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

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Scientific Evaluation of the 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. 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 manag- ing 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 in- vestigated 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:info@gmj.ir GMJ.2017;6(3):166-84 167 Telephone Number: +982188773525 www.gmj.ir Email Address : Sesmaeili@sbmu.ac.ir 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 medi- cines, 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 responsi- ble 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
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