Assay | Cell viability | Dose-dependent cytotoxicity | Significant activity at 50-200 μg/mL concentrations |
| MTT Assay | IC50 value | 128 μg/mL after 24 hours | Potent cytotoxic potential |
| Scratch Assay | Cell migration | Suppressed migration at 110 μg/mL | Interferes with wound closure mechanisms |
Table: Experimental Results of EM on KB Cell Line 3
These findings are particularly significant when considering that wound healing is a complex, multi-stage process involving hemostasis, inflammation, proliferation, and remodeling. The migration and proliferation of keratinocytes and fibroblasts play crucial roles in the proliferation phase of wound healing, and substances that modulate these processes have potential therapeutic applications 3 .
Modern scientific investigation of traditional medicines like EM requires specialized laboratory tools and reagents:
The investigation into Ettikottai Mathirai represents a fascinating convergence of traditional wisdom and modern scientific validation. As research continues to uncover the molecular mechanisms behind EM's therapeutic effects, this ancient formulation offers promising avenues for developing novel pain management and wound healing strategies.
The demonstrated anti-inflammatory, analgesic, and wound healing properties of its individual components, combined with the synergistic effects of the polyherbal formulation, position EM as a valuable subject for further pharmacological research.
While preliminary results are promising, comprehensive clinical trials and additional mechanistic studies are needed to fully understand EM's therapeutic potential and safety profile.
As the scientific community increasingly recognizes the value of traditional knowledge systems, formulations like Ettikottai Mathirai serve as powerful reminders that ancient medical traditions can offer valuable insights for addressing contemporary health challenges.
The careful, scientific study of such traditional remedies not only validates their historical use but may also unlock new possibilities for integrative approaches to healthcare that combine the best of ancient and modern medicine.