Scientific Evaluation of the Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications

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Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Dehdari S, et al. GMJ.2017;6(3):166-84 www.gmj.ir

Received 2016-12-12 Revised 2017-03-28 Accepted 2017-05-09

Scientific Evaluation of the Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications

Sahar Dehdari1, Homa Hajimehdipoor2, Somayeh Esmaeili 2, Rasool Choopani3

1Department of Traditional Pharmacy, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2 Traditional Medicine and Materia Medica Research Center and Department of Traditional Pharmacy, School of Traditional Medi- cine, Shahid Beheshti University of Medical Sciences, Tehran, Iran 3Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Hemorrhoidectomy is an impressive surgery that relieves discomfort in patients who suffer from grade 3 or 4 hemorrhoids. This review is designed to investigate useful herbs for managing post-surgery complications by presenting an overview of Avicenna’s view compared to new scientific evidences. The herbs with anti-inflammatory, analgesic, anti-bleeding, antispasmodic, and wound-healing properties may be important for managing patient discomfort. Avicenna’s most frequently prescribed herbs were selected using Bavasir as a keyword (traditional term for hemorrhoids) from volumes 2 and 5 of the Canon of Medicine textbook, and they were investigated in scientific databases including Scopus, PubMed, Web of Science, Science Direct, and Cochrane Library to obtain researches that confirmed their efficacy. Among the different herbs, Hypericum perforatum and Portulaca oleraceae were the most supported in scientific databases. Other herbs including Anethum graveolens, Cocos nucifera, Ferula assa-foetida, Myrtus communis, Ocimum basilicum, and Plantago major were next in order, while Arte- misia absinthium, Solanum melongena, and Trigonella foenum-graecum exhibited few related pharmacological effects. The results established Avicenna’s claims regarding the importance of these herbs in post hemorrhoidectomy complications. Although there were many in vitro and/ or in vivo researches on the selected herbal medicines, there were no obtained clinical studies on patients after their hemorrhoidectomy surgeries. So, the aforementioned herbs, especially H. perforatum and P. oleraceae, are recommended for future clinical studies. Among the different classes of compounds, flavonoids were the most responsible phytocomponents for displaying pharmacological effects.[GMJ.2017;6(3):166-84] DOI:10.22086/gmj.v0i0.774

Keywords: Herbal medicines; Hypericum perforatum; Portulaca oleracea; Hemorrhoidectomy

Introduction ment and distal dislocation of rectal cushions [1, 2]. Intensified pressure on the vascular emorrhoids is the most prevalent rectal plexus of hemorrhoids, mainly due to strain- Hdisease and is described as the enlarge- ing or pregnancy, seems to play a major role

 Correspondence to: GMJ Somayeh Esmaeili, Traditional Medicine and Materia ©2017 Galen Medical Journal Medica Research Center and Department of Traditional Tel/Fax: +98 71 36474503 Pharmacy, School of Traditional Medicine, Shahid Be- PO Box 7193616563 heshti University of Medical Sciences, Tehran, Iran Email:[email protected] GMJ.2017;6(3):166-84 167 Telephone Number: +982188773525 www.gmj.ir Email Address : [email protected] Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Dehdari S, et al. GMJ.2017;6(3):166-84 www.gmj.ir

in the development of hemorrhoids [3]. A the key terms from the Bavasir (hemorrhoids) hemorrhoidectomy is an impressive surgery chapter. The search terms in this chapter were that relieves discomfort in patients suffering Zede varam (anti-inflammatory), Zede vaja/ from grade 3 or 4 hemorrhoids [4]. This sur- dard (pain reliever), and Zede khoon rizi/say- gery is also used in situations like non-oper- alan (means anti-bleeding). Then, most of the ative therapy failures, patient preference, and prescribed herbs were collected in individu- concomitant anorectal diseases including anal al or polyherbal formulations. Afterward, the fistulas or fissures [2]. scientific name of each herb was found in text- The main complications after a hemorrhoid- books that matched traditional plant names to ectomy can include inflammation, acute and their scientific names [10-12]. chronic pain, unhealed wounds, fecal urgen- Next, scientific databases including Scopus, cy, and rectal bleeding [5, 4]. The main cause PubMed, Web of Science, Science Direct, of post hemorrhoidectomy pain is ascribed to and Cochrane Library were searched to obtain the spasmodic condition of the internal anal reports of any related pharmacological ef- sphincters [6]. Avicenna is a famous ancient fects including anti-inflammatory, analgesic/ physician who wrote the well-known book antinociceptive, anti-bleeding, antispasmod- “Canon of Medicine” [7, 8]. He thoroughly de- ic, and wound healing, as well as any active scribed “Bavasir” (the traditional term for hem- constituents and possible mechanisms of each orrhoids) in his book. He also recommended herb. Data were collected from 1987 to Au- surgery for severe conditions of hemorrhoids gust 2016. and proposed different herbal medicines to manage post-surgery complications [9]. The Results herbs with anti-inflammatory, analgesic, - an ti-bleeding, antispasmodic, and wound-heal- The proposed herbs’ scientific and traditional ing properties may be important in manag- names, parts used, and routes of administra- ing post hemorrhoidectomy complications. tion are presented in Table-1. Table-2 summarizes the reported scientific Materials and Methods studies’ results regarding the herbal medicines, their used parts, extracts, and pharma- In this review study, volumes 2 and 5 from the cological models. These results are also dis- Canon of Medicine were investigated using cussed below.

Table 1. Main Herbs Prescribed by Avicenna for the Management of Post Hemorrhoidectomy Complications Traditional Route of Scientific name Family Used part(s) name administration(s) Anethum graveolens L. Shebet Apiaceae Aerial part Topical Artemisia absinthium L. Afsantin Asteraceae Aerial part Oral Cocos nucifera L. Narjil Arecaceae Fruit Oral Ferula assa-foetida L. Anjodan Apiaceae Fruit Topical Hypericum perforatum L. Hofarighoon Hypericaceae Seed Oral Myrtus communis L. Murta Myrtaceae Leaf Topical Ocimum basilicum Willd. Faranjamoshk Lamiaceae Aerial part Oral, topical Plantago major L. Lesan-ol-haml Plantaginaceae Root, leaf Oral Baghlat-ol- Portulaca oleraceae L. Portulacaceae Aerial part Oral homgha Solanum melongena L. Badenjan Solanaceae Fruit Topical Trigonella Holbe Fabaceae Seed Topical foenum-graecum L.

GMJ.2017;6(3):166-84 167 www.gmj.ir Dehdari S, et al. Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Dehdari S, et al.

Anethum graveolens L. bined with silver sulfadiazine cream [24]. The aqueous extract of A. graveolens fruits exhibited more potent antinociceptive effects Ferula assa-foetida L. than its volatile oil in vivo [13]. A. graveolens F. assa-foetida showed significant analgesic revealed significant analgesic effects in the properties in vivo [25, 26]. This effect was late phase of formalin tests. Further, its aerial most potent in 10 mg/kg doses. In a dose of parts demonstrated potent analgesic activity 2.5 mg/kg, the plant significantly reduced during hot plate tests in vivo [14]. Sabinene, edema in vivo. These pharmacological ef- the most active constituent in the essential fects were not reversed by antagonists like oil, may be responsible for the plant’s nota- naloxone, glibenclamide, theophylline, etc. ble anti-inflammatory effects due to its- in Phytochemicals including monoterpens, fla- hibitory effects on inducible nitric oxide syn- vonoids, and phenolic constituents had nota- thase [15]. Moreover, Naseri et al. attributed ble lipoxygenase inhibitory effects [26]. Fur- this species’ anti-inflammatory effects to its thermore, F. assa-foetida’s essential oil and monoterpenoid constituents including car- oleo gum resin exhibited antispasmodic ac- vone and limonene [16]. In addition, the herb tivity through a remarkable reduction in ace- exerted its antispasmodic properties via its tylcholine-induced contraction method [27]. inhibitory effect on calcium channels [17]. Hypericum perforatum L. Artemisia absinthium L. Although its antinociceptive effects were con- A. absinthium revealed its anti-inflammatory firmed by different in vivo models [28-30], and analgesic effects in different in vivo mod- there were no significant properties observed els [18, 19]. The fresh leaves’ essential oil in 4 in the acetic acid-induced writhing test [29]. and 8 mg/kg doses considerably reduced ede- Further, H. perforatum hydroethanolic ex- ma in rats. The presence of phytochemicals tract revealed dose-dependent antinociceptive like neradiol, santolina triene, α-piene and effects that were reversed by naloxone [30]. trans-β-farnesene may have an important role Phytochemicals including pseudohypericin, in the plant’s pharmacological effects [19]. hypericin, and flavonoids may be responsible for its anti-inflammatory effects due to Cocos nucifera L. its iNOS, COX-2, and PGE-2 inhibitory ef- C. nucifera exhibited anti-inflammatory and fects [31-33]. Among the different extracts analgesic effects in various in vivo models and pure compounds of H. perforatum that [20-23]. During a hot plate test on rats, a 200 were investigated on mice with croton oil-in- mg/kg dose of an aqueous extract of husk fi- duced ear edema, liophilic extract and amen- ber significantly prolonged the reaction time toflavone demonstrated the most considerable to heat stimulants. This effect was reversed anti-inflammatory properties [34]. This plant by naloxone (an opioid antagonist). So, it exerted wound-healing effects in vivo and in can be concluded that opioid receptors me- vitro [35-38]. Enhancements in polygonal fi- diate this analgesic effect [20]. The presence broblasts and collagen granules were seen in of phytoconstituents like polyphenols, sapo- the cultured NIH3T3 fibroblast model [36]. nins, and flavonoids can be important for a H. perforatum exerted its wound-healing ef- plant’s antinociceptive and anti-inflammato- fects via an increase in the wound closure ry properties [21]. C.nucifera’s water extract percentage and wound contraction and tis- displayed a significant inhibition during the sue regeneration in vivo [35]. Wound-heal- second phase of a formalin-induced licking ing effects of the species’ aerial parts can be test in mice through a dose-dependent man- attributed to its quinoids, flavonoids, tannins, ner [23]. In the burn wounds model, after xanthones, and naphtaquinones [35-38]. The 16 days of a C.nucifera oil topical applica- species also exerted its smooth muscle relax- tion, improvements in the wound contrac- ant properties by releasing phytochemicals tions were seen. However, this effect was such as hyperforin and kaempferol. How- more powerful when C. nucifera was com- ever, this effect was potently reduced by

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naloxone [39]. In addition, the herb showed antinociceptive properties observed during calcium antagonistic and phosphodiester- the tail flick test [55]. While its notable- an ase inhibitory properties in vitro [40, 41]. ti-inflammatory effects were proven using different in vitro and in vivo methods [55- Myrtus communis L. 57], there were no observed significant -an M. communis displayed its analgesic and ti-inflammatory effects using a dextran-in- anti-inflammatory effects in in vitro and in duced edema [55]. Among the herb’s various vivo models [42-45]. Tannins, alkaloids, and extracts, P. major’s methanol and ethanol ex- flavonoids play an important role in these tracts were the most potent reductions in the pharmacological effects [42]. Acylphloro- inflammatory cytokines levels in vitro [57]. glucinol phytoconstituents including myrtucommulone (MC) and semimyrtucommu- Portulaca oleraceae L. lone, which were isolated from plant leaves, P. oleraceae exhibited analgesic effects in displayed cyclooxygenase-1 and 5-lipox- vivo [58]. The aqueous extract of its aerial ygenase inhibitory effects in vitro [45]. In parts exerted anti-inflammatory effects by in- addition, MC showed anti-inflammatory hibiting the effects on TNF-α action in vitro properties in carrageenan-induced paw ede- [59]. Alkaloid phytocompounds, especially ma and pleurisy models [44]. Moreover, oleracimine, exerted intense anti-inflamma- the plant acts as an antispasmodic agent by tory properties by inhibiting the effects on blocking the calcium channels in vitro [46]. nitric oxide generation and suppressing the effects on IL-6, TNF-α, and PGE-2 secretions Ocimum basilicum L. in vitro [60]. Additionally, crude extracts The leaves of O. basilicum revealed antinoci- of aerial parts displayed potent wound-heal- ceptive effects in vivo [44,45]. The presence ing effects in doses of 50 mg/kg by reducing of linalool in the essential oils and flavonoids the in-wound surface and enhancing tensile of the species’ ethanolic extract is ascribed strength in vivo [61]. The plant also manifest- to its antinociceptive properties [47, 48]. It ed smooth muscle relaxant effects in vitro. seems that the possible mechanisms of its Because phentolamine significantly reduced antinociceptive properties are its inhibitory the herb’s relaxant effects, it can be pro- effects on prostaglandins and prostacyclins posed that adrenergic receptors are involved synthesis, as well as its interaction with opi- in the herb’s antispasmodic effects [62]. oid receptors [47]. Its robust anti-inflammatory effects were confirmed using in vitro and Solanum melongena L. in vivo models [49-51]. Aqueous extracts S. melongena demonstrated powerful analge- showed more potent anti-inflammatory prop- sic properties using acetic acid-induced writh- erties than ethanol extracts in vitro [49]. The ing tests in 500 mg/kg doses. Phytochemicals species demonstrated anti-inflammatory -ef like flavonoids, alkaloids, and tannins were fects via its reductive action in producing in- reported to be the most important agents for flammatory mediators such as tumor necrosis its analgesic property [63]. Lignanamides, factor-α (TNF-α), Interleukin-1β, IL-2, and which are presented in the ethanol extract of NO [50]. Phytoconstituents such as eugenol, the roots, exhibited inhibitory effects on ni- rosmarinic acid, and estragole may play a sig- tric oxide generation in vitro [64]. Addition- nificant role in its anti-inflammatory effects ally, 200 and 400 mg/kg doses of S. melon- [49, 51]. Moreover, the species manifested gena displayed less inhibitory effects on paw antispasmodic properties in vitro [52, 53]. edema (42.62%) compared to aspirin, which was used as a reference drug (64.5%) [65]. Plantago major L. P. major ethanol extracts with a polyphe- Trigonella foenum-graecum L. nol composition at a 1 mg/mL concentration There were many reports about anti-inflam- demonstrated powerful wound-healing ef- matory and analgesic effects of the plant fects ex vivo [54]. There were no significant through in vitro and in vivo models [66-77].

168 GMJ.2017;6(3):166-84 GMJ.2017;6(3):166-84 169 www.gmj.ir www.gmj.ir Dehdari S, et al. Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Dehdari S, et al.

The herb’s leaves revealed significant antino- nol extract may antagonize the prostaglandin ciceptive effects at doses of 2000 mg/kg in and bradykinin actions [68]. T. foenum-grae- vivo [66]. Mandegary et al. reported that alka- cum may exert its robust anti-inflammatory line chloroform and aqueous fractions of the effects by reducing COX-2 and 5-LOX activ- seeds’ methanolic extracts, which contained ities and has a stabilizing effect on red blood alkaloids and flavonoids, showed powerful cells against lyses due to its steroidal sapo- antinociceptive and anti-inflammatory prop- nins, flavonoids, and polyphenols [72, 74, 77]. erties [67]. Moreover, the analgesic and an- The pharmacological effects of the afore- ti-inflammatory effects of the seeds’ methano- mentioned herbs are summarized in Table-3. lic extracts can be attributed to their glycoside Reported phytoconstituents of each herb and steroid constituents [69]. The presence of along with their observed pharmaco- tannins and flavonoids in the leaves’ metha- logical effects are illustrated in Table-4.

Table 2. Scientific Studies On the Main Prescribed Herbs by Avicenna for the Management of Post Hemor- rhoidectomy Complications Study Scientific name Part / extract Model Results Ref. type Fruit / Aqueous Hot plate in mice Antinociceptive extract and In vivo [13] Acetic acid-induced activity volatile oil writhing test in mice

Seeds and aerial Formalin test in mice Analgesic parts/ Aqueous In vivo activity [14] ethanol extract Hot plate in mice

Anethum graveolens L. Anti- In vitro RAW 264.7 inflammatory [15] Aerial Parts / macrophages activity Essential oil Anti- Formalin-induced In vivo inflammatory [16] inflammation in rat paw activity Seeds/ Antispasmodic Hydroalcoholic In vitro Isolated rat ileum [17] effect extract Seeds and Analgesic Tail immersion in mice stems/ activity In vivo Methanol Anti- [18] Carrageenan-induced extract inflammatory paw edema in rat activity Acetic acid-induced Artemisia absinthium L. writhing test in mice Fresh leaves/ Analgesic Essential oil Formalin test in mice activity In vivo and aqueous [19] extracts Hot plate test in mice Anti- Carrageenan-induced inflammatory paw edema in mice activity

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continue of Table 2. Scientific Studies On the Main Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Acetic acid-induced writhing response in Analgesic In vivo mice activity [20] Husk fiber/ Tail flick in mice Aqueous extract Hot plate in rat Formalin-induced Anti- licking model in mice inflammatory In vivo [23] Carrageenan-induced activity paw edema in rat Acetic acid-induced The bunch Antinociceptive writhing response in of spadix of activity mice coconut tree/ In vivo Cocos nucifera L. Hot plate in mice [21] Hydromethanol Anti- extract Carrageenan-induced inflammatory paw edema in rat activity Acetic acid-induced abdominal writhing in mice Antinociceptive activity Husk fiber/ Tail flick test in mice In vivo Crude extract Hot plate test in mice [22] Formalin test in mice Anti- Carrageenan-induced inflammatory paw edema in rat activity Dried inner flesh In vivo Partial thickness burn Wound-healing [24] / Oil wound in rat property Hot plate test in mice Analgesic [25, Acetic acid-induced activity 26] Oleo gum resin In vivo writhing test in mice Anti- Carrageenan-induced Ferula assa-foetida L. inflammatory [26] paw edema in mice activity

Essential oil of Isolated ileum Antispasmodic In vitro [27] seeds and of rat activity oleo gum resin Acetic acid-induced writhing response in Analgesic Aerial parts / mice activity Hypericum perforatum Aqueous and Hot plate in mice In vivo L. ethanolic Tail flick test in mice [28] extracts Carrageenan-induced Anti- paw edema in rat inflammatory Cotton pellet-induced activity granuloma continue in page 172

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continue of Table 2. Scientific Studies On the Main Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Aerial parts / Antinociceptive In vivo Acetic acid-induced Hydroethanolic effect [30] abdominal constriction extract Tail electric stimulation in rat Antinociceptive Aerial parts / effect In vivo Hot plate in rat [29] Aqueous extract No significant Acetic acid-induced antinociceptive writhing test in rat activity Carrageenan-induced In vivo Anti- Aerial parts / paw edema in rat inflammatory Aqueous extract [31] activity Peritoneal In vitro macrophages Flowering tops/ Hydroalcoholic, lipophilic, ethylacetic extracts and the Anti- pure compounds Croton oil-induced ear In vivo inflammatory [34] hypericin, edema in mice activity Hypericum perforatum adhyperforin, L. amentoflavone, hyperoside, isoquercitrin, hyperforin Anti- Flower stems / RAW 264.7 mouse inflammatory [32] Ethanol extract macrophages In vitro activity Anti- Whole plant / RAW264.7 Mouse inflammatory [33] Ethanol extract Macrophage Cells activity Incision wound in rat Wound-healing In vivo property [35] Aerial parts / Circular excision in rat Total extract In vivo Wound-healing Thermal burn in rat property [36] Cultured NIH3T3 In vitro fibroblast Flowering aerial Wound-healing Excision wound parts / Ethanol property In vivo [37] extract Incision wound

Aerial parts/ In vitro Chicken embryonic Wound-healing [38] Ethanol extract fibroblast property continue in page 173

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continue of Table 2. Scientific Studies On the Main Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Flowering top/ Hydromethanolic In vitro Antispasmodic Isolated urinary bladder [39] extract activity

Standardized HP In vitro Antispasmodic Isolated rat aorta [41] extract activity Aerial parts/ Petroleum spirit, Hypericum perforatum L. chloroform, ethyl acetate and aqueous Rabbit jejunum, Guinea- In vitro Antispasmodic and its pig trachea and rabbit [40] activity phytocompounds aorta hyperforin, hypericin, and hyperoside

Hot plate in mice Antinociceptive Aerial parts / activity Acetic acid-induced Aqueous and In vivo writhing in mice [42] ethanolic extracts Xylene-induced ear edema Anti-inflammatory in mice activity Cotton pellet in mice Acetic acid-induced Leaves/ Essential In vivo writhing Analgesic activity [43] Myrtus communis L. oil test in mice Anti-inflammatory Human platelets and In vitro activity [45] PMNLs Leaves Carrageenan-induced paw Anti-inflammatory In vivo edema in mice activity [44] Carrageenan-induced pleurisy in mice Aerial parts/ Crude Antispasmodic In vitro Isolated rabbit jejunum [46] methanolic extract activity Acetic acid-induced Leaves/ Essential abdominal writhing test Antinociceptive In vivo oil in mice activity [47] Hot plate in mice Formalin test in mice Ocimum basilicum L. Leaves/ Ethanol Antinociceptive In vivo Formalin test in rat [48] extract activity Mouse macrophage (RAW264.7) and Aerial parts/ Anti-inflammatory In vitro human chondrosarcoma Aqueous and activity [49] (SW1353) cell lines, methanolic extracts and human primary chondrocytes continue in page 174

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continue of Table 2. Scientific Studies On the Main Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Whole Anti- Human peripheral plant/Crude In vitro inflammatory blood mononuclear [50] methanolic activity cells extract Carrageenan-induced paw edema in rat Dextran-induced paw edema in rat Anti- Leaves / Histamine-induced paw inflammatory Essential oil In vivo edema in rat [51] activity Ocimum basilicum L. Arachidonic acid- induced paw edema in rat Cotton pellet induced- granuloma Aerial parts/ Aqueous In vitro Antispasmodic Isolated rabbit jejunum [53] methanol effect extract Leaves/ Guinea pig Antispasmodic In vitro [52] Aqueous extract tracheal effect Seed/ Water Wound-healing In vivo Burn wound in rat [83] extract property Leaves/Ethanol Wound-healing Porcine wound-healing and water Ex-vivo property of both [54] model extracts extracts No significant Tail flick in mice antinociceptive activity Acetic acid-induced antinociceptive writhing in mice activity Leaves/Aqueous In vivo Croton oil-induced ear Anti- extract edema in mice inflammatory [55] Plantago major L. Carrageenan-induced activity paw edema in rat No significant Dextran-induced paw anti- edema in rat inflammatory activity Seeds/ Anti- In vivo Carrageenan-induced Methanol inflammatory [56] paw edema in rat extract activity Collected blood Leaves/Aqueous Anti- sample of rat following ,methanol and In vitro inflammatory [57] Acetaminophen- ethanol extracts activity induced liver injury

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continue of Table 2. Scientific Studies On the Main Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Hot plate in mice Analgesic activity Aerial parts / Tail-flick in rat In vivo Ethanolic extract [58] Anti- Carrageenan-induced inflammatory paw edema in rat activity Human umbilical Anti- In vitro vein endothelial cell inflammatory [59] Portulaca oleraceae L. Aerial parts / (HUVEC) activity Aqueous extract Lipopolysaccharide Anti- In vitro stimulated inflammatory [60] macrophages activity Aerial parts/ Excision wound in Wound-healing In vivo [61] Crude extract mouse activity Isolated rabbit jejunum, Leaves/ Antispasmodic In vitro taenia coli and guinea [62] Aqueous extract effect pig fundus Dry residue of Acetic acid-induced Analgesic In vivo [63] leaf juice writhing test in mice activity Anti- Roots/ Ethanol RAW 264.7 Solanum melongena L. In vitro inflammatory [64] extract macrophages activity Anti- Leaves /Aqueous In vivo Carrageenan induced inflammatory [65] extract paw edema in rat activity

Leaves/ Water Tail flick in rat Antinociceptive In vivo extract activity [66] Formalin test in rat Trigonella foenum- Antinociceptive graecum L. Seeds/ Formalin test in mice activity Methanol In vivo [67] extract Anti- Carrageenan-induced inflammatory paw edema activity continue in page 176

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continue of Table 2. Scientific Studies On the Main Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Leaves and Hot plate in mice seeds / Petroleum ether, Antinociceptive chloroform, In vivo Acetic acid induced activity [68] ethyl acetate writhing test in mice and methanolic extracts

Acetic acid-induced Analgesic writhing in mice activity Seed/ Analgesic Methanolic In vivo Hot-plate in mice [69] activity extract Anti- Carrageenan-induced inflammatory paw edema in rat activity Hot immersion test in Analgesic Seed powder In vivo rat activity [70] Formalin Trigonella foenum- Test in rat graecum L. Acetic acid induced Analgesic writhing in mice activity Seeds/ Ethanolic In vivo Hot plate in mice extract [71] Anti- Carrageenan-induced inflammatory paw edema in rat activity Seed/ Anti- Cultured human Methanolic In vitro inflammatory [72] myeloma THP-1 cells extract activity Anti- Seeds/ Diethyl Carrageenan-induced inflammatory [73] ether extract paw edema in rat In vivo activity Anti- Carrageenan-induced [74, inflammatory Seeds/ Ethanolic paw edema in rat 75] activity extract Anti- Peripheral blood In vitro inflammatory [74] mononuclear cells activity continue in page 177

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continue of Table 2. Scientific Studies On the Main Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Anti- Leaves/ Water Formalin-induced In vivo inflammatory [76] extract edema in rat activity Leaves/ Petroleum ether, benzene, Anti- Trigonella foenum- chloroform, In vitro Human RBCs inflammatory [77] graecum L. ethyl acetate, activity methanol, and water extracts

Anti- Seeds/ Ethanol Cotton pellet-induced In vivo inflammatory [75] extract granuloma activity

Table 3. Pharmacological Effects of the Main Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Analgesic Wound Anti- Scientific name Antispasmodic Score (Antinociceptive) healing inflammatory Hypericum perforatum L. + + + + 4 Portulaca oleraceae L. + + + + 4 Anethum graveolens L. + - + + 3 Cocos nucifera L. + + - + 3 Ferula assa-foetida L. + - + + 3 Myrtus communis L. + - + + 3 Plantago major L. + + - + 3 Ocimum basilicum L. + - + + 3 Artemisia absinthium L. + - - + 2 Solanum melongena L. + - - + 2 Trigonella foenum-graecum L. + - - + 2 -: there is no report.

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Table 4. Reported Phytoconstituents of the Main Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Scientific name Chemical constituent Effect(s) Ref. [15, Anethum graveolens L. Terpenoids Anti-inflammatory activity 16] Analgesic activity, anti- [19] Artemisia absinthium L. Terpenoids inflammatory activity Analgesic activity/ [20, Tannins, flavonoids, Cocos nucifera L. antinociceptive activity, anti- 21] saponins, and polyphenols inflammatory activity Analgesic activity, anti- [25, Ferula assa-foetida L. Terpenoids, flavonoids inflammatory activity 26] [31- Naphtoquinones, Anti-inflammatory activity, 33, Hypericum perforatum L. phloroglucinols, flavonoids, wound-healing activity, 35, polyphenols, and tannins antispasmodic activity 37, 39] [42, Tannins, alkaloids,flavonoids, Antinociceptive activity, anti- Myrtus communis L. 45, and phloroglucinols inflammatory activity 44] Terpenoids, flavonoids, [47- Antinociceptive activity, anti- Ocimum basilicum L. phenylpropenes, and 49, inflammatory activity polyphenols 51] [54] Plantago major L. Polyphenols Wound-healing activity

[60] Portulaca oleraceae L. Alkaloids Anti-inflammatory activity

Flavonoids, [63- Analgesic activity, anti- Solanum melongena L. alkaloids, tannins, and 65] inflammatory activity lignanamides [67- Alkaloids, flavonoids, Antinociceptive/ analgesic 69, Trigonella foenum-graecum L. tannins, glycosides, steroids, activity, anti-inflammatory 72, and polyphenols activity 76, 77]

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Discussion tent anti-bleeding effects on symptomatic patients [80, 81]. Moreover, Yousefi et al. Herbal medicines with vigorous his- revealed that Commiphora mukul can im- torical backgrounds are great sourc- prove some patients’ discomforts such as es to discover novel drugs [78, 79]. constipation and bleeding severity [82]. The Canon of Medicine prescribed eleven Our review study revealed that most of Avi- important herbs for the management of post cenna’s prescribed herbs demonstrate potent hemorrhoidectomy complications (Table-1). related pharmacological effects in modern As it is apparent in Table-1, the plants used medicine. So, these herbs are good candi- for the management of post hemorrhoidecto- dates for future clinical purposes. Howev- my complications belonged to different fam- er, these plants need to be evaluated by sci- ilies, and they were equally utilized in oral entists and go through clinical trial tests to and topical forms. Moreover, aerial parts and confirm their efficacy and safety. The second fruits were the most frequently used for the suggestion is to examine the plant mixtures management of post-surgery complications. to observe their possible synergistic effects. These herbal medicines exerted reliev- ing effects on post hemorrhoidectomy Conclusion complications using two or more pharmacological effects including anti-inflam- H. perforatum L. and P. oleraceae L. have matory, analgesic, antinociceptive, antispas- revealed most support through scientific -da modic, and wound-healing activities (Table-3). tabases. They showed anti-inflammatory, an- As demonstrated in Table-4, different classes algesic, antinociceptive, antispasmodic, and of phytoconstituents especially flavonoids, wound-healing effects. All of the mentioned polyphenols, terpenoids, alkaloids, and tan- herbs displayed analgesic and anti-inflamma- nins are responsible for the discussed phar- tory effects. While 36% of medicinal plants macological effects. Flavonoids displayed displayed wound-healing properties, 54% all of the mentioned pharmacological effects of them exhibited antispasmodic activities. [67, 68, 77]. However, lignans had less im- These results don’t establish wound-healing portance, and there was only one report about or antispasmodic activities for all of the dis- their anti-inflammatory effects [64]. cussed plants; however, these species may All of the phytocomponents displayed an not have been tested for their pharmacolog- anti-inflammatory effect [64-67, 72, 76, 77], ical effects, and future research on them are while analgesic/antinociceptive effects were recommended. Among the various phyto- reported in terpenoids, tannins, flavonoids, components, only flavonoids exhibited all saponins, polyphenols, alkaloids, glyco- of the mentioned pharmacological effects. sides, and steroids [19-21, 67-69]. Further, wound-healing properties were attributed to Acknowledgements naphtoquinones, tannins, and flavonoids [35, 37,54]. Moreover, antispasmodic effects were This article was a part of Ph.D. thesis (Sahar ascribed to phloroglucinols and flavonoids Dehdari, No. 171), Traditional Pharmacy, [39]. School of Traditional Medicine, Shahid Be- Although there was no clinical study that heshti University of Medical Sciences, Teh- observed the selected herbs’ effects on pa- ran, Iran. tients after hemorrhoidectomy surgery, there are some clinical studies on hemorrhoid Conflict of Interest patients. For example, Mosavat et al. confirm Allium ampeloperasum L. cream’s po- None

178 GMJ.2017;6(3):166-84 GMJ.2017;6(3):166-84 179 www.gmj.ir www.gmj.ir Dehdari S, et al. Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Dehdari S, et al.

References

1. Zampieri N, Castellani R, Andreoli R, 13. Racz-kotilla E. The sedative and Geccherle A. Long-term results and antinociceptive effects dill of (Anethum quality of life in patients treated with graveolens L.) used in folk medicine. hemorrhoidectomy using two different Médicaments et aliments : l’approche techniques: Ligasure versus transanal ethnopharmacologique1993. p. 303-5. hemorrhoidal dearterialization. Am J Surg. 14. Rezaee-Asl M, Vahid Nikoui AB. 2012;204(5):684-8. Antinociceptive properties of hydro 2. Association AG. Technical Review on the alcoholic extracts of Anethum graveolens L. Diagnosis and Treatment of Hemorrhoids. (dill) seed and aerial parts in mice. Clin Exp Gastroenterology. 2004;5085(4):1463-73. Pharmacol. 2015;03(02):2-5. 3. Fauci A, Brauneald E, Kasper D, Hauser S, 15. Kazemi M. Phenolic profile, antioxidant Longo D, Jameson J. Harison’s principles capacity and anti-inflammatory activity of of internal medicine. 18 ed. New York: Mc Anethum graveolens L. essential oil. Nat Graw Hillm Health Profession Division; Prod Res. 2015;29(6):551-3. 2008. p. 2507-8. 16. Naseri M, Mojab F, Khodadoost M, 4. Pescatori M, Gagliardi G. Postoperative Kamalinejad M. The study of anti- complications after procedure for prolapsed Inflammatory activity of oil-based dill hemorrhoids (PPH) and stapled transanal (Anethum graveolens L.) extract used rectal resection (STARR) procedures. Tech topically in formalin-induced inflammation Coloproctol. 2008;12(1):7-19. male rat paw. Iran J Pharm Res. 5. Mauricio De la G, Timothy C, Facs F. 2012;11(4):1169-74. Complications of hemorrhoid surgery. 17. Gharib Naseri MK, Heidari A. Semin Colon Rectal Surg. 2013;21(3):96- Antispasmodic effect of Anethum 102. graveolens fruit extract on rat ileum. Int J 6. Roe AM, Bartolo DC, Vellacott KD, Pharmacol. 2007;3(3):260-4. Locke-Edmunds J, Mortensen NJ. 18. Ahmad F, Khan R, Rasheed S. Study of Submucosal versus ligation excision analgesic and anti-inflammatory activity haemorrhoidectomy: a comparison of anal from plant extracts of Lactuca scariola and sensation, anal sphincter manometry and Artemisia absinthium. J Islam Acad Sci postoperative pain and function. Br J Surg. 1992:111-4. 1987;74(10):948-51. 19. Hadi A, Hossein N, Shirin P, Najmeh 7. Fahimi S, Hajimehdipoor H, Abdollahi N, Abolfazl M. Anti-inflammatory M, Mortazavi SA. Burn healing plants and analgesic activities of Artemisia in Iranian Traditional Medicine. RJP. absinthium and chemical composition of 2015;2(1):53-68. its essential oil. Int J Pharm Sci Rev Res. 8. Zargaran A, Mehdizadeh A. Avicenna (980– 2014;24(2):237-44. 1037 AD). J Neurol 2012;259(9):389-90. 20. Alviano DS, Rodrigues KF, Leitao SG, 9. 9. Ibn Sina AAH. Al Qanun Fi al-Tibb Rodrigues ML, Matheus ME, Fernandes (Canon of medicine) [in Arabic]. Beirut: PD, et al. Antinociceptive and free radical Alamy Le- Al-Matbooat Institute; 2005. p. scavenging activities of Cocos nucifera 370-85. L. (Palmae) husk fiber aqueous extract. J 10. Ghahraman A, Okhovvat A. Matching the Ethnopharmacol. 2004;92(2-3):269-73. Old Medicinal Plant Names with Scientific 21. Naskar S, Mazumder UK, Pramanik G, Terminology. Tehran: Tehran University Saha P, Haldar PK, Gupta M. Evaluation Press; 2004. of antinociceptive and anti-inflammatory 11. Soltani A. Dictionary of Medicinal Plants. activity of hydromethanol extract of Tehran: Arjmand Press; 2004. Cocos nucifera L. Inflammopharmacolog. 12. Biruni Ar. ketab al-seydana fi-al-tibb. 2012;21(1):7-11. Tehran: Iran academy of persian language 22. Rinaldi S, Silva DO, Bello F, Alviano and literature; 2004. CS, Alviano DS, Matheus ME, et al.

180 GMJ.2017;6(3):166-84 GMJ.2017;6(3):166-84 181 www.gmj.ir www.gmj.ir Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Dehdari S, et al.

Characterization of the antinociceptive and 33. Hammer KDP, Hillwig M, Solco AKS, anti-inflammatory activities from Cocos Dixon PM. Inhibition of prostaglandin E2 nucifera L. (Palmae). J Ethnopharmacol. production by anti-inflammatory Hypericum 2009;122(3):541-6. perforatum extracts and constituents in 23. Silva RR, Oliveira e Silva D, Fontes RAW264.7 mouse macrophage cells. J HR, Alviano CS, Fernandes PD, Alviano Agric Food Chem. 2008;55(18):520-9. DS. Anti-inflammatory, antioxidant, and 34. Sosa S, Pace R, Bornancin A, Morazzoni antimicrobial activities of Cocos nucifera P, Riva A, Tubaro A, et al. Topical anti- var. typica. BMC Complement Altern Med. inflammatory activity of extracts and 2013;13(1):107. compounds from Hypericum perforatum L. 24. Pallavi S, Durgaprasad S. Burn wound J Pharm Pharmacol 2007;59(5):703-9. healing property of Cocos nucifera: 35. Prisacaru AI, Andriţoiu CV, Andriescu C, An appraisal. Indian J Pharmacol. Havarneanu EC, Popa M, Motoc AGM, et 2008;40(5):144-6. al. Evaluation of the wound-healing effect 25. Bagheri SM, Dashti-R MH, Morshedi A. of a novel Hypericum perforatum ointment Antinociceptive effect of Ferula assa-foetida in skin injury. Rom J Morphol Embryol. oleo-gum-resin in mice. Res Pharm Sci. 2013;54(4):1053-9. 2014;9(3):207-12. 36. Dikmen M, Ozturk Y, Sagratini G, 26. Bagheri SM, Hedesh ST, Mirjalili A, Ricciutelli M, Vittori S, Maggi F. Dashti-R MH. Evaluation of Anti- Evaluation of the wound healing potentials inflammatory and Some Possible of two subspecies of Hypericum perforatum Mechanisms of Antinociceptive Effect on cultured NIH3T3 fibroblasts. Phytother of Ferula assa foetida oleo gum resin. J Res. 2011;25(2):208-14. Evid Based Complementary Altern Med. 37. Suntar IP, Akkol EK, Yilmazer D, Baykal 2015;22(4):1-6. T, Kirmizibekmez H, Alper M, et al. 27. Bagheri S, Hejazian S, Dashti R M. The Investigations on the in vivo wound healing relaxant effect of seed’s essential oil and potential of Hypericum perforatum L. J oleo-gum resin of Ferula Assa-foetida on Ethnopharmacol. 2010;127(3):468-77. isolated rat’s ileum. Ann Med Health Sci 38. Ozturk N, Korkmaz S, Ozturk Y. Wound- Res. 2014;4(2):4-7. healing activity of St. John’s Wort 28. Kumar V, Singh PN, Bhattacharya SK. (Hypericum perforatum L.) on chicken Anti-inflammatory and analgesic activity of embryonic fibroblasts. J Ethnopharmacol. Indian Hypericum perforatum L. Indian J 2007;111(1):33-9. Exp Biol. 2001;39(4):339-43. 39. Capasso R, Borrelli F, Capasso F, Mascolo 29. Abdel-Salam OME. Anti-inflammatory, N, Izzo AA. Inhibitory effect of the antinociceptive, and gastric effects antidepressant St. John’s Wort (Hypericum of Hypericum perforatum in rats. perforatum) on rat bladder contractility in ScientificWorld Journal 2005;5:586-95. vitro. Urology. 2004;64(1):168-72. 30. Subhan F, Khan M, Ibrar M. Antagonism 40. Khan A-u, Gilani A-h. Pharmacological of antinociceptive effect of hydro-ethanolic studies on Hypericum perforatum extract of Hypericum perforatum Linn. Pak fractions and constituents. Pharm Biol. J Biol Sci. 2007;10(5):792-6. 2011;49(1):46-56. 31. Raso G, Pacilio M, Carlo G. In-vivo and in- 41. Tugrul I, Demirci B, Demir O, Dost T, vitro anti-inflammatory effect of Echinacea Birincioglu M. The effect of Hypericum purpurea and Hypericum perforatum. J perforatum on isolated rat aorta. Pharm Pharm Pharmacol. 2002;54(6):1379-83. Biol. 2011;49(8):879-83. 32. Huang N, Rizshsky L, Hauck C, Nikolau 42. Hosseinzadeh H, Khoshdel M, Ghorbani M. BJ, Murphy PA, Birt DF. Identification Antinociceptive, anti-inflammatory effects of anti-inflammatory constituents in and acute toxicity of aqueous and ethanolic Hypericum perforatum and Hypericum extracts of Myrtus communis L. aerial gentianoides extracts using RAW 264.7 parts in mice. J Acupunct Meridian Stud. mouse macrophages. Phytochemistry. 2011;4(2):242-7. 2011;72(16):2015-23.

180 GMJ.2017;6(3):166-84 GMJ.2017;6(3):166-84 181 www.gmj.ir www.gmj.ir Dehdari S, et al. Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Dehdari S, et al.

43. Mubarak SS, Ibrar M, Barkatullah, 51. Bezerra L, Oliveira A, Pereira B, Martins Muhammad N, Ehsan M. Evaluation of B, Júnior Q, Anderson B, et al. Anti- essential oil of Myrtus communis leaves inflammatory and antiedematogenic for analgesic and gistrointestinal motility activity of the Ocimum basilicum essential profile. Pharmacologyonline. 2012;2(7):41- oil and its main compound estragole:In 5. vivo mouse models. Chem Biol Interact. 44. Rossi A, Di Paola R, Mazzon E, 2016;257(3):14-25. Genovese T, Caminiti R, Bramanti P, et al. 52. Boskabady MH, Kiani S, Haghiri B. Myrtucommulone from Myrtus communis Relaxant effects of Ocimum basilicum on exhibits potent anti-inflammatory guinea pig tracheal chains and its possible effectiveness in vivo. J Pharmacol Exp mechanism (s). DARU. 2005;13:28-33. Ther. 2009;329(1):76-86. 53. Janbaz KH, Hamid I, Gilani AUH, Qadir 45. Feisst C, Franke L, Appendino G, MI. Spasmolytic, bronchodilator and Werz O. Identification of molecular vasodilator activities of aqueousmethanolic targets of the oligomeric nonprenylated extract of ocimum basilicum. Int J Agric acylphloroglucinols from Myrtus communis Biol. 2014;16(2):321-7. and their implication as anti-inflammatory 54. Zubair M, Nybom H, Lindholm C, compounds. J Pharmacol Exp Ther. Brandner M, Rumpunen K. Promotion of 2005;315(1):389-96. wound healing by Plantago major L . leaf 46. Janbaz KH, Nisa F, Imran I, Zia-ul-haq extracts – ex- vivo experiments confirm M. Bronchodilator , vasodilator and experiences from traditional medicine. Nat spasmolytic activities of methanolic Prod Res. 2015(5):37-41. extract of Myrtus communis L. J Physiol 55. Guillen MEN, Emim ASE, Souccar C, Pharmacol. 2013;64(4):2016. Lapa AJ. Analgesic and antiinflammatory 47. Venancio AM, Onofre AS, Lira AF, activities of the aqueous extract of Plantago Alves PB, Blank AF, Antoniolli AR, et al. major L. Int J Pharmacog. 1997;35(5):99- Chemical composition, acute toxicity, and 104. antinociceptive activity of the essential 56. Ozbek H, Erten R, Oner A, Cengiz N, oil of a plant breeding cultivar of basil Yilmaz O, Turel I. Hepatoprotective (Ocimum basilicum L.). Planta Med. and anti-inflammatory activities of 2011;77(8):825-9. Plantago major L. Indian J Pharmacol. 48. Sabib Al-ghurabi SE. Study the analgesic 2009;41(3):120-5. and sedative effect of Ocimum basilicum 57. Hussan F, Mansor AS, Hassan SN, Tengku alcoholic extract in male rats. Diyal Agr Sci Nor Effendy Kamaruddin TNT, Budin SB, J. 2014;6:9-22. Othman F. Anti-inflammatory property 49. Raina P, Deepak M, Chandrasekaran CV, of Plantago major leaf extract reduces the Agarwal A, Wagh N, Kaul-ghanekar R. inflammatory reaction in experimental Comparative analysis of anti-inflammatory acetaminophen-induced liver injury. activity of aqueous and methanolic extracts Evid Based Complement Alternat Med. of Ocimum basilicum in RAW264.7, 2015(6):1-8. SW1353 and human primary chondrocytes. 58. Chan K, Islam MW, Kamil M, Perspect Med. 2016. Radhakrishnan R, Zakaria MNM, 50. Selvakkumar C, Gayathri B, Vinaykumar Habibullah M, et al. The analgesic and KS, Lakshmi BS, Balakrishnan A. Potential anti-inflammatory effects of Portulaca anti-inflammatory properties of crude oleracea L. subsp. sativa (Haw.) Celak. J alcoholic extract of Ocimum basilicum L. in Ethnopharmacol. 2000;73(3):445-51. human peripheral blood mononuclear cells. J Health Sci. 2007;53(9):500-5.

182 GMJ.2017;6(3):166-84 GMJ.2017;6(3):166-84 183 www.gmj.ir www.gmj.ir Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications Dehdari S, et al.

59. Lee AS, Kim JS, Lee YJ, Kang DG, Lee 70. Prem Kumar N, Abbamalai A, Ram S. HS. Anti-tnf- α activity of Portulaca (Fenugreek seeds ) in high fat diet-fed / oleracea in vascular endothelial cells. Int J low dose streptozotocin induced diabetic Mol Sci. 2012;13(8):5628-44. neuropathy in rats. Pharmacologyonline. 60. Li C, Meng Y, Ying Z, Xu N, Hao D, 2009;2(9):24-36. Gao M, et al. Three novel alkaloids from 71. Abbas N, Naz M, AlSulaim M. A Portulaca oleracea L. and their anti- comparative study of analgesic, antipyretic inflammatory effects. J Agric Food Chem. and anti-inflammatory effect of ethanolic 2016;3(9):131-37. extract of Trigonella foenum-graecum with 61. Rashed AN, Afifi FU, Disi AM. Simple indomethacin and diclofenac sodium. BJPR. evaluation of the wound healing activity 2016;10(5):1-8. of a crude extract of Portulaca oleracea L. 72. Kawabata T, Cui MY, Hasegawa T, (growing in Jordan) in mus musculus JVI-1. Takano F, Ohta T. Anti-inflammatory J Ethnopharmacol. 2003;88(2-3):131-6. and anti-melanogenic steroidal saponin 62. An OF, Extract A, Muscle ONS, Pressure glycosides from fenugreek (Trigonella RATB. Effect of an aqueous extract of foenum-graecum L.) seeds. Planta Med. Portulaca oleracea leaves on smooth muscle 2011;77(7):705-10. and rat blood pressure. J Ethnopharmacol. 73. Oner AC, Mercan U, Onturk H, Cengiz N, 1988;22(9):33-44. Erten R, Ozbek H. Anti-inflammatory and 63. Mutalik S, Paridhavi K, Rao MC, Udupa N. hepatoprotective activities of Trigonella Antipyretic and analgesic effect of leaves foenum-graecum L. Pharmacologyonline. of Solanum melongena LINN in rodents. 2008;2(9):126-32. Indian J Pharmacol. 2003:312-5. 74. Sindhu G, Ratheesh M, Shyni GL, 64. Sun J, Gu YF, Su XQ, Li MM, Huo Nambisan B, Helen A. Anti-inflammatory HX, Zhang J, et al. Anti-inflammatory and antioxidative effects of mucilage of lignanamides from the roots of Solanum Trigonella foenum graecum (Fenugreek) melongena L. Fitoterapia. 2014;98(5):110- on adjuvant induced arthritic rats. Int 6. Immunopharmacol. 2012;12(1):205-11. 65. Maniyar YA. Evaluation of anti- 75. Subhashini N, Nagarajan G, Kavimani S. inflammatory activity of aqueous extract Anti-inflammatory and in vitro antioxidant of leaves of Solanum melongena linn . in property of Trigonella foenum graecum experimental animals. J Clin Diagn Res. seeds. J Pharm Toxicol. 2011;6(4):371-80. 2015;9:1-3. 76. Ahmadiani A, Javan M, Semnanian S, Barat 66. Javan M, Ahmadiani A, Semnanian S, E, Kamalinejad M. Anti-inflammatory Kamalinejad M. Antinociceptive effects and antipyretic effects of Trigonella of Trigonella foenum-graecum leaves. J foenum-graecum leaves extract in the rat. J Ethnopharmacol. 1997;58(3):125-9. Ethnopharmacol. 2001;75(2-3):283-6. 67. Mandegary A, Pournamdari M, Sharififar F, 77. Thinagaran R, Dharman M. Phytochemical Pournourmohammadi S, Fardiar R, Shooli screening and in-vitro anti-inflammatory S. Alkaloid and flavonoid rich fractions activity of Trigonella foenum-graecum of fenugreek seeds (Trigonella foenum- leaves extracts thinagaran. IJPS. graecum L.) with antinociceptive and anti- 2014;26(9):157-61. inflammatory effects. Food Chem Toxicol. 78. Yavari M, Rouholamin S, Tansaz 2012;50(7):2503-7. M, Esmaeili S. Herbal Treatment of 68. Bhalke RD, Anarthe SJ, Sasane KD, Satpute Oligomenorrhea with Sesamum indicum SN, Shinde SN, Sangle VS. Antinociceptive L.: A Randomized ControlledTrial. GMJ activity of Trigonella foenum-graecum 2016;5(3):114-21. leaves and seeds (Fabaceae). Iranian J 79. Heydarirad G, Sadeghi S, KHameneh S, Pharmacol Ther. 2009;8(2):57-9. KHodadoost M, Kamalinejad M, Jafari S, et 69. Vyas S, Agrawal RP, Solanki P, Trivedi P. al. Effects of Natural Substances on Healing Analgesic and anti-inflammatory activities of Long Bone Fractures: A Narrative of Trigonella foenum-graecum (seed) Review of Traditional Persian Medicine. extract. Acta Pol Pharm. 2008;65(4):473-6. GMJ. 2016;5(4):165-72.

182 GMJ.2017;6(3):166-84 GMJ.2017;6(3):166-84 183 www.gmj.ir www.gmj.ir Dehdari S, et al. Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications

80. Mosavat SH, Ghahramani L, Sobhani 82. Yousefi M, Mahdavi MRV, Hosseini SM, Z, Haghighi ER, Heydari M. Topical Bahrami A, Davati A, Kamalinejad M, et al. Allium ampeloprasum subsp iranicum Clinical Evaluation of Commiphora Mukul, (leek) extract cream in patients with a Botanical resin, in the Management of symptomatic hemorrhoids: A pilot Hemorrhoids: A randomized controlled trial. randomized and controlled clinical trial. J Pharmacogn Mag. 2013;9(36):350-6. Evid Based Complementary Altern Med. 83. Amini M, Kherad M, Mehrabani D, 2015;20(2):132-6. Azarpira N, Panjehshahin MR, Tanideh 81. Mosavat SH, Ghahramani L, Sobhani N. Effect of Plantago major on burn Z, Haghighi ER, Chaijan MR, Heydari wound healing in rat. J Appl Anim Res. M. The effect of leek (Allium iranicum 2010;37(1):53-6. (Wendelbo) Wendelbo) leaves extract cream on hemorrhoid patients: A double blind randomized controlled clinical trial. Eur J Integr Med. 2015;7(6):669-73.

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