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Burn Healing Plants in Iranian Traditional Medicine

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Burn Healing Plants in Iranian Traditional Medicine Research Journal of Pharmacognosy (RJP) 2(1), 2015: 53-68 Received: Aug 2014 Accepted: Sep 2014 Review article Burn healing plants in Iranian Traditional Medicine Sh. Fahimi1, H. Hajimehdipoor1*, M. Abdollahi2, S.A. Mortazavi3 1Traditional Medicine and Materia Medica Research Center and Department of Traditional Pharmacy, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2Department of Pharmacology and Toxicology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran. 3Department of Pharmaceutics, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Abstract Burns are known as one of the most common forms of injury with devastating consequences. Despite the discovery of several antiseptics, burn wound healing has still remained a challenge to modern medicine. Herbal products seem to possess moderate efficacy with no or less toxicity and are less expensive compared to synthetic drugs. Burn is a well-known disorder in Iranian Traditional Medicine (ITM). Iranian physicians have divided burns into various types based on the cause and recommended treatment for each type. According to ITM references, herbal therapy was the major treatment prescribed by Iranian physicians for burns. In the present study, seven ancient Iranian medical texts were screened for the herbs with burn healing effects along with their applied dosage forms. The medicinal herbs were listed and scored based on the frequency of their repetition. Moreover, the best scientific name that was suitable for each plant as well as surveying modern studies about their biological effects has been carried out. In our investigation eighteen plants with seven topical application categories have been obtained as the most frequent herbs for burn healing in ITM. Modern studies have revealed that these plants have shown some biological activities such as anti- inflammatory, antimicrobial and antioxidant effects which might establish the relationship between the mentioned activities and burn wound healing property. This list can provide a suitable resource for future researches in the field of burn treatment. Keywords: anti-bacterial, anti-inflammatory, antioxidant, burn healing, Iranian Traditional Medicine Introduction Burns are one of the most common and procedures and prolonged period of rehabilitation devastating forms of trauma, with outcomes [2, 3]. Burn is defined as tissue injury caused by spanning the spectrum from physical heat, chemicals, electricity, radiation, etc. [4]. impairments and disabilities to emotional and Thermal burn and related injuries have remained mental consequences [1, 2]. Burn management a major cause of death and disability [5]. entails significant duration of hospital stay, According to the depth, burn wounds are expensive medication, multiple operative classified as first degree (superficial), second © Available at: http://rjpharmacognosy.ir Copy right 2014 by the Iranian Society of Pharmacognosy *Corresponding author: [email protected], Tel/Fax: +9821-88776027 Fahimi Sh. et al. degree (partial thickness) and third degree (full- treatment. The aim of the first stage was thickness). Burn wound healing is a complicated prevention of blistering by cooling and non- process including inflammation due to disruption irritant agents. However, extra cooling should of blood vessels and extravasation of blood have been avoided due to the heat retention constituents, re-epithelialization that begins which might lead to tissue decomposition. In this several hours after injury, formation of situation, oils were usually useful to remove the granulation tissue, neovascularization, migration heat. In the second stage, if the blister had been and mitogenic stimulation of endothelial cells formed, detergent and desiccant medications with and finally wound contraction as a result of moderate hot and cold temperament were interaction between cells, extracellular matrix recommended. Generally, low fat desiccant and cytokines. Severe burn wounds need to be products were preferred for wet wounds, treated as soon as possible since any delay can whereas, wet temperament preparations or oils postpone the healing process or result in infection and waxes were considered as suitable [4]. This makes burn care expensive and every medications for dry wounds [6,7]. Moreover, effort should be made to provide a shorter different dosage forms have been used in ITM for treatment period for the burnt patients [3]. burn healing. The aim of the present study has Although small burns are not usually life been introducing some medicinal plants and their threatening, they need the same attention as large dosage forms used in ITM for burn healing. burns, in order to achieve functional and cosmetic outcome. Most of the early treatments Methods include topical application of medicaments, Seven ITM texts including al-Qanun fi al -Tibb mainly to prevent infections [5]. Healing of burn (Avicenna) [7], Al Havi (Rhazes) [8], Al-abniah wounds still remains a challenge to modern An Haghayegh el-adviah (Heravi) [9], al-jāmi li- medicine, though many antiseptics have been mufradāt al-adwiyawa al-aghdhiy (Ibn al-Baitar) discovered [3]. It may be due to the fact that most [10], Ekhtiarat-e-Badiee (Ansari) [11], Tohfat-ul- of the available products have antimicrobial momenin (Mo,men tonekaboni) [12] and activity rather than wound healing effect, as well Makhzan-ul-Adviah (Aghili Shirazi) [13] were as their probable negative performance and studied. The traditional word of “hargh” was toxicity as in the case of silver sulfadiazine on considered as the keyword for extracting the fibroblasts [4]. Improving the methods of wound plants with healing effect in all kinds of burns. healing and tissue repair offers enormous First al-Qanun fi al –Tibb, the main text of ITM, opportunities to enhance the quality of life for was screened using the keyword and the burn trauma and burn patients. It may also help to healing property of the selected plants was reduce health care costs. Nowadays, many drugs checked in the rest of ITM texts to find the most with natural sources have been retrieved from frequently used plants. In addition to the traditional medical systems [5]. In Iranian temperament and used part, different dosage Traditional Medicine (ITM), plants have been forms of the chosen plants, applied to burns, have used to combat various diseases and pathological been studied. So, the description of the used conditions. Burn is a well-known disorder in ITM dosage forms has been investigated [14]. and several traditional prescriptions have been Afterwards, traditional names of the selected recommended for burn healing. According to plants were matched to the scientific names using ITM manuscripts, topical preparations have been botanical text references [15-17]. In the next step, considered as the main treatment for burns, a substantial search has been performed in though in some cases, phlebotomy was scientific databases such as ‘‘Google Scholar’’ prescribed. ITM scholars believed that there were and ‘‘pubmed’’ to find the plant biological two stages which should be noticed in burn activities concerning burn healing effect. For this 54 RJP 2(1), 2015: 53-68 Burn healing plants in Iranian Traditional Medicine purpose, the scientific plant names in The antioxidant potential of different fractions of combination with the key terms including "burn L. inermis has been demonstrated through DPPH healing", "wound healing", “antioxidant”, “anti- and β-carotene-linoleic acid assays as well [21]. inflammatory and “antibacterial" were used The anti-inflammation effects of the plant leaves separately and in vivo, in vitro and clinical trials have been established in a manner that butanol regarding to the search terms have been screened. and chloroform fractions exhibited more potent anti-inflammatory effect than aqueous fraction, Results and Discussion dose dependently [22]. Searching ITM references revealed eighteen plants as the most frequently used herbs for burn Hypericum perforatum L. healing which have been listed in table 1. These The healing properties of H. perforatum ointment plants have been ordered according to their have been evaluated and the histopathological repetition in the references along with their results, along with the wound contraction rate traditional names, family, temperament, used and period of epithelialization, have parts, dosage forms and biological effects. The demonstrated the healing effect of H. perforatum plant parts which had been used for burn healing ointment in linear incisions, circular excisions consisted of leaves, flowers, fruits, seeds, seed and thermal burn wounds [23]. Moreover, a oil, roots, bulbs, barks and gum resins while clinical research has shown that applying a leaves appeared to be the most used parts among specific H. perforatum ointment (Gol-Daru others. According to table 1, most of the herbs company) three times a day for 16 days has have hot and dry temperament (>66%) while significantly improved wound healing and has dryness is the prominent characteristic of the reduced scar formation compared to placebo [24]. majority of burn healing plants introduced by The ethanol extract of the plant has demonstrated Iranian scholars (>83%). Different types of anti- inflammatory effects in carrageenan induced dosage forms used in ITM for burn healing have pedal edema and cotton pellet induced granuloma been summarized in table 2. All of
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