Well look at that...a subject that plays to my strengths!
Good to see some other physicians in here
My education and practice - is in Chinese Medicine. LOTS that can be said about Agarwood and it's use in medicine.
For starters - there are well over 450 formulas that use Chen Xiang (Agarwood) as an ingredient.
As for "lack of research" - I was just interviewed the other day, and this was a topic of discussion. A few things to keep in mind...
When you hop on Google and search a medical topic - are there any medical journals that pop up in the search? In general - no, they do not. To get medical research, you usually need to search within a specific medical journal, and also - you usually need a subscription to do so. This is why much "research" isn't found the Internet.
Secondly - I am assuming most of us speak English here - but regardless. When you search on the Internet, most of us don't think about it, but there are "many Internets" out there. Search in Chinese or Japanese or Arabic - and you'll get results that don't pop up when you search in English. So keep in mind that a search will only get a sliver of what is available out there to access.
Thirdly - there are more than 120x more medical journals in China than there are here in the US. And that's just China. Factor in Korea, Japan, Vietnam, India, etc - and the amount of research going on makes the information we know and have access to as Westerners look a bit miniscule.
Following on that - research on herbs encompasses Agricultural, Medical, Flavor and Fragrance, and other smaller industries. The research isn't being done just under a medical context. Think of all the industries built on the back of herbs...Pharmaceutical, Nutraceutical, Flavor and Fragrance, Culinary (ever thought about what your food would taste like without the Spice Trade??), and an often overlooked gajillion dollar industry - the Incense Industry. Hundreds of billions of dollars built on top of something most of us never think twice about - HERBS. This little nugget of info is what I realized while in med school, and ultimately helped me see the larger picture - my medical education wasn't just about treating the patient in front of me. My education tapped into a whole lot more.
Take a moment to let that sink in...
OK - so, Agarwood as medicine.
Ensar mentioned the "anxiolytic" and psychoactive properties, particularly of Kyara. In general, we say Chen Xiang Moves Qi ("Where there is no flow, there is pain - where there is pain, there is no flow"). This Qi Moving function is why it helps to reduce pain. We say it also Directs Rebellious Stomach Qi Downwards - a reference to the "Qi Rectifying" action on the directionality / mechanism of Qi Flow within the body - specifically as it relates to the Downward moving direction of the Stomach (the Spleen, conversely, has an Upward moving direction).
Lastly, we say it Benefits the Kidneys in Grasping the Qi - this statement gets a paragraph of its own. Chen Xiang Moves Qi in the Lower Abdomen (Kidneys and Large Intestine) - and benefits the Grasping function of the Kidneys. The Lungs are responsible for the Exhale. In Chinese Medicine, it is the Kidneys that Inhale. This is why Chen Xiang is used in a lot of Asthma formulations - and also why many who use the material will notice that it will Deepen their Breathing. Sandalwood, on the other hand, acts in the Upper Body - Circulating Qi in the Lungs, Stomach and Spleen. And now you understand why Sandalwood and Agarwood form the backbone of the incense industry, and their heavy use within meditation traditions that are centered on - Breathing. They both Open and Connect the Upper and Lower, Deepen the Breath, and Facilitate the Free Flow of Qi. Go burn some incense and tell me you don't notice this affect your breathing - making the breath come easier, and deeper - now that you know this
Antelope horn, btw - depending on the species was most likely Ling Yang Jiao. We say it Clears Liver Heat and Internal Liver Wind, Subdues Liver Yang Rising - as well as Improves the Vision (where there is Liver Wind and/or Liver Heat involvement). It also Clears Blood Level Fire Toxicity. The meaning of these statements doesn't quite translate into English or Western Medical Language so well - but suffice it to say, it is a very effective medicinal that I've seen first hand work wonders.
I'm well connected in the CM Pharmaceutical industry, and speak frequently with many in influential roles in China, Taiwan, Hong Kong, and Japan, as well as the leading Westerners in the industry, many of whom are personal friends. In fact - I supply material to some of them for their research.
Those familiar with my Thai Pa Pa Kea and Thai Snga Makham oils - I got quite a bit of flack for my "claims" about these two oils from the regular rabble-rousers. They gave me hard time because I had mentioned that these two oils were distilled by the personal distiller for the King of Thailand (God now rest his Soul). My connection to this distiller - was through Chinese Medicine. This guy extracts a wide variety of materials for the Royal Family - initially for their own benefit, but they have put him to work to supply their family-owned hospitals in Thailand. If anyone ever wants Pharmaceutical Oud Oil - or some of the Chinese Medical Oud Oil-Based formulations that they now use in their hospitals - I can hook folks up. They've asked on several occasions for me to bring the products to the West, given my education and understanding of the materials. It's always the finances of getting that done that have held me back. Not an inexpensive venture, as I'm sure you can imagine, launching pharmaceuticals to half the world.
@RobertOne - a word about trying to figure out the "active ingredients" of Oud...
Trying to look at Oud in this manner is a bit reductionistic. Take for example - what is the active ingredient in a car? How about the active ingredients in a luxury car, vs a standard car? A car is more than the sum of its individual parts - and a luxury car even more so. And don't forget - a car still needs a driver. Is the person the actual active ingredient of a car? Or is the car? But can one exist without the other? I apologize if my writing out the analogy isn't quite as clear as it would be in a conversation - the point is - the way Chinese Medicine understands how something functions goes beyond individual chemical analysis.
With that being said - keep in mind that Oud Oil and Oud Wood are actually two different Herbs. The Oil doesn't contain any of the water-soluble components. And it is distilled, rather than decocted (like the wood would be).
Medically speaking - oil-rich wood is valued over resin-rich wood when decocting. For Tincturing (in which both alcohol and oil-soluble components would be extracted) - resin-rich wood is preferred.
In the pharmaceutical industry, both the oil and water soluble components are captured and used in "patent" formulations. "Patent" in Chinese Medicine simply means "prepared" - so taking a capsule or tea pill with Chen Xiang in it will contain a special method of extraction containing a complete extraction of the material, as opposed to an Oud Oil, which is more like a refined product containing only the Oil-soluble components.
For smoking - the wood has a modifying effect on the Tobacco, and decreases the toxic burden on the body - as well as its Breath Deepening action (all smokers have trouble taking deep breaths), as well as the appreciation of the flavor, itself.
Back to the Anxiolytic properties - I suggest using Xiao Yao San. A heck of a lot cheaper than Kyara! XYS is jokingly referred to as "CM Xanax". It's a very inexpensive and effective formula for Moving Liver Qi and Tonifying the Spleen (the Spleen has an important role in Circulating Qi within the body). Functionally - it'll help a person to relax and chill out a bit. Great for high stress individuals (and menstruating women). Helps attain more restful sleep, as well. I can drop ship to anyone wanting some.
I'm sure I'll think of more to say...but that was a start!